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]

 

Pennsylvania Wins CMS Waivers for Medicaid Expansion

 

The Centers for Medicare and Medicaid Services (CMS) notified the Pennsylvania Department of Public Welfare on August 28, 2014 that it has approved the Commonwealth’s “Healthy Pennsylvania” demonstration waiver. The Department is authorized under this waiver to expand Medicaid for over 500,000 non-aged adults with incomes up to 133 percent of the federal poverty level (FPL). Coverage under Pennsylvania’s “private coverage option” (PCO) will be offered through competing private health plans. [More]

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NY Medicaid Selects PCG as Medicaid Reform Independent Assessor

 

Albany, NY, August, 2014 – The New York Department of Health recently awarded PCG Health a contract to serve as Independent Assessor for its Medicaid reform efforts. In April, 2014, the federal Centers for Medicare & Medicaid Services (CMS) approved New York State’s waiver, allowing it to redesign its Medicaid system through its new Department of Health Delivery System Reform Incentive Payment (DSRIP) Program. [More]

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HHS Report Shows ACA Impact on Medicaid Enrollments

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), released on August 8, 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 June 2014 saw on average a 18.50 percent increase in Medicaid/CHIP enrollments for June 2014, as compared to their average monthly enrollments in a July – September 2013 baseline period. States which had not implemented Medicaid expansion saw on average a 4.01 percent increase as compared to their 2013 baselines. Aggregating data for all states shows a 12.43 percent increase overall as compared to 2013 baselines. Total reported Medicaid/CHIP enrollments as of June 2014 reached 66,112,314. [More]

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RWJF Releases Reports on the Uninsured and Medicaid Expansion

 

The Robert Wood Johnson Foundation (RWJF) and the Urban Institute Health Policy Center released on July 29, 2014 a report entitled, “Who Are the Remaining Uninsured as of June 2014?” The report shows socio-economic, demographic, and geographic shifts in the composition of the uninsured population from September 2013 to June 2014, points-in-time before and after the Medicaid expansion in some states and the first open enrollment period under the Affordable Care Act (ACA). The national data in the report may help states formulate innovative outreach, consumer assistance, and enrollment strategies for 2015 and beyond taking into account the changing attributes of the remaining uninsured. State-specific data not available in that report can be used to supplement the data in the report. [More]

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NEJM Report Shows 10.3 Million Persons Gain Coverage

 

The New England Journal of Medicine (NEJM) published a special report on July 23, 2014 estimating a net increase of 10.3 million insured adults aged 18 - 64 during the October 2013 – March 2014 open enrollment period offered through health insurance Exchanges under the Affordable Care Act (ACA). The study used Gallup-Healthways Well-Being Index (WBI) survey data from 440,429 survey respondents and linear regression models accounting for socio-economic variables to calculate adjusted average rates of uninsured adults aged 18 – 64 before and after the 2013-2014 open enrollment period. [More]

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HHS Announces Health Care Innovation Awards

 

The U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (CMMI), announced a new batch of “round two” health care innovation awards on July 9, 2014. These are grants to applicants who have set forth compelling new ideas to improve care and control costs for persons enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). [More]

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Kaiser Commission Releases Report on Successful SBEs

 

The Kaiser Commission on Medicaid and the Uninsured released an excellent report on July 20, 2014 about the successful state-based health insurance Exchanges (SBEs) and Medicaid expansions in Colorado, Connecticut, Kentucky, and the State of Washington. The report, “What Worked and What’s Next? Strategies in Four States Leading ACA Enrollment Efforts,” includes interviews with stakeholders in each state about exemplary marketing, outreach and enrollment, consumer assistance, and systems/operations strategies, with insights on 2014 and lessons for 2015. It shows that each of the states marketed the coverage expansions as state-based initiatives; conducted statewide marketing via a wide range of methods, including social media and promotional materials; and emphasized the enrollment deadline in their marketing efforts. [More]