GAO Issues Report on Transparency of CMS Websites for Consumers


The U.S. Government Accountability Office (GAO) released a report on November 18, 2014 entitled, “Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers.” GAO found that five Centers for Medicare and Medicaid Services (CMS) websites launched over 12 years – Nursing Home Compare (1998), Dialysis Compare (2001), Home Health Compare (2005), Hospital Compare (2005), and Physician Compare (2010) – do not use language consumers understand, do not present data in ways meaningful to consumers, and do not help consumers collect information they need to make informed, value-based decisions about their care. While the CMS websites can motivate providers to improve quality of care, research shows that providers and consumers look at data differently. [More]

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HHS OIG Releases Work Plan for Federal Fiscal Year 2015


As the new Federal Fiscal Year began on October 1, 2014, a work plan was released that outlines the engagements planned throughout the year. The Office of Inspector General (OIG) was created was created “to protect the integrity of US Department of Health and Human Services (HHS) programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal health care laws.” [More]

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CMS Launches $840 Million Quality Improvement Initiative


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued two funding opportunity announcements on the Transforming Clinical Practices Initiative (TCPI) on October 23, 2014. The two announcements describe opportunities for applicants to compete for up to $840 million in federal funding under cooperative agreements with CMS over a May 1, 2015 - April 30, 2019 performance period. Applicants may seek funding under cooperative agreements as Practice Transformation Networks (PTNs) or as Support and Alignment Networks (SANs). [More]

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CMS Issues Proposed Notice to Establish Methodology to Determine Federal Payments Under BHP in 2016


The Centers for Medicare & Medicaid Services (CMS) published in the October 23, 2014 Federal Register a proposed Notice (79 Fed. Reg. 63363) which would establish the methodology the agency intends to utilize to determine federal payments under the Basic Health Program (BHP) in 2016. Pursuant to Section 1331 of the Affordable Care Act (ACA), states can elect to operate a BHP, which would provide affordable health coverage to individuals under age 65 with household incomes between 133% and 200% of the federal poverty level who are not otherwise eligible for Medicaid, CHIP, or affordable employer-sponsored coverage. [More]

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HHS-ONC Releases Health IT Progress Report


The U.S. Department of Health and Human Services (HHS), Office of the National Coordinator for Health Information Technology (ONC) has released an October 2014 report to Congress which describes progress toward the development of a nationwide system for the electronic use and exchange of health information. The report shows that, as of June 2014, 75 percent (over 403,000) of the nation’s eligible health professionals and 92 percent (over 4,500) of eligible hospitals had received Medicare or Medicaid incentive payments for the adoption and meaningful use of certified electronic health record (EHR) technology authorized under the American Recovery and Reinvestment Act of 2009 (ARRA). [More]

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UCLA Publishes Study on Hospital Service Utilization in Demonstration Program


The UCLA Center for Health Policy Research published a landmark study on October 17, 2014 entitled, “Increased Service Use Following Medicaid Expansion Is Mostly Temporary: Evidence from California’s Low-Income Health Program.” UCLA analyzed hospital emergency room (ER) use, hospital inpatient admissions, and other hospital outpatient department (OPD) service utilization for individuals who were enrolled in 2011-2013 in the Low-Income Health Program (LIHP) under California’s innovative “Bridge to Reform” Medicaid demonstration waiver. UCLA sorted 182,443 LIHP enrollees in eight counties into four distinct groups based on expected “pent-up demand” in each group (the 69,095 in the highest group had the least access to county funded indigent care before enrolling in LIHP), controlled for other differences such as demographic variables using regression models, and tracked service utilization from the July 1 – September 30, 2011 quarter through the April 1 – June 30, 2013 quarter. [More]


HHS Report Updates ACA Impact on Medicaid Enrollments


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), released on October 17, 2014 a report showing that 26 jurisdictions (25 states and the District of Columbia) which implemented Medicaid expansion under the Affordable Care Act (ACA) by August 2014 saw on average a 22.09 percent increase in Medicaid/CHIP enrollments for August 2014, as compared to their average monthly enrollments in a July – September 2013 baseline period. [More]


CMS Releases Pioneer ACO Performance Data


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) released data on October 8, 2014 showing the quality of care and financial performance of accountable care organizations (ACOs) over the first two years of its Medicare Pioneer ACO program. For year two, the program achieved $96 million in net aggregate Medicare savings along with substantial improvements in 28 out of 33 quality of care metrics across four major quality of care domains. [More]

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U.S. Supreme Court Agrees to Review Ninth Circuit Court of Appeals Decision Allowing Providers to Challenge Medicaid Reimbursement Rates


On October 2, 2014, the U.S. Supreme Court agreed to consider whether the Supremacy Clause of the U.S. Constitution grants Medicaid providers a private right of action to challenge a state’s reimbursement rates. The Supremacy Clause of the U.S. Constitution provides that when a federal law and a state law deal with the same subject matter, the federal law will prevail. [More]

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Report Shows ACA Impact on Uncompensated Care


The U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) released a report on September 24, 2014 showing the impact of the Affordable Care Act (ACA) on hospitals’ uncompensated care (bad debts and charity care for the uninsured). The report offers the first evidence that 2014 enrollments in qualified health plans (QHPs) through health insurance Exchanges along with Medicaid expansions in 25 states and the District of Columbia are starting to reverse the growth in the cost of uncompensated care. [More]