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]


CMS extends Texas’ 1115 Medicaid waiver program for 15 months


The Center for Medicare and Medicaid Services (CMS) has agreed to grant the Texas Health and Human Services Commission (HHSC) a 15 month extension through December 2017 of its section 1115 Medicaid waiver program. The waiver relates to the state’s Uncompensated Care and Delivery System Reform Incentive Program (DSRP) and will continue existing program funding levels. [More]


CMS outlines transition to new Medicare payment system for clinical practitioners


On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) issued proposed rules to implement the Merit-Based Incentive Payment System (MIPS) authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals Medicare’s sustainable growth rate (SGR) formula, replaces three prior Medicare incentive programs, and outlines steps toward new performance incentives and penalties in 2019 and beyond for physicians and other clinical practitioners. [More]

Tags: , , , , , , , , , , ,

Categories:Health and Human Services


CMS announces extension of SHOP direct enrollment transition


On April 18, 2016, CMS released guidance entitled “Extension of state-based SHOP Direct Enrollment Transition,” which extends the option of direct enrollment until the end of 2018 giving state based SHOPs more time to make online enrollment available. In order to allow facilitation of enrollment without SHOP portal functionality, CMS has allowed states to direct enroll employers and their employees, while also extending the small business tax credits to those eligible small employers offering coverage on a state-based SHOP utilizing direct enrollment. This most recent guidance includes three options for states regarding enrolling SHOP eligible employers in 2019. States should begin planning now, because significant time is needed to not only give CMS notice but also to implement the option of choice. [More]


Final Medicaid Managed Care Rules


CMS released a proposed overhaul of the regulations governing Medicaid and CHIP Managed Care last May and accepted comments through July. In addition to their sweeping impact, these rules are particularly meaningful as they are the first major changes to the rules governing Medicaid Managed Care since 2002. As states agencies and others review the final regulations, we are sharing a summary of the proposed regulations that we first released last summer. The proposed regulations seek to modernize the rules in light of the expanded use and scope of managed care in Medicaid programs across the country. [More]


CMS announces CPC+ primary care model


On April 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the Comprehensive Primary Care Plus (CPC+) model. The CPC+ model, which builds on the CPC model launched in October 2012, is designed to align Medicare, state Medicaid agencies, and commercial insurance payers to achieve comprehensive, coordinated primary care, especially for patients with complex medical and behavioral health needs. [More]


HHS issues report on behavioral health benefits of Medicaid expansion


On March 28, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) issued a report entitled, “Benefits of Medicaid Expansion for Behavioral Health.” The report estimates that about 1.9 million low-income uninsured persons with mental illness or substance use disorders live in states that have not yet expanded Medicaid under the Affordable Care Act (ACA). [More]

Tags: , , , , , , , ,

Categories:Health and Human Services


Behavioral Health’s Move Toward Value-Based Purchasing


“Alternative payment models are not an option for behavioral health providers,” Arizona Medicaid Director Tom Betlach said, “They are your growth strategy.” Betlach’s point was very clear and it resonated with the more than 5,500 attendees at NatCon, where Payment Reform – be it alternative payment methodologies (APMs) or value-based purchasing (VBP) models like Delivery System Reform Incentive Payment (DSRIP) initiatives – was a key theme. In line with this, New York State’s DSRIP efforts were highlighted repeatedly throughout the conference. (PCG has played an instrumental role in spearheading New York’s initiative). Government agencies have become “first movers” towards VBP, stressing the importance of “whole person care,” not just “sick care.” [More]

Tags: , , , , , , , ,

Categories:Health and Human Services


CCBHC Is The Start of Something Good!


CCBHCs! That’s Certified Community Behavioral Health Centers, for those not familiar with the billion dollar investment that the Substance Abuse and Mental Health Services Administration (SAMHSA) will soon make to state behavioral health systems. In 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. [More]


CMS Issues Final Guidance for QHPs


States have been awaiting the final guidance regarding 2017 certification standards for Qualified Health Plans (QHPs) since the Centers for Medicare and Medicaid Services (CMS) issued its proposals at the end of last year. [More]

Tags: , , , , , , ,

Categories:Health and Human Services