NGA calls for Congressional action on CHIP renewal

On May 11, 2017, the National Governors Association (NGA) released a letter to the Senate Finance Committee and the House Committee on Energy and Commerce calling for Congressional action to renew funding for the Children’s Health Insurance Program (CHIP) for five more years. The letter is signed by Virginia Governor Terry McAuliffe, NGA Chair, and Massachusetts Governor Charlie Baker, NGA Vice-Chair for Health and Human Services. [More]

CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [More]

CMS expands authorized use of Medicare data

On July 1, 2016, the Centers for Medicare and Medicaid Services (CMS) issued final rules which expand authorized uses of Medicare claims data in order to improve health care quality and to control costs. The new rules allow CMS-approved “qualified entities” (QEs) to purchase Medicare claims data from CMS, to combine Medicare data with data from other payers, and to use such combined data to prepare multi-payer data analyses that QEs can provide or sell to authorized users. [More]

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]

Final Medicaid managed care rules issued

Nearly a year after releasing its proposed overhaul of the regulations governing Medicaid and Children’s Health Insurance Program (CHIP) managed care, the Centers for Medicaid and Medicare Services (CMS) issued the final version of the regulations last week. In addition to their sweeping impact, these rules are particularly meaningful as the first major changes to the Medicaid and CHIP managed care rules since 2002. [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 finalizes mental health parity rules

On March 30, 2016, the Centers for Medicare and Medicaid Services (CMS) published final rules on mental health/substance use disorder parity requirements applicable to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP). The final Medicaid/CHIP rules are based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which generally prohibits more restrictive cost-sharing (e.g., co-payments and deductibles), quantitative limitations (e.g., visit limits), and non-quantitative limitations in mental health/substance use disorder benefits under a health plan than in medical/surgical coverage under the same plan. [More]

CMS and AHIP announce alignment in physician quality measures

On February 16, 2016, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) announced multi-payer alignment and simplification of core quality measures to be used in calculating quality-based payments for seven physicians’ services specialties. Multi-payer alignment is expected to reduce the reporting burden for providers and to accelerate the nationwide shift to value-based payment. [More]

CMS and ONC update health IT goals

On January 19, 2016, the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released a joint statement which defines guiding principles on promoting “meaningful use” of electronic health records (EHRs) for purposes of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). [More]