Description: This article focuses on mandatory supplemental benefits offered by general enrollment plans and Dual Eligible Special Needs Plans (D-SNPs) Medicare Advantage plans from 2017 to 2021.

Description: Outline of changes to the Adjust Community Rate ACR Proposal process and Beneficary Information Form, Issue No. 38

Description: Two Medicare risk funding provisions that were radically changed by the BBA of 1997 funding variations by geographic area and risk adjustment. Issue No. 36

Description: Congress has been debating a revision to Medicare Advantage payments including limiting payments to the Medicare Fee-For-Service FFS cost. A county-specific impact study to the benchmark payment rates for each county nationally based on the FFS limitation criteria was performed. This article includes results for Florida, California, Pennsylvania and New York.

Description: Budget concerns should not be allowed to override sound actuarial rate development in setting Medicaid capitation rates.

Description: Article explores why many integrated delivery systems are struggling and what actions they need to take to succeed.

Description: This article discusses the legislative summary of the changes that will occur with the new Medigap policies, which will be effective on or after June 1, 2010. Issue No 60

Description: Issue No. 36. Issues relating to Provider Sponsored Organizations PSOs contracting with HCFA to sponsor Medicare + Choice. Article discusses revenue and the addition of non-Medicare covered benefits.

Description: This article describes the Health Insurance Providers Fee implemented through Section 9010 of the Affordable Care Act (ACA) and discusses how the fee will creates challenges in Managed Medicaid Rate development. It also offers some suggested ways to include the fee in Managed Medicaid rates.

Description: Discussion of Medicare's Ambulatory Payment Classification APC system as the standard for reimbursement of non-capitated outpatient hospital services with sample calculations. Issue No. 37.