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]

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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]

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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]

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HHS releases report on growth in national health care spending


On March 22, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) released a report showing that overall health care spending per person in the United States grew at a 4.3 percent rate in 2014. HHS indicates that the increase was largely the result of coverage expansions under the Affordable Care Act (ACA) and pent-up needs for care among previously uninsured and underinsured persons. [More]

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HHS finalizes ACA benefit and payment parameters for 2017


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) finalized its “Notice of Benefit and Payment Parameters” for 2017 in the March 8, 2016 Federal Register. As in prior years, this annual rules notice adjusts a wide range of policy, operational, and information technology requirements applicable to health insurance coverage obtained through Exchanges under the Affordable Care Act (ACA). [More]


CMS expands funding for health information technology


On February 29, 2016, the Centers for Medicare and Medicaid Services (CMS) released a bulletin expanding the availability of 90 percent Federal financial participation (FFP) on state Medicaid administrative expenditures to promote the adoption and meaningful use of electronic health records (EHRs). With this funding increase, CMS seeks to address the need for improved patient care coordination and care transitions across a wide range of services (e.g., acute, chronic, behavioral health, long term care, etc.), using system-wide health information exchange (HIE) technology solutions. [More]