Contentsprograms, this whitepaper examines two case studies. In Massachusetts, ... Increased Federal match rate for cost recovery activities; and Performance-based audit contracts

ContentsExecutive Summary .........................4

Background .....................................5

Cost-Saving Solutions .....................7

Case Studies .................................14

Resources ......................................18

About the Authors ........................19

To cover more uninsured individuals in a fiscally sustainable way, the U.S. needs to direct resources to those without access to private coverage, carefully manage costs, and put in place programs to identify fraud, waste, and abuse.

4 Cost-Saving Solutions for Healthcare Reform Cost-Saving Solutions for Healthcare ReformCost-Saving Solutions for Healthcare Reform Cost-Saving Solutions for Healthcare Reform

Executive SummaryDriven by a slowing economy and the policy goals of a new administration, healthcare reform is once again a national priority. The economic crisis is adding millions of people to the rolls of Medicaid and the Children’s Health Insurance Program (CHIP), while the Obama Administration is planning to fulfill a major campaign pledge to make healthcare more accessible and affordable for all Americans.

In an era of scarce resources and increasing public debt, the U.S. government must carefully and responsibly manage costs and target resources as part of any sustainable healthcare program expansion.

HMS, a leader in cost management services for government agencies, has developed eight recommendations for covering more people and reducing the costs of healthcare.

Implementation of enrollment integrity practices;

Full implementation of asset verification programs;

Outreach to the uninsured through the use of public school records;

Expansion of third party liability rights to all government healthcare programs;

Increased funding for State Medicaid Fraud Control Units;

Application of fee-for-service Medicaid drug rebate to drugs purchased for Medicaid managed care enrollees;

Increased Federal match rate for cost recovery activities; and

Performance-based audit contracts for Medicare Part D and Medicare Advantage.

To illustrate how these recommendations could improve government programs, this whitepaper examines two case studies. In Massachusetts, cost management initiatives are improving the Commonwealth Connector, the state’s landmark program to ensure healthcare coverage for all residents. In New Jersey, cost management initiatives are reducing the cost of the Charity Care Program to taxpayers and hospitals in the state.

Solutions are needed to sustain healthcare reform initiatives and to avoid millions of dollars in unnecessary costs. Consideration of these solutions should be part of any public discussion regarding the Administration’s goals and the growing need for access to healthcare coverage.

Cost-Saving Solutions for Healthcare Reform Cost-Saving Solutions for Healthcare Reform 5Cost-Saving Solutions for Healthcare Reform Cost-Saving Solutions for Healthcare Reform

BackgroundFor years, the federal government has sought to rein in healthcare costs while addressing the needs of the increasing number of uninsureds. In the face of the current economic recession and rising unemployment, these goals have become more urgent. A recent study conducted by the Kaiser Family Foundation shows that for every 1% increase in unemployment, 1.1 million more people become uninsured, driving up enrollment in Medicaid and the Children’s Health Insurance Programs (CHIP).

White House Budget Director Peter Orszag has recently stated that the correlation between healthcare costs and the economy is undeniable. President Obama’s FY 2010 budget proposal targets healthcare reform as a national priority, underscored by these actions:

In early March, the White House invited senior Administration officials, members of Congress, stakeholders, and consumers to participate in a Healthcare Summit on the challenges facing our country’s healthcare system.

President Obama named Kansas Governor Kathleen Sebelius, a former insurance commissioner and long-time advocate of healthcare reform, as Secretary of Health and Human Services, responsible for spearheading the reform effort.

0

1

2

3

4

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7.8%7.6%7.4%7.2%7.0%6.8%6.6%6.4%6.2%6.0%5.8%

Growth in the Uninsured at Various Unemployment Rates

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in th

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nins

ured

(m

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Unemployment Rate

2.22.4

2.62.9

3.13.4

3.63.8

4.14.3

4.6


The President created the new White House Office of Health Reform, and announced the appointment of Nancy-Ann DeParle as Director.

In May, President Obama met with healthcare stakeholders to discuss ways to cut $2 trillion in healthcare costs over the next 10 years.

Much attention is being directed toward expanding coverage, reducing costs, and making the system work better for everyone. In testimony before Congress, Director Orszag emphasized the need for a long-term solution and asked lawmakers to focus on cutting costs in their healthcare reform legislation.

For healthcare programs to cover more individuals in a fiscally sustainable manner, the government must direct resources to those without access to private coverage, carefully manage costs, and put into place programs that identify waste, fraud, and abuse. HMS is prepared to deploy custom solutions that have been proven to yield both savings and sustainability to healthcare expansion initiatives.


HMS’s Cost-Saving Solutions Enable Targeted and Fiscally Sustainable Healthcare ReformHMS has witnessed firsthand the stresses that expanding healthcare costs have placed on governments, and the lingering impact of regulatory and legislative changes throughout the entire government healthcare arena. Innovative and effective cost-saving solutions are needed in any healthcare reform initiative to avoid millions of dollars in unnecessary costs. HMS is in a position to assist lawmakers in expanding coverage while protecting the fiscal integrity of existing and future government healthcare programs, and offers the following eight solutions:

Implementation of enrollment integrity practices;

Full implementation of asset verification programs;

Outreach to the uninsured through the use of public school records;

Expansion of third party liability rights to all government healthcare programs;

Increased funding for State Medicaid Fraud Control Units;

Application of fee-for-service Medicaid drug rebate to drugs purchased for Medicaid managed care enrollees;

Increased Federal match rate for cost recovery activities; and

Performance-based audit contracts for Medicare Part D and Medicare Advantage.

Implementation of enrollment integrity practices

OtherCoverage

AssetVerification

Wage Match

Demographics ImmigrationStatus

• Commercial• Public

• State Tax• New Hire

• Bank Accounts• Cars• Real Estate

• DOB, SSN• Dependents• Date of Death

• Homeland Security

Correct | Compliant | Fast | Cost Effective | Electronic | Comprehensive

HMS recommends that existing and future government programs include measures to verify accurate enrollment. Enrollment integrity can be accomplished through wage matching, employer surveys, asset verification, commercial insurance matching, and other due-diligence efforts.


These types of processes would help ensure that only individuals who meet eligibility criteria receive benefits. Please refer to the Massachusetts Commonwealth Connector case study on page 14.

Cost Savings: The cost savings associated with implementing enrollment integrity practices cannot easily be quantified. Measurable savings, however, will likely accrue over the long term from ensuring that individuals are enrolled in the appropriate government healthcare program.

Full implementation of asset verification programs In 2008, legislation was enacted that requires Medicaid agencies to perform asset verification services among the aged, blind, and disabled population in order to uncover assets not disclosed at time of enrollment. This requirement is being phased in over five years, with 100% participation required by the end of FY 2013. HMS recommends that Congress mandate asset verification programs in all existing and future government healthcare programs for the full program population. A more robust asset verification program will help control the cost of healthcare provided to high net-worth individuals and continue to reduce fraud, waste, and abuse in Federal entitlement programs.

Cost Savings: The Congressional Budget Office estimated that asset verification procedures for Medicaid’s aged, blind, and disabled population alone would result in cost savings of $1 billion from 2009 to 2013 and $4.5 billion from 2009 through 2018. Based on these baseline numbers for a subset of the Medicaid population, HMS estimates additional annual cost savings of over $500 million for each 1% of the non-aged, blind, or disabled Medicaid population identified as having undeclared assets. HMS believes this savings could also be applied to other existing and future government healthcare programs.

Outreach to the uninsured through the use of public school records An estimated two-thirds of uninsured children are eligible for public coverage. Lack of awareness and understanding of the programs are cited as reasons for this coverage gap. As a result, states must find innovative ways to reach and enroll these children.

President Obama’s campaign proposal included a mandate for healthcare coverage for all children. CHIP reauthorization and expansion legislation signed into law in February 2009 was a down payment on his campaign promise. In an effort to enroll more children in CHIPs, the reauthorization legislation allocates $100 million to support states in their outreach and enrollment activities, and calls for the programs to conduct public awareness initiatives and public health awareness campaigns.

Estimated savings = more than $500 million per 1% non-ABD population

Enrollment Integrity = measurable cost savings.


HMS recently initiated a pilot program in New Jersey to match public school rosters against our national database of eligibility insurance information from over 1,000 insurance plans representing virtually every major insurance carrier in the country. Through this approach, HMS identifies children without current health insurance coverage for the state to target for outreach and enrollment. HMS believes this is an efficient way for states to conduct a focused

enrollment campaign since it allows CHIP programs to direct their attention to children who may be eligible, but are not yet enrolled.

In addition, given that millions of children who live with one parent do not have health insurance, HMS recommends that child support agencies share data on their IV-D population for the purpose of CHIP outreach and enrollment.

Cost Savings: States are under pressure to contain costs, but have limited funding for communicating to families about their insurance options. Although the CHIP reauthorization bill allocates funding to states for a national outreach campaign, states must meet their objectives of increasing enrollment in CHIP, while spending judiciously. On average, it costs approximately $280 to enroll a child in CHIP, 20% of which is associated with outreach and education. If outreach efforts were targeted to those children who do not currently have insurance, states could realize significant cost savings, and a reduction in overall program cost.

Expansion of third party liability rights to all government healthcare programsThird party liability identification programs are operated by states to identify and recover funds for claims paid by Medicaid for which a third party was liable. Some examples of liable third parties include casualty carriers, insurance companies, estates, and Medicare. According to a 2006 Government Accountability Office (GAO) report, states reported savings of nearly $5.5 billion in FY 2004 from ensuring that private third parties paid before Medicaid. HMS recommends that provisions requiring coordination of benefits and recovery from liable third parties be implemented in all existing and future government healthcare programs. Please refer to the New Jersey Charity Care Program case study on page 16.

Cost Savings: CHIP is an example of a government program that does not currently have authority to recover from liable third parties. HMS studies in three states have identified that between 3 to 7% of children enrolled in CHIP have other health insurance coverage. By identifying this coverage and recovering the dollars that should have been paid by commercial insurers, states can save millions of dollars that can be reinvested in coverage for more needy children.

Significant reduction in

the $280/per child outreach & enrollment costs

Potential cost savings could =

$1 billion over five years.


But CHIP regulations vary from state to state, and most states lack the authority to recover CHIP costs. Congress could correct this disparity. HMS recommends that Congress grant all states the authority to recover CHIP payments from third parties. The national average cost to insure a child in CHIP is $115 per child per month. HMS estimates that by identifying 4% of all CHIP beneficiaries nationwide who have private insurance, state programs could reap savings of over $1 billion over five years. These savings could be reinvested in the program to provide health security for more children, or offset other budget demands. In addition to granting CHIP programs third party liability rights, HMS recommends that all existing and future healthcare programs should be granted recovery rights and be required to coordinate benefits.

Increased funding for State Medicaid Fraud Control Units Charged with the investigation and prosecution of healthcare providers who defraud the Medicaid program, Medicaid Fraud Control Units have long been in the forefront of healthcare fraud enforcement. These units are funded by annual grants from the Department of Health and Human Services, and matched with state funding. Because of budgetary issues, a number of states have not had the resources to meet the Federal match and, as a result, are forced to limit activities aimed at fraud and abuse.

States such as New York and Florida, however, have been successful in negotiating additional Federal funds for their Medicaid Fraud Control Units. Florida’s Medicaid fraud prevention efforts parlayed $2 million in additional Federal funding into savings of $134.3 million in 2007. It is worth noting that the state’s fraud-combating program cost $11.6 million to run in 2007, providing the state and Federal government with a significant return on investment.

Cost Savings: HMS recommends that the Federal government increase funding for all state Medicaid Fraud Control Units in an effort to give these units the necessary resources to implement programs aimed at identifying fraud, waste, and abuse. Every dollar recovered from Medicaid fraud and abuse is another dollar that could be spent on a Medicaid recipient.

Recoveries by state Medicaid Fraud Control Units have consistently exceeded Federal expenditures required to support those units. In 2007, states received $169 million in Federal grant money, and recovered over $1 billion—representing more than a 500% return on the Federal investment. In 2005, the GAO reported a wide disparity between the level of resources the Federal government expends to support and oversee fraud and abuse control activities, and the amount of Federal dollars at stake in Medicaid payments. Without additional funding, the ability for states to do more will decrease, and the overall fiscal integrity of the program will be threatened.

States recovered over $1 billion – a 500% ROI


Application of fee-for-service Medicaid drug rebate to drugs purchased for Medicaid managed care enrollees In fee-for-service (FFS) Medicaid, manufacturers of drugs pay rebates to the program on Medicaid’s purchases of those drugs. Currently, Federal law prohibits states from collecting the drug rebate for drugs purchased for Medicaid managed care enrollees and, as a result, Medicaid Managed Care Organizations (MCOs) are being charged a premium price for those drugs. This prohibition was enacted at a time when less than 5% of Medicaid beneficiaries were enrolled in MCOs. Today, approximately 45% of all Medicaid beneficiaries are members of capitated Medicaid managed care —meaning that states and Federal governments lose the benefits of the Medicaid drug rebate for nearly half of all Medicaid beneficiaries.

There is presently legislation in Congress, the Drug Rebate Equalization Act of 2009, which would make Medicaid MCOs eligible for rebates on prescription drugs, just as FFS plans are already. President Obama also included this in his FY 2010 budget as a way to help pay for an expansion of health coverage for more Americans. By combining the drug rebate discounts with existing drug utilization management systems, Medicaid MCOs will achieve important savings in the care provided to Medicaid beneficiaries. These savings will, in turn, reduce the cost of the Medicaid program to the federal and state governments.

Cost Savings: Currently, States are paying more for the acquisition of prescription drugs for Medicaid managed care enrollees, than for beneficiaries in FFS Medicaid, thereby raising costs for Federal and state governments. HMS recommends that prescription drug manufacturers be required to pay rebates on drugs purchased for enrollees in Medicaid MCOs that is similar to the rebate required in the FFS components of the program. Additionally, HMS supports recent changes to the legislation that require the rebate to be paid directly to states. The Congressional Budget Office has scored the proposal of applying the FFS Medicaid drug rebate to drugs purchased for Medicaid managed care enrollees as saving approximately $9 - $11 billion over 10 years.

Increased Federal match rate for Medicaid cost recovery activitiesStates save billions of dollars annually by recovering Medicaid dollars from liable parties. The Federal government pays for 50% of the costs of these recovery programs through the administrative match rate, but receives between 50% and 75% of the dollars recovered based on the state’s Federal Medical Assistance Percentage (FMAP) rate.

Increasing the Federal match

by 25% will double Medicaid

cash recoveries.


When the states and the Federal government share the costs and benefits relatively equally, states have an incentive to implement robust program integrity and cost recovery programs. As the Federal contribution to Medicaid payments increases, however, states may be less inclined to perform cost recovery and program integrity activities, since they are still paying 50% of the costs but in some cases keeping as little as 17% of the recoveries. As a result, millions in costs that could be recovered and returned to the Federal treasury may go uncollected.

In order to incentivize states to identify and recover from liable third parties, HMS recommends that the 75% Federal administrative match rate that currently applies to program integrity activities be extended to all certified cost recovery programs as well. A consistent match rate across cost recovery programs is in the financial interest of both the Federal government and states. It would incentivize states to maximize recoveries and implement new cost recovery initiatives. An increased Federal match also protects the Federal investment in Medicaid, and aligns with President Obama’s objective to increase funding for program integrity activities.

Cost Savings: Office of Management and Budget (OMB) Director Peter Orszag has stated that for every $1 spent on healthcare recovery activities, evidence suggests that the government recoups $1.60. In a state which currently has a 70% FMAP rate, every state administrative dollar matched at 50% becomes $2 to invest in cost recovery, and would yield $3.20 in total savings. Under current law, however, the state would only be able to retain $.96 of the recovered amount. Under this current formula, states cannot afford to maximize cost recovery programs and additional savings may be lost to both the state and Federal government.

If the match rate for cost recovery activities was increased to 75%, a $1 investment in cost recovery by a state would be eligible for a $3 Federal match for a total of $4, which could result in $6.40 in savings. Based on this calculation, the state would retain $1.92 and the Federal government would be allocated $4.48, a sound investment for both parties. As a result, raising the administrative match to 75% is equitable in that it will more closely align the administrative rate to the highest FMAP rate and is a strong incentive for states to pursue recovery of the corresponding program dollar.

Performance-based audit contracts for Medicare Part D and Medicare AdvantageTargeted contracts should be developed to respond to the emerging program integrity vulnerabilities in the Medicare Prescription Drug Program and Medicare Advantage Plans. Many analysts have recognized the limited oversight of Part D, and a resulting need for greater program safeguards to prevent and detect fraud, waste, and abuse. According to the Department of Health and Human Services (HHS) Office of Inspector General, inaccurate bids by some plan sponsors have resulted


in Medicare paying higher subsidies, and beneficiaries paying higher premiums. The HHS Inspector General has reported that, as of June 2008, CMS’s Medicare Drug Integrity Contractors (MEDICs) had failed to analyze the Part D claims data for aberrant billing patterns or potential fraud, although MEDICs gained access in August 2007.

Medicare Advantage plans have come under similar scrutiny for lack of oversight,

and President Obama has spoken about the need to rein in these private insurer-sponsored plans. Opening up the Medicare program to private Medicare Advantage plans was originally intended to help save Medicare money while offering seniors extra benefits like vision and dental coverage. Today, it is reported that the government pays Medicare Advantage plans 14% more per person than it does for beneficiaries enrolled in traditional fee-for-service Medicare. President Obama’s budget recommends cutting Federal payments to Medicare Advantage plans, requiring them to competitively bid to offer plans. The government would then pay them based on an average of the bids, saving $177 billion over 10 years.

Medicare spending is projected to accelerate over the next three years as the first wave of Baby Boomers becomes eligible for the program. Medicare Part D spending is expected to be the fastest-growing component of Medicare as beneficiaries enroll in the program.

Cost Savings: The President’s budget proposes $311 million in FY 2010 for program integrity activities for CMS to remedy vulnerabilities in public healthcare programs, including Medicare Advantage and Medicare Part D. HMS recommends that CMS use this funding allocation to create a performance-based contracting program to oversee and audit the two programs for waste, fraud, and abuse. Because of the nature of these programs, we recommend that the contractors have specific proficiency and expertise in pharmacy auditing, and expertise in financial, clinical, and compliance reviews and audits.

OMB Director Peter Orszag recently stated that for every $1 spent on Medicare Program Integrity, there is a $1.60 return in benefit. Under a performance-based contracting program, a 25% contingency fee could potentially return $4 for every dollar spent by the government. As an example, CMS recently awarded a Medicare Zone Program Integrity contract to a vendor in the amount of $107.9 million. Based on Mr. Orszag’s statement, this contract award should result in savings to CMS of approximately $64.7 million. In comparison, under a performance-based contract with a contingency fee as high as 25 percent, the savings to CMS would be approximately $129.4 million, and the vendor would be incentivized to perform at an even higher level.

Current $64.7 million cost savings could increase to $129.4 million.


Since Massachusetts launched its landmark healthcare reform plan in 2006, the number of uninsured residents has declined significantly. In fact, 450,000 previously uninsured people now have medical coverage. Additionally, the number of visits to hospitals and community health centers by the uninsured has declined

by 37%, and payments from the Health Safety Net Program (Uncompensated Care Pool) have declined 41%.

Because enrollment exceeded projections, costs have also increased substantially. This is, in part, because more than half of the previously uninsured now have insurance that is either subsidized or paid forby the government.

The Governor’s healthcare budget request for 2009 is $400 million more than the 2008 budget, and many are concerned that this amount may be insufficient. Additionally, under legislation passed this year, insurers will be assessed an additional $33 million, and healthcare providers another $20 million to cover the rising cost of the program.

HMS partners with the Commonwealth to determine whether plan applicants and enrollees have private or other government coverage. Our initial search identified 3,800 enrollees with other coverage and 1,800 eligible but not enrolled residents who already had other insurance coverage.

Per plan guidelines, members with other insurance coverage are disenrolled from the Commonwealth Care program, reserving program resources for the truly uninsured. Residents who are disenrolled may appeal if their current coverage is unaffordable. HMS administers this appeals process on behalf of the Commonwealth Connector Authority.

HMS works with Massachusetts

to control costs, manage enrollment,

and ensure that subsidies benefit

those without insurance coverage.

Case Study: Massachusetts Healthcare Reform and Cost Containment


HMS also investigates whether Commonwealth Care enrollees have access to employer-based coverage, college/university-sponsored insurance (QSHIP), TRICARE, or other subsidized or unsubsidized plans.

In the future, HMS will provide additional services to Commonwealth Care or Commonwealth Connector Authority, including identifying existing coverage during the waiting period, and performing real-time screening to determine whether applicants have other coverage. These services will save additional money, and ensure that resources are benefiting those in need.

Source: Urban Institute

0%

5%

10%

15%

20%

25%

Lower Income Higher Income

Drop in Uninsured Significant Across Income Strata

2007

2006


New Jersey has long required acute care hospitals to provide medical care to patients in need, regardless of a patient’s ability to pay. To offset the cost of this care, New Jersey created the Charity Care Program.

Although the State spends more than $500 million annually on Charity Care, the program

only covers a portion of the cost incurred by low-income residents. As a result, the State’s hospitals struggle financially due to the cost of providing care to the poor.

Governor Corzine recently proposed dramatic cuts to this program. Although these cuts are intended to help alleviate budget pressures, they will also hinder the ability of these hospitals to serve those mostin need.

Recently, HMS met with New Jersey state officials to discuss opportunities to reduce costs and improve management of the State’s Charity Care Program. Using a vendor for third party liability services could reduce the State’s budget deficit, ease the financial strain on new acute care hospitals, and ensure that the program benefits the neediest patients.

Thousands of Charity Care Program recipients have health insurance coverage either through their employer or another government program. However, the State currently does not have the ability to identify or recover costs that should have been paid by a liable third party.

HMS worked hand-in-hand with State officials to demonstrate how third party recovery methods could help the State recover more than $50 million annually, allow more low-income residents to receive healthcare, alleviate the financial burden that State hospitals must absorb, and ensure that the program continues to help those for whom it was intended.

In New Jersey, HMS helped legislators identify barriers to cost savings in the

Charity Care Program.

A recent report noted that the State has “missed the opportunity to recover tens of millions of dollars [for Charity Care] …and the amount of money forfeited by the State…continues to mount.”

Source: State of New Jersey Commission of Investigation Report-

Charity Care: An Ailing System

Case Study: Uncompensated Care in New Jersey


Last year, for the third consecutive year, HMS assisted states in recovering more than $1 billion.

ConclusionThe ability to contain costs will be critical as Congress looks to enact healthcare reform legislation. The President’s budget invests substantial resources in program integrity measures, including ensuring that healthcare benefits are allocated appropriately, and that healthcare providers receive the appropriate payment. HMS can assist the government in its efforts to expand access to affordable healthcare programs by:

Reducing waste from incorrect or unnecessary claim payments

Improving efficiency and enrollment accuracy

Eliminating fraud and abuse

Every dollar recovered or saved can be invested to cover citizens most in need, save taxpayer dollars, and make the system work better for everyone.

About HMS HMS is the leader in coordination of benefits and program integrity services for government healthcare programs. The company’s clients include health and human services programs in more than 40 states, more than 100 Medicaid managed care plans, the Centers for Medicare and Medicaid Services (CMS), and Veterans Administration facilities. HMS helps ensure that healthcare claims are paid correctly and by the responsible party. As a result of the company’s services, government healthcare programs recover over $1 billion annually, and avoid billions of dollars more in erroneous payments. HMS is a wholly owned subsidiary of HMS Holdings Corp., which is headquartered in New York and operates offices nationwide.

For more information about HMS and its program integrity proposals and solutions, please visit hms.com or contact Maria Perrin, Executive Vice President of Government Services at [email protected] or Arika Pierce, Director, Federal Government Relations at [email protected].


ResourcesAlliance for Health Reform: http://www.allhealth.org/

CATO Institute, Healthcare Reading List: http://www.cato.org/research/healthcare/rl-healthcare.html

Center for Healthcare Transformation: http://www.healthtransformation.net/

Centers for Medicare and Medicaid Services Overview of Third Party Liability: http://www.cms.hhs.gov/ThirdPartyLiability/

Congressional Budget Office, Budget Options, Volume 1, Health Care, December 2008: http://www.cbo.gov/ftpdocs/99xx/doc9925/12-18-HealthOptions.pdf

HMS Third Party Liability Services: http://www.hms.com

The Lewin Group Report: Analysis of Drug Rebate Equalization Act’s Savings to the Medicaid Program: http://www.communityplans.net/Portals/0/ACAP%20Pharmacy%20Savings%20Paper%20DRE%20091808.pdf

Kaiser Family Foundation Report, States Moving Toward Comprehensive Healthcare Reform: http://www.kff.org/uninsured/kcmu_statehealthreform.cfm

Massachusetts Commonwealth Connector Program: http://www.mahealthconnector.org/portal/site/connector/

National Conference of State Legislators, “Comprehensive Reform, State Examples:” http://ncsl.org/programs/health/dhmaine.htm

Progressive Policy Institute Reports on Healthcare and the Uninsured: http://www.ppionline.org/ppi_sub.cfm?knlgAreaID=111&subsecID=137

Urban Institute’s Health Policy Center: http://www.urban.org/health_policy/

U.S. Department of Health and Human Services, Office of Inspector General, FY 2008 Agency Financial Report, Top Management and Performance Challenges identified by the Office of Inspector General: http://www.oig.hhs.gov/publications/challenges/files/TM_Challenges08.pdf


About the Authors Maria Perrin Executive Vice President, Government Markets, HMS As Executive Vice President of Government Services, Maria Perrin has responsibility for ensuring client satisfaction and the effective operation of our State and Federal contracts. Ms. Perrin works closely with clients at all levels of government, including CMS. She coordinates with legislative bodies to enact effective statutory and regulatory requirements in support of efficient cost management programs and government-sponsored healthcare program goals.

Arika L. Pierce, JD Director, Federal Government Relations, HMS As Director of Federal Government Relations, Arika Pierce is responsible for developing HMS’s Federal Government Relations program. This program serves as a vehicle for supporting legislation that promotes healthcare expansion and efficient government healthcare spending. In addition, Ms. Pierce works closely with CMS, Federal legislators, and other health policy stakeholders to develop and promote policy and legislation that furthers the reach and effectiveness of public health programs.

Copyright © 2009 HMS. All rights reserved.

Documents

Contentsprograms, this whitepaper examines two case studies. In Massachusetts, ... Increased Federal match rate for cost recovery activities; and Performance-based audit contracts