HHS Proposes New Rules on Medicare Nursing Facility Quality and Reimbursement

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the Federal Register on April 20, 2015 to update its Medicare skilled nursing facility prospective payment system (SNF PPS) and quality reporting program (SNF QRP). The proposed rules would offer, on average, a 1.4 percent increase in SNF PPS rates for Federal fiscal year 2016 (October 1, 2015 - September 30, 2016), a $500 million aggregate increase in Medicare payments as compared to FFY 2015. [More]

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Categories:Health and Human Services

 

HHS Releases Funding Opportunity Announcement for Navigator Grants

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued a funding opportunity announcement (FOA) on April 15, 2015 related to grants to support health insurance eligibility and enrollment “navigators” in Federally-facilitated and State Partnership Marketplaces/Exchanges under the Affordable Care Act (ACA). [More]

 

HHS Proposes New Rules for Eligibility IT Systems

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the Federal Register on April 16, 2015 which would authorize 90 percent Medicaid federal financial participation (FFP) for the design, development, installation or enhancement of Medicaid eligibility and enrollment (E&E) systems; and 75 percent Medicaid FFP for the maintenance and operation (M&O) of such systems. The proposed rules would also update requirements for federal prior approval of State Medicaid agencies’ Advance Planning Documents (APDs) for system enhancements, contract solicitation, and contract execution. [More]

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Categories:Health and Human Services

 

U.S Supreme Court Issues Ruling That Providers Cannot Sue States for Higher Medicaid Rates

 

On March 31, 2015, the U.S. Supreme Court ruled, 5 to 4, “that neither the Constitution nor federal law authorizes doctors and other health care providers to go to court to enforce the law’s directive that the reimbursement rates set by states be ‘sufficient to enlist enough providers so that care and services are available’ to Medicaid recipients just as they are to the general population.” [More]

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Categories:Health and Human Services

 

HHS Proposes New Mental Health Parity Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued proposed rules on April 7, 2015 on mental health/substance abuse treatment coverage requirements applicable to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP). [More]

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Categories:Health and Human Services

 

HHS Proposes New Rules on Incentive Payments for Electronic Health Records

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), issued proposed rules on March 20, 2015 on “stage 3” criteria that eligible professionals, general hospitals, and critical access hospitals must meet in 2018 to qualify for Medicare and Medicaid incentive payments for the adoption and meaningful use of electronic health record (EHR) systems. “Stage 3” will be the final, highest stage in these incentive payment programs, and it will be the only stage for which incentive payments will be available for 2018-2021. [More]

 

HHS Launches New ACO Model

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), announced on March 10, 2015 that accountable care organizations (ACOs) soon will have an opportunity to participate in Medicare under the “Next Generation ACO” model, another important step under section 3021 of the Affordable Care Act (ACA) toward paying for services based on value to patients rather than volume of services. [More]

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Categories:Health and Human Services

 

Office of Inspector General Audit Reveals Children in Foster Care Lack Required Health Screenings

 

On March 2, the Office of Inspector General (OIG) released an audit indicating that a significant number of foster children do not receive required health screenings. The audit included a sample of 100 children from each of the four large states (California, Illinois, New York, and Texas) selected for a period between July 1, 2011 and June 20, 2012. The review also considered how the Administration for Children and Families (ACF) ensures that children in foster care receive required screenings. [More]

 

HHS Report Updates ACA Impact on Medicaid/CHIP Enrollments

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), released on February 23, 2015 a report showing that 27 jurisdictions (26 states and the District of Columbia) which implemented Medicaid expansion under the Affordable Care Act (ACA) by December 2014 saw on average a 27.01 percent increase in Medicaid/CHIP enrollments for December 2014, as compared to their average monthly enrollments in a July – September 2013 baseline period. [More]

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AL Medicaid Agency Awards TC Significant Contract Amendment

 

The State of Alabama is leveraging both the Affordable Care Act (ACA) regulations and the A-87 exception to create a single centralized eligibility system to replace multiple antiquated less functional systems. This approach will lower costs to both the state and its federal partners while improving the experience for users as well as creating a more flexible, easily configurable system. This expanded effort for the AL eligibility system will impact 12 legacy systems. [More]

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