Health Care Reform

State Medicaid agencies are at the forefront of transformative changes that impact how health care is accessed, delivered, managed, and reimbursed. These changes require strategic thinking,
thoughtful planning, and effective tactics.

Public Consulting Group (PCG) has provided effective, results-driven management consulting to state
agencies for 25 years. We played an active role in helping many state agencies to implement the
Health Insurance Portability and Accountability Act, the Welfare Reform Act, No Child Left Behind, and
Medicare Part D. PCG now leads the field in providing consulting services that help state agencies to
implement the Affordable Care Act. How can we help your agency?

How is your state implementing the Affordable Care Act (ACA), with its myriad challenges and opportunities for state governments, regulators, the private insurance market, and individuals? Public Consulting Group (PCG) has 25 years of experience helping state governments to effectively navigate the financing, budgeting, operations, policy, and regulatory aspects of federal policies including the ACA. We also offer deep subject matter expertise in design and implementation of health insurance programs.

Under the Affordable Care Act, all states must have a Health Insurance Exchange in place by January 1, 2014 to support the selection and purchase of health plans by individuals and small businesses. From choosing the type of Exchange that best suits your state’s needs to its governance structure and implementation, you have a number of important decisions to make and tasks to perform over the next several months. Public Consulting Group (PCG) can help.

At Public Consulting Group (PCG), we know one size does not fit all. Our Health Insurance Exchange consulting team can help you create and implement an Exchange that best meets the needs of your state.

 

As the implications of ACA become clearer, PCG is also working with states to analyze and redesign several key aspects of their Medicaid programs, including eligibility issues, dual eligibles, behavioral health, utilization review, workforce assessment, gap analyses, and staffing.

 

PCG continues to work with several states to help them develop their State Medicaid Health Information Technology Plan (SMHP). These efforts include the development of an implementation plan for Electronic Health Records (EHR) and Provider Incentive Payments (PIP).

The Centers for Medicare & Medicaid Services (CMS) has been very clear that initiatives to coordinate health care reform efforts with Medicaid must be properly cost allocated. Has your agency thoroughly examined its cost allocation plan? Are there additional avenues for federal funding maximization? Can your state show the federal government that your claim for Federal Financial Participation (FFP) is valid? And will your state withstand a federal audit of its current FFP submissions? PCG's experience with cost allocation is unsurpassed.

 

Your pre-payment verifi cations may be inadequate to prevent fraud, waste, and abuse. How can you be sure the right providers are being paid the correct amount? What is an effective audit strategy? PCG helps states to use the right audit methodologies and data sources and to conduct risk assessments of their specifi c provider communities. We have trained audit professionals who can work with you to meet CMS and Offi ce of Inspector General concerns.

 

Now that the EHR program is underway, what other CMS and Offi ce of National Coordinator for Health (ONC) requirements face your state? Are you ready to move forward with your Medicaid Health Information Technology (HIT) vision? Are you ready for MITA 3.0? PCG can help your state plan and make the business process changes needed to achieve your HIT vision.

 

Have estimates from your Implementation Advance Planning Document (IAPD) changed? PCG has completed IAPD updates for MMIS funding, HIT funding, and eligibility system funding. Let us apply our knowledge to assure that your IAPDs are complete and request the right funding at the right times.

 

For more information about PCG's Health Care Reform services please contact us at
pcghhs@publicconsultinggroup.com or 1-800-210-6113.