CMS Approves $628 Million for 7 MA Hospitals as Part of Medicaid Waiver

On May 23, 2012, Massachusetts Governor Deval Patrick and congressional leaders released statements announcing approval by the Centers for Medicare & Medicaid Services (CMS) of $628 million to support a plan for improving care and lowering costs at 7 hospitals that treat many of the state’s most indigent citizens. The statements indicate that the funding will be used to develop integrated care programs, alternative payment methods, and speed the transition to electronic medical records. [More]

ED Announces Approval of Eight New NCLB Waivers

In a May 29, 2012 press release, the U.S. Department of Education (ED) announced its approval of No Child Left Behind Act (NCLB) waivers for eight additional states: Connecticut, Delaware, Louisiana, Maryland, New York, North Carolina, Ohio, and Rhode Island. ED previously granted NCLB waivers for 11 states; 18 additional waiver applications are still under review. The approved states must agree to “prepare all students for college and career, focus aid on the neediest students, and support effective teaching and leadership.”


Rhode Island Awards Health Insurance Exchange PMO Project to PCG

Boston, MA, May, 2012 – The Rhode Island Executive Office of Health and Human Services (RI EOHHS) has awarded a contract to PCG Health to provide a Project Management Office (PMO) to oversee development and implementation of the EOHHS/Medicaid components of the new Health Insurance Exchange/Integrated Eligibility System the state is currently procuring. Work will begin in June. PCG Health will also oversee major enhancements to the state’s MMIS project. For more information, contact


Florida DCF Awards SAMH Payment Contract to PCG

Boston, MA, May 2012 – The Florida Department of Children and Families (DCF) has awarded PCG a contract to assist in reaching consensus on changes to the DCF’s method of payment for certain substance abuse and mental health (SAMH) services. The project has two key components: planning a conversion of SAMH services to a utilization-based method of payment and establishing a uniform approach to defining and calculating allowable administrative costs for all publicly-funded SAMH services. For more information, contact


Colorado DBH Awards SUD Treatment Cost Project to PCG

Boston, MA, May 2012 – The Colorado Department of Human Services, Division of Behavioral Health (DBH) recently awarded PCG a contract to conduct multiple phases of work associated with improving accuracy and consistency in providing reimbursement for substance use disorder (SUD) treatment services. PCG will develop uniform service coding standards and cost calculations for SUD and health services, revising guidance related to accounting practices, developing SUD treatment service valuation methodology to set reimbursement rates, and creating a Web-based application that incorporates all of the newly established requirements. For more information, contact


DHHS Awards Loans to Nonprofit Co-ops in Nevada and Michigan

On Friday, May 18, 2012, the Centers for Medicare & Medicaid Services (CMS) announced the awarding of loans to two more health care nonprofit co-ops, one in Nevada and one in Michigan. In Nevada, the Hospitality Health Co-op was awarded $65.9 million with sponsorship by the Culinary Health Fund, the United HERE labor union, and the Health Services Coalition. In Michigan, the $71.5 million loan went to the Michigan Consumers Healthcare Co-op, which is sponsored by a coalition of 15 private, nonprofit county health plans in Michigan that provide insurance coverage to low-income people. [More]

Medicaid Eligibility Increasing Under ACA

Recent media reports indicate that a number of states are already increasing Medicaid eligibility pursuant to the expansion requirements in the Affordable Care Act (ACA), scheduled to come into effect in 2014. Under the 2014 legislative change, individuals making up to 133% of the federal poverty level, or about $14,494 per year, or a family of three that earns $24,645 a year, can qualify for Medicaid. [More]

States Win $181 Million in Exchange Grants

The Center for Consumer Information and Insurance Oversight (CCIIO) announced on May 16 that Illinois, Nevada, Oregon, South Dakota, Tennessee, and Washington have won an additional $181 million in health insurance exchange establishment grants. Washington becomes the second state, after Rhode Island, to win a “level two” exchange establishment grant. Aggregate exchange grants awarded to states under Title I of the Affordable Care Act (ACA) now exceed $1 billion. [More]

Massachusetts Senate Passes Health Care Financing Reform Bill

On May 17, the Massachusetts Senate passed S. 2260, which seeks to improve quality of care and reduce overall health costs in the Commonwealth through increased transparency, efficiency and innovation. The legislation aims to reduce Massachusetts health costs by $150 billion over 15 years. It passed the Senate on a 35-2 vote. It contains wellness, preventive care, care coordination, global payment, and medical malpractice reform provisions comparable but not identical to the House bill (H. 4070) introduced on May 4. [More]