Payer Roundup—Centene dinged for failing to fix ACA plans; ACHP CEO calls out glitch in MA bonus payments

Document titled, Affordable Care Act
Centene was fined $100,000 by Washington state for failing to improve network adequacy in ACA plans. (Getty/Designer49)

Centene’s ACA troubles continue in Washington

Centene has been fined $100,000 by Washington for failing to adhere to a previous agreement requiring the insurer to fix issues with its provider networks.

The state’s Office of the Insurance Commissioner said the insurer has been fined for not complying with the December agreement. Insurance Commissioner Mike Kreidler initially barred Centene from selling plans in the state after the company admitted to not having enough anesthesiologists in certain counties. But he lifted the order days later after Centene agreed to pay a $1.5 million fine and entered a compliance plan to fix network deficiency issues.

RELATED: Centene slapped with lawsuit over provider networks in ACA exchange plans

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The state suspended $1 million of that fine pending no further violations. Thursday’s penalty was issued because the insurer did not meet several deadlines outlined in the contract and failed to meet requirements proving its provider networks were adequate. The state said the remaining $900,00 may be imposed “if the company continues to violate the compliance plan it agreed to.” (Announcement)

ACHP CEO calls on CMS to fix Medicare Advantage “payment glitch”

Some Medicare Advantage plans are being shortchanged on bonus payments from the federal government due to a “glitch” in the system, according to the CEO of the Alliance for Community Health Plan.

RELATED: Budget deal will dampen Medicare Advantage bonus payments

In an op-ed for Morning Consult, ACHP's Ceci Connolly says star rating bonuses are being miscalculated and “some of the highest quality MA plans have not received their full incentive payments as promised,” to the tune of $821 million in 2018.

Connolly called on CMS to fix the glitch and “raise the bar on quality overall” by differentiating “truly superior and sustained performance” among MA plan sponsors. (Morning Consult)

Virginia governor reiterates plan to expand Medicaid

Virginia Gov. Ralph Northam is once again calling for the state to expand Medicaid, an issue that is poised for a heated debate among state lawmakers during a special session next month.

RELATED: Virginia edges closer to Medicaid expansion, with some Republicans on board

Northam told the Associated Press that his stance that every Virginia resident "have access to good, affordable healthcare” remains unchanged. The new governor, who made Medicaid expansion a focal point of his campaign, met immediate opposition from Senate Majority Leader Tommy Norment, who said Northam’s proposal to build Medicaid expansion into the state budget means “the current standoff cannot be resolved quickly.” (Associated Press)

Maryland could lead the charge on ACA fixes with a “down payment” approach

Maryland could emerge as a leader among states looking to shore up ACA exchanges if lawmakers can pass two fixes being considered by the General Assembly, according to the Washington Post’s Editorial Board.

One bill, that appears likely to pass, would create a reinsurance program for the state. The second—a workaround following the federal government’s repeal of the individual mandate—would charge Maryland residents a fee on their tax forms if they fail to buy coverage. That fee then would be applied to enroll uninsured residents, which supporters of the legislation are pitching as a “down payment” for health insurance.

The editorial board says this “ingenious” approach could “show other states how to make the Obamacare system work.” (Washington Post).

Antibiotic resistance costs soar

A new study shows antibiotic resistance adds more than $1,300 to treatment costs for a single patient, generating well over $2 billion each year for the entire healthcare industry.

Researchers from Emory University and Saint Louis University found antibiotic-resistant infections more than doubled between 2002 and 2014. They acknowledged that their cost estimate likely “understated the economic and healthcare impacts” of the infections but argued that even conservative estimates make the case for additional resources for stewardship. (FierceHealthcare)

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