Innovative approaches to Medicaid expansion within the Medicaid managed care delivery system

 

Much attention has been paid to innovative approaches to coverage of the Medicaid expansion population that leverage the private commercial insurance market for coverage through “premium assistance” programs. However, other states have turned to the Medicaid managed care delivery system as the vehicle for implementing innovative coverage designs for the newly eligible population. As outlined below, these states have received 1115 Medicaid Demonstration waivers to gain flexibility in the coverage offered to this population via managed care plans. [More]

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Categories:Health and Human Services

 

CMS announces the release of $22 Million in Health Insurance Enforcement and Consumer Protections grant funding

 

On June 15, 2016, the Centers for Medicare and Medicaid (CMS) announced the release of $22 million in grant funding for State planning and implementing of the health insurance market reform provisions of the Affordable Care Act (ACA). The grants are aimed at helping States ensure their laws, regulations and procedures are in line with Federal requirements and that the States are able to effectively monitor and enforce health insurance market reforms and consumer protections under the ACA. States must submit a letter of intent by July 6th. Grant applications are due August 15th at 3:00 pm. [More]

 

U.S. Supreme Court expands use of implied certification theory in False Claims actions

 

On June 16, 2016, the U.S. Supreme Court in a unanimous decision somewhat expanded the use of an “implied certification theory” in actions brought under the False Claims Act (FCA) in the case of United Health Services, Inc. v United States et al. Ex Rel. Escobar et al. [More]

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Categories:Health and Human Services

 

U.S. Supreme Court expands use of “implied certification theory” in False Claims actions

 

On June 16, 2016, the U.S. Supreme Court in a unanimous decision somewhat expanded the use of an “implied certification theory” in actions brought under the False Claims Act (FCA) in the case of United Health Services, Inc. v United States et al. Ex Rel. Escobar et al. [More]

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Categories:Health and Human Services

 

CMS awards grants to promote children’s enrollment in Medicaid and CHIP

 

On June 13, 2016, the Centers for Medicare and Medicaid Services (CMS) announced $32 million in grant awards supporting innovative strategies to enroll and retain children in Medicaid and the Children’s Health Insurance Program (CHIP). Innovation awardees include 38 state, local, and provider-based organizations in 27 states, such as the Los Angeles Unified School District (involving multi-lingual outreach information at over 800 district sites), the Bexar County Hospital District in Texas, and the Refuah Health Center, Inc. in New York State. [More]

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CMS announces steps to protect ACA risk pools

 

On June 8, 2016, the Centers for Medicare and Medicaid Services (CMS) announced new steps to protect the integrity of health insurance “risk pools.” The integrity of those pools directly affects the accuracy and stability of health insurance premiums under the Affordable Care Act (ACA). CMS has outlined new steps pertaining to: controlling the abuse of “short-term” health plans, improving the accuracy of risk adjustments, reducing abuse of Exchanges’ special enrollment periods, improving Exchanges’ data matches, and transitioning consumers to Medicare as they approach age 65. [More]

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CMS finalizes changes to Medicare ACO rules

 

On June 6, 2016, the Centers for Medicare and Medicaid Services (CMS) issued final regulations on payment methods for accountable care organizations (ACOs) under the Medicare “shared savings” program (MSSP), which includes 434 ACOs serving 7.7 million Medicare beneficiaries in 49 states and the District of Columbia. Medicare Part A and Part B fiscal intermediaries and carriers pay ACOs on a fee-for-service (FFS) basis under the MSSP, but an ACO may qualify for a “shared savings” bonus if the ACO achieves CMS-specified Medicare savings targets while meeting CMS-specified quality of care performance metrics. Medicare ACOs achieved $411 million in Medicare savings in 2014; savings calculations for 2015 will be released this summer. [More]

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Categories:Health and Human Services

 

Lawsuits filed by health insurers over shortfalls in risk corridor payments under the ACA

 

On June 1, 2016, MODA Health Plan, Inc., one of the largest health insurers in the Pacific Northwest, filed a claim in the U.S. Court of Federal Claims, alleging that the Plan was entitled to risk corridor payments from the Federal Government of more than $89 million in 2014 and $102 million in 2015. [More]

 

Louisiana implements Medicaid expansion

 

On June 1, 2016, Louisiana became the 31st state to implement Medicaid expansion under the Affordable Care Act (ACA). Louisiana has obtained federal approval to use pre-existing data from its Supplemental Nutrition Assistance Program (SNAP) to adjudicate Medicaid eligibility in real time, both at initial Medicaid enrollment and upon re-enrollment; it is the first State to have won such approval via a Medicaid plan amendment rather than time-limited federal waivers. [More]

 

Examining the final Medicaid and CHIP managed care rules: summary and webinar

 

Members of PCG's Health Innovation Policy Information Technology ("HIPIT") team have released a summary of the final Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Rules promulgated by the Centers for Medicaid and Medicare Services (CMS) at the end of April. [More]