States Target Causes of Hospital ER Overuse

 

The Centers for Medicare and Medicaid Services (CMS) issued a bulletin on January 16, 2014 spotlighting exemplary state strategies to reduce unnecessary and often uncoordinated, duplicative, and costly utilization of hospital emergency departments. Key strategies pioneered by states and provider organizations include improving access to primary care services in medical/health homes and other community-based sites offering same day appointments, extended hours of operation, and 24/7 nurse advice lines (about two-thirds of hospital ER visits occur after regular business hours); offering assistance to recurrent users of ER services (ER users with four or more visits per year, less than 8 percent of all ER users, account for up to 28 percent of all ER visits); and addressing the needs of persons with behavioral health and substance abuse disorders (such persons account for about 12.5 percent of all ER visits). [More]

Tags:

Categories:Payment Reform | State Health Care Reform

 

Maryland Redesigns All-Payer Cost Containment System

 

The Centers for Medicare and Medicaid Innovation (CMMI) has approved Maryland’s plan to redesign its longstanding, all-payer hospital cost containment system. CMMI approved Maryland’s 2014-2019 redesign plan on January 10, 2014 after intensive negotiations and stakeholder consultations. CMMI as well as the New England Journal of Medicine have heralded the plan as a potential framework for state-based payment reform nationwide. [More]

Tags:

Categories:Payment Reform | State Health Care Reform

 

New Report Outlines State-Based Strategies to Contain Health Costs

 

A distinguished panel of health care experts released a report on January 8, 2014 entitled “Cracking the Code on Health Care Costs: A Report by the State Health Care Cost Containment Commission.” The commission is co-chaired by former governors Mike Leavitt (R-UT) and Bill Ritter (D-CO). The report cites extensive research on policy levers at the state level that influence how the health care system is organized and how it operates. [More]

Tags:

Categories:State Health Care Reform

 

HHS Report Shows December Growth in Exchange Enrollments

 

The U.S. Department of Health and Human Services (HHS) released a report on January 13, 2014 showing an accelerating rate of growth in enrollments in qualified health plans through Exchanges in the December 1 – December 28, 2013 period. The 364,682 enrollments during October 1 – November 30 leaped by 1,788,739 in December 1 – 28 to a cumulative total of 2,153,421. By December 28, a cumulative total of 956,991 enrollees selected a plan through State-based Exchanges in 15 States and 1,196,430 did so through Federally-facilitated Exchanges in all other States. [More]

Tags:

Categories:Federal Health Care Reform | Health Insurance Exchanges

 

Michigan Wins CMS Approval of Medicaid Expansion Plan

 

The Centers for Medicare and Medicaid Services (CMS) notified Michigan on December 30, 2013 that CMS has approved the Healthy Michigan research and demonstration project under section 1115 of the Social Security Act. Michigan has won approval of waivers from CMS to design, test, and evaluate the results of new state policies related to co-payments on Medicaid services, monthly Medicaid enrollment premiums up to two percent of family income for beneficiaries with incomes from 100 percent to 133 percent of the Federal poverty level (FPL), and incentives to encourage beneficiaries experiencing risks to their own health (such as tobacco use, alcohol/substance abuse disorders, obesity, or lack of appropriate immunizations) to take immediate steps to mitigate those risks. [More]

Tags:

Categories:Federal Health Care Reform | State Health Care Reform

 

Iowa Wins CMS Approval of Private Insurance Medicaid Expansion

 

The Centers for Medicare and Medicaid Services (CMS) notified Governor Terry Branstad on December 10, 2013 that it has approved a three year demonstration waiver under which the Iowa Department of Human Services may expand Medicaid for 100,000 Iowans aged 19-64, with incomes up to 133 percent of the Federal poverty level (FPL), mainly by offering premium assistance for them to select qualified health plans (QHPs) offered through the Exchange. [More]

Tags:

Categories:Federal Health Care Reform

 

HHS Releases New Report on Exchange Enrollments

 

The U.S. Department of Health and Human Services (HHS) released a report on December 11, 2013 showing that State-based Exchanges continue to lead Federally-facilitated Exchanges by a wide margin in health plan enrollments. [More]

Tags:

Categories:Federal Health Care Reform | Health Insurance Exchanges

 

CMS Issues Final Rules on Medicare Payments for Outpatient Services

 

The Centers for Medicare & Medicaid Services (CMS) published a final rule in the December 10, 2013 Federal Register on Medicare payments for outpatient hospital and ambulatory surgical center services. The rule is another incremental step in a multi-year progression toward an all-inclusive, quality-driven bundled payment methodology analogous to Medicare’s inpatient hospital prospective payment system. [More]

Tags:

Categories:CMS Regulations

 

CMS Launches Monthly Medicaid Application and Eligibility Reporting

 

The Centers for Medicare and Medicaid Services (CMS) released on December 3, 2013 the first in a series of monthly reports on State Medicaid and Children’s Health Insurance Program application and eligibility determinations. The report indicates that states received 2,479,114 Medicaid/CHIP family and individual applications in October 2013, a 15.5 percent increase in applications (versus monthly averages for the preceding three months in the same state) in states that had elected to expand Medicaid (effective January 2014 except in early expansion states) and a 4.1 percent increase in states that had not yet elected to expand Medicaid as of October 2013. [More]

Tags:

Categories:Federal Health Care Reform

 

Covered California Reports Detailed Application and Enrollment Data

 

Covered California, the nation’s largest health insurance Exchange, released detailed application and enrollment data on November 21, 2013. The data show that, from the beginning of its first open enrollment period on October 1 through November 19, Covered California determined eligibility on 360,464 completed applications. Completed applications per week rose from 28,699 in the first week to 71,188 (over 10,000 per day) in the week ending November 16. [More]

Tags:

Categories:Federal Health Care Reform | Health Insurance Exchanges

 

HHS Proposes Quality Rating System for Exchange Health Plans

 

The U.S. Department of Health and Human Services published a notice in the Federal Register on November 19, 2013 proposing a quality rating system (QRS) for qualified health plans (QHPs) offered through health insurance Exchanges. [More]

Tags:

Categories:CMS Regulations | Federal Health Care Reform

 

CCIIO Offers New Option for States on ACA Market Reforms

 

Acknowledging demands for “transitional relief” as perhaps 4 million individuals are facing health insurance cancellation notices for 2014 and websites for Federally-facilitated health insurance Exchanges are not meeting consumers’ expectations, the Center for Consumer Information and Insurance Oversight (CCIIO) has released a letter to State health insurance commissioners stating that health insurance issuers in the individual and small group markets may choose to extend coverage that would otherwise be cancelled due to market reform provisions of the Affordable Care Act (sections 2701-2709 on establishing premiums, comprehensive benefits coverage, guaranteed availability of coverage, coverage of adults with pre-existing conditions, etc.). [More]

Tags:

Categories:Federal Health Care Reform