CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [More]

House passes 21st Century Cures bill

On November 30, 2016, the U.S. House of Representatives passed an amended “21st Century Cures” bill by a 392-26 vote. The bill covers a diverse range of topics, such as: medical research, development of drugs and medical devices, interoperability of electronic health record systems, and mental health/substance use disorder (MH/SUD) programs. [More]

Centers for Medicare and Medicaid Services issues new guidance

The Centers for Medicare and Medicaid Services (CMS) released a draft of its 2018 Letter to Issuers in the Federally-Facilitated Marketplaces (Letter) on November 10, 2016. The Letter – updated annually - provides operational and technical guidance for issuers seeking to offer Qualified Health Plans (QHPs) and Standalone Dental Plans (SADPs) on Federally-Facilitated Marketplaces (FFMs) and State-Based Marketplaces on the Federal Platform (SBM-FPs). [More]

PCG announces final “30 for 30” grants

To commemorate our 30th year of service, and to offer some very humble thanks to our clients and the communities that we serve, PCG pledged to donate $30,000 every other month, ($180,000), to selected charities during calendar year 2016.

December marks the final award in our yearlong campaign, and as such, we are pleased to announce that three “30 for 30” $10,000 grants, ($30,000), will go to organizations dedicated to supporting individuals with disabilities and their families: Parent to Parent USA, Self Advocates Becoming Empowered, and Sibling Leadership Network... [More]

PCG sponsors statewide Delivery System Reform Incentive Payment symposium

It seems entirely fitting that the historic Syracuse Marriott Downtown was the setting for New York’s second annual Statewide Delivery System Reform Incentive Payment (DSRIP) Learning Symposium from September 20 to September 22. The hotel’s renovation was completed just weeks before the event, with an eye toward preserving the workmanship of the past and melding it with 21st century upgrades and innovation. In many ways, that mission is mirrored by the New York State Department of Health in its devotion to time-honored quality of care and its dedication to modernizing the healthcare delivery system through the DSRIP project. [More]

Office of Inspector General releases 2017 Work Plan

The Office of Inspector General (OIG) within the U.S. Department of Health and Human Services (HHS) is charged with determining, on an annual basis, the use of federal funds across all HHS agencies and areas. These include the Centers for Medicare and Medicaid Services (CMS); Public Health (e.g., Centers for Disease Control and Prevention [CDC], Indian Health Services [HIS], Substance Abuse and Mental Health Administration [SAMHSA], Food and Drug Administration [FDA], etc.); and Human Services (i.e., Administration for Children and Families [ACF] and Administration for Community Living [ACL]). [More]

Brief - Child Welfare / Child Neglect

Highlights of a paper by Public Consulting Group and the Institute for Child Success. Click here for the white paper.

Neuroscience shows us that by redressing child neglect, child welfare agencies can not only reduce human suffering, but equip generations of children to become productive members of society. State policymakers can now build on scientific facts to raise the odds of success for youth born into challenging circumstances, break the inter-generational cycle of child neglect, and ease the burden on our systems of child welfare, education, and criminal justice. [More]

Highlights from the annual NAMD conference

The National Association of Medicaid Directors (NAMD) held its annual conference in Virginia last week to discuss the hot healthcare topics facing state Medicaid programs. No surprises about which topics are at the top Medicaid Directors' minds these days: (1) Delivery System and Payment Reforms; (2) IT Systems; and (3) Mental Health and Substance Abuse issues (i.e., integration). All of these are inter-related, of course -- the delivery system and payment reforms will, for many states, focus on the behavioral health populations and providers, which tend to have higher overall Medicaid costs, and in order to implement these reforms robust IT systems will be needed. [More]

Massachusetts wins CMS renewal of demonstration waivers

On November 4, 2016, the Commonwealth of Massachusetts won approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year renewal of its $52.4 billion MassHealth demonstration waiver program. The waiver renewal authorizes MassHealth to pioneer an innovative Medicaid accountable care organization (ACO) model, under which ACOs will partner with community-based organizations to integrate health care and social services, to address social determinants of health, and to achieve patient-centered, outcomes-based care. The renewal includes $1.8 billion in new, up-front investments under a delivery system reform incentive program (DSRIP) initiative to support transition throughout the Commonwealth to the new ACO model, under which provider-led ACOs will be accountable for costs and quality of care. [More]