CMS Issues Proposed Rule Modifying Uninsured Definition for Determining DSH Payments

In the January 18, 2012 Federal Register (77 Fed. Reg. 2500), the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would implement a service-specific basis to define the uninsured for purposes of determining the hospital-specific limitation on Disproportionate Share Hospital (DSH) payments. Section 1923(g) of the SSA limits DSH payments to hospitals to the uncompensated costs of furnishing hospital services to individuals who are Medicaid eligible or "have no health insurance (or other source of third party coverage) for the services furnished during the year". If the proposed rule is finally adopted, it would reverse the final rule issued in December 2008 (73 Fed. Reg. 77904) that defined the uninsured for purposes of the DSH limitation as those individuals without "creditable coverage," consistent with the definitions under 45 C.F.R. pt. 144 and 45 C.F.R. pt. 146. [More]

HHS and USDA Update Guidance on Cost Allocation

The U.S. Department of Health and Human Services and the U.S. Department of Agriculture released additional guidance to all state health and human service agencies on January 23 on cost allocation plans and advance planning documents on eligibility systems serving multiple state health and human services programs. The new letter clarifies guidance provided on August 10 that design and development costs for new eligibility systems needed to implement health programs (Medicaid, the Children’s Health Insurance Program, and state-operated health insurance exchanges) under the Affordable Care Act (ACA) may be allocated in their entirety among those programs, even if the new eligibility systems also benefit other income-related programs (per a limited exception to OMB Circular A-87 section C. 3. cost allocation principles). [More]

CBO Issues Report on Care Management and Value-Based Purchasing

The Congressional Budget Office (CBO) released a report on January 18 outlining key findings and lessons learned from six disease management/care coordination projects and four value-based purchasing projects under Medicare research and demonstration authority. Rigorous independent evaluations have been completed on the projects, which were implemented before 2008. The first six demonstration projects, involving 34 separate programs, showed that factors such as the extent and type of care management were important determinants as to whether the programs actually achieved reductions in hospital admissions and net reductions in Medicare program spending after accounting for the extra care management fees under the projects. Only four of the 34 programs achieved reductions in hospital admissions greater than 15 percent. [More]

PCG To Assist State of CA with Health Care Reform Project

Boston, MA, January, 2012 – PCG Health was recently selected as the state of California’s Health Care Options (HCO) Program consultant. HCO coordinates activities in the managed care counties that include outreach, oversight of beneficiary education, and processing plan enrollment and disenrollments. PCG will help the program to define a business model to ensure that its Enrollment Broker contract has the ability to accommodate health care reform changes to Medi-Cal over the coming years. For more information, contact


Expert Panel Proposes Changes in Definition of Autism

A January 19, 2012 New York Times article reported that a new study proposes changes in the definition of autism that could significantly decrease the number of individuals diagnosed with the condition. The rate of autism diagnoses has significantly increased since the 1980’s; current estimates are as high as one in 100 children in some areas. A panel of mental health experts appointed by the American Psychiatric Association is reviewing the current definition of autism and presented its preliminary results on January 19th. The results “offer the latest and most dramatic estimate of how tightening the criteria for autism could affect the rate of the diagnosis.” [More]

ACF Requests Comments on Reporting Improper Payments Regarding CCDF Funds

On January 10, the Administration for Children and Families (ACF) released a notice in the Federal Register (77 FR 1494) requesting comments on the Child Care and Development Fund's (CCDF) improper payment reports. The purpose of the request is to announce ACF's proposal to collect information on states' compliance with the Improper Payments Information Act of 2002 (IPIA) and the Improper Payments Elimination and Recovery Act of 2010. Section 2 of the IPIA of 2002 requires states to prepare and submit a report of errors connected with the administration of CCDF grant funds once every three years. The Office of Child Care (OCC) is completing the second three-year cycle of case record reviews. [More]

ACF Issues Interim Final Rule for Tribal Child Welfare

On January 6, the Administration for Children and Families (ACF) published an interim final rule in the Federal Register to implement statutory provisions related to the Tribal title IV-E program. The rule is effective February 12, 2012 and addresses multiple provisions related to the Fostering Connections Act (P.L. 110-351) that provided tribal agencies with the option of applying to the secretary of the Department of Health and Human Services (HHS) to operate a Title IV-E program. The legislation provided for planning grants for tribal agencies to use for the purposes of developing infrastructure programmatically and fiscally that would ensure that the tribes were able to operate a Title IV-E program that was consistent with federal guidance. The Interim Final Rule provides further detail on how tribal agencies must operate going forward. Also on January 6, ACF released an Information Memorandum (ACYF-CB-IM-12-01) which informs states, tribes, and territorial agencies that an interim final rule was released. [More]

CA Federal Judge Blocks Medicaid Rate Cuts

On December 29, 2011, U. S District Court Judge Christina Snyder ruled that "California can't cut reimbursements hospitals receive for the skilled-nursing services they provide to low-income people." Both state and federal officials had approved the cuts based on the reasoning that patients could utilize free-standing skilled nursing facilities. But Judge Snyder concluded that state and federal officials "likely relied on unreasonable projections and faulty reasoning about how the cuts would affect frail patients". The case is California Hospital Association v. Douglas, 11-09078, US District Court, Central District of California (Los Angeles). [More]