CMS finalizes new Medicaid drug reimbursement rules

 

On February 1, 2016, the Centers for Medicare and Medicaid Services (CMS) published final regulations in the Federal Register on Medicaid upper payment limits (UPLs) for covered outpatient drugs, as well as rebates that drug manufacturers must provide to states. State Medicaid agencies must take into account “average manufacturers’ prices” (AMPs) and other factors in calculating state Medicaid payments for covered outpatient drugs and dispensing fees to pharmacies that purchase medications, usually from wholesalers. Based on data in reports generated by state Medicaid agencies, drug manufacturers must calculate rebates to states under methods specified in the rule. [More]

 

U.S. Supreme Court turns down appeal of challenge to ACA

 

On Tuesday, January 19, 2016, the U.S. Supreme Court refused to take up an appeal of a Washington, D.C., U.S. Court of Appeals decision denying another challenge to the Affordable Care Act (ACA). [More]

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Congress includes ACA tax delays in Omnibus spending legislation

 

On December 18, 2015, Congress passed a spending and tax package that will potentially keep the Federal Government operating through September 2016, but contains three significant Affordable Care Act (ACA) tax delays. [More]

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PCG's top health trends to look for in 2016

 

Year end is a time of reflection, and a time to plan for what’s to come. Here at PCG, our Health team has much to be proud of in 2015: we helped more than 40 states develop and implement health care reform and Medicaid policy that will impact millions of Medicaid members nationwide. And so we look ahead to 2016, and PCG Health’s leadership sees a few trends that we are keeping an eye one that we think will impact the Medicaid healthcare system in 2016, and for years to come. [More]

 

HHS finalizes new rules for eligibility IT systems

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the Federal Register on December 4, 2015, authorizing 90 percent Medicaid Federal financial participation (FFP) for the design, development, installation (DDI) or enhancement of Medicaid eligibility and enrollment (E&E) systems. Additionally, the final rules authorize 75 percent Medicaid FFP for the maintenance and operation (M&O) of such systems. [More]

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CMS proposes ACA Benefits and Payments Parameters Rules for 2017

 

On December 2, 2015, the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) officially published its proposed “Notice of Benefits and Payments Parameters” rules for 2017. As in prior years, this annual rules notice proposes adjustments to a wide range of policy, operational, and information technology requirements applicable to health insurance coverage obtained through Exchanges, as well as other related topics under the Affordable Care Act (ACA). [More]

 

TC wins IV&V contract in California

 

PCG Technology Consulting (TC) was recently awarded a twenty-eight month contract to provide Independent Verification & Validation (IV&V) services to the California Department of Social Services (CDSS) for the California Appeals Case Management System (ACMS) project. The ACMS supports the CDSS State Hearings Division (SHD), which is responsible for ensuring due process for individuals who wish to appeal administrative decisions pertaining to benefits for California public assistance programs, including Child Welfare, Covered California (Affordable Care Act), and Medi-Cal. [More]

 

HHS issues 2016 Exchange enrollment data

 

On November 12, 2015, the U.S. Department of Health and Human Services (HHS) issued data on the first week of the 2016 open enrollment period (November 1, 2015 – November 7, 2015) for qualified health plans (QHPs) under the Affordable Care Act (ACA). This initial “snapshot” shows that 3,180,777 persons visited the Healthcare.gov website, 1,153,270 persons completed their eligibility applications, and 543,098 eligible persons selected a QHP in the first week. [More]

 

Texas, Kansas, and Louisiana sue HHS and IRS claiming provider insurance fees imposed by the ACA are unconstitutional

 

On October 22, 2015, the states of Texas, Kansas, and Louisiana filed a complaint in the U.S. District Court for the Northern District of Texas, Wichita Falls Division, against the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), alleging that a provision of the Affordable Care Act (ACA), which imposes a health insurance fee on all providers, including, by extension, managed care organizations, is unconstitutional. (Case 7:15-cv-00151-0 Document 1 filed 10/22/15). [More]

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Legislation introduced to support Medicaid coverage to aging out youth

 

The “Health Insurance Former Foster Youth Act of 2015” was introduced on October 5 by Congressional Representatives Karen Bass (D-CA) and Jim McDermott (D-WA), who are co-chairs of the Congressional Caucus on Foster Youth. The legislation will address a loophole in the Affordable Care Act (ACA) regarding the portability of a youth’s Medicaid coverage. [More]

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