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Judge Rules BCBS North Carolina Can Continue State Health Plan Challenge
Visit Becker’s Payer Issues to learn more about the judge ruling, allowing BCBS North Carolina to continue the challenge of the State Health Plan being awarded to Aetna.
The Cigna Group to Sell Medicare Businesses and CareAllies to Health Care Service Corporation (HCSC)
Global health company The Cigna Group (NYSE: CI) today announced that it has entered into a definitive agreement whereby Health Care Service Corporation (HCSC) will acquire The Cigna Group’s Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D and CareAllies businesses, for a total transaction value of approximately $3.7 billion. As part of the transaction, The Cigna Group and HCSC have agreed to enter into a four-year services agreement under which Evernorth Health Services, a subsidiary of The Cigna Group, will continue to provide pharmacy benefit services to the Medicare businesses, effective on closing of the transaction.
Enhanced Medicaid PMPM for Medicaid Expansion
The North Carolina Department of Health and Human Services (NCDHHS) is releasing updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Standard Plan Prepaid Health Plans (Standard Plans), including consideration for Medicaid expansion effective Dec. 1, 2023.
As of Dec. 1, 2023, people ages 19 through 64 years with higher incomes are eligible for Medicaid coverage in North Carolina. For this expansion population, on average, $13.65 per member per month (PMPM) is the assumed cost of delivering care management in accordance with NCDHHS’s requirements, compared to $10.17 for non-expansion populations for State Fiscal Year 2024 (July 1, 2023-June 30, 2024).
This information is based on a set of assumptions about care manager staffing ratios by care management need level and qualifications, which should be understood as averages rather than policies about how each care team must be constructed. In reality, care teams will vary in how they are staffed according to the needs of individual members and assigned panels. NCDHHS has not established minimum care management fees and maintains the expectation that Standard Plans and practices will arrive at mutually agreeable rates that are commensurate with the intensity and breadth of the care management being provided.
By providing additional information on the assumptions NCDHHS used to develop components of the care management component of capitation payments, Standard Plans and AMH Tier 3 practices will be better positioned to enter into care management contracts that enable all parties to meet NCDHHS’ expectations in the execution of care management responsibilities and achievement of improved health outcomes.
Details on the current care management rate assumptions can be found in the Care Management Assumptions document updated Jan. 3, 2024. Additional information on NC Medicaid’s AMH program can be found on the Advanced Medical Home webpage.
Filed under: Did You Know?, Education, healthcare, Legislative, News, Payer, technology | Tagged: 2024, Advocacy, Advocacy Committee, Aetna, AMH Tier 3, BCBS North Carolina, CareAllies, Challenge, Cigna Group, Cigna Supplemental Benefits, Did You Know?, Evernorth Health Services, HCSC, Health Care Services Corporation, Medicare Advantage, Medicare Part D, NC AHEC, NC Medicaid Managed Care Standard Plan, NCDHHS, NCMGMA, North Carolina Department of Health and Human Services, North Carolina Medical Group Management Association, State Health Plan | Leave a comment »
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