CMS proposes reductions in Medicaid allotments to states for hospitals’ uncompensated care

On July 28, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement $43 billion in reductions in federal Medicaid allotments to state Medicaid agencies for payment adjustments to hospitals serving a disproportionate share of low-income persons. The reductions in such allotments under the proposed rule will apply to federal fiscal years 2018-2025. Reductions nationwide will start at $2 billion in FY 2018 and will reach $8 billion per year in FY 2024 and FY 2025. [More]

Centers for Medicare and Medicaid Services Awards PCG Quality Improvement Organization-like Certification

Boston, MA, June 16, 2017 – Public Consulting Group (PCG) is pleased to announce its certification as a Quality Improvement Organization-like (QIO-like) entity by the Centers for Medicare and Medicaid Services (CMS). Already a champion of improvement to the nation’s healthcare system, this new certification will further enable PCG to work to enhance the quality and cost efficiency of care for Medicare and Medicaid beneficiaries. [More]

Section 1332 State Innovation Waiver – Recent developments and the newly-released checklist

In follow-up to its letter to Governors regarding the Section 1332 Waiver opportunity, the Centers for Medicare and Medicaid Services (CMS) and the Department of Treasury released a Section 1332 checklist on May 16 designed to help states pursue ACA State Innovation Waivers. Section 1332 of the ACA allows states to waive specific ACA provisions as long as they apply according to the process set out in regulations and meet the following comparability requirements:

• The waiver will provide coverage to at least a comparable number of the state’s residents as would be provided without the waiver;
• The waiver will provide coverage and cost-sharing protections that are at least as affordable as would be provided without the waiver;
• The waiver will provide for coverage that is at least as comprehensive as would be provided without the waiver; and
• The waiver will not increase the federal deficit. [More]

What you need to know about modularity

If you work in state Medicaid or health information technology (HIT), chances are you have seen the term modularity discussed with increasing frequency lately. Countless articles have been written about it, and it has been a focus at some of the largest Medicaid and HIT conferences over the past year including MESC, HIMSS, and the Health IT Connect Summit. For all of the coverage it has gotten, defining what modularity truly means has been an ongoing debate among states, the Centers for Medicare and Medicaid Services (CMS), and the vendor community. [More]

Transitional health plans to continue through 2018

In November of 2013, the Centers for Medicare & Medicaid Services (CMS) introduced the concept of “grandmothered plans,” coverage in place prior to 2014 that would have been prohibited as of 2014 as a result of changes under the Affordable Care Act (ACA). CMS issued guidance permitting those plans to be renewed for existing policyholders if permitted by states. Specifically, such plans are not considered to be out of compliance with ACA provisions related to... [More]

Proposed ACA repeal legislation would impose new restrictions on state Medicaid programs

On March 6, 2017, the U.S. House of Representatives released its initial draft legislation to “repeal and replace” the Affordable Care Act (ACA). The initial draft legislation would impose significant new restrictions on state Medicaid programs. The legislation would impose annual per capita caps on federal financial participation (FFP) in state Medicaid expenditures beginning with the federal fiscal year (FFY) 2020 (October 1, 2019 – September 30, 2020). The Centers for Medicare and Medicaid Services (CMS) would impose separate per capita caps for six Medicaid eligibility categories: the aged, blind, disabled, children, Medicaid expansion adults, and non-expansion adults.
For FFY 2020, CMS would... [More]

CMS proposes rules to stabilize health insurance markets

On February 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued draft proposed regulations intended to stabilize the individual and small group health insurance markets under the Affordable Care Act (ACA). The proposed rules would shorten the open enrollment period for 2018, amend standards on special enrollment periods, increase pre-enrollment verification of eligibility on the HealthCare.gov website, allow health insurance issuers to apply consumers’ payments to past unpaid debts for coverage, increase allowable variations in the actuarial value (AV) calculations, offer more flexibility in substantiating provider network adequacy, and facilitate insurers’ compliance with essential community provider (ECP) standards. [More]

GAO releases report on CMS oversight of Medicaid expenditures

On February 6, 2017, the U.S. Government Accountability Office (GAO) issued a report on the Medicaid program entitled, “Program Oversight Hampered by Data Challenges, Underscoring the Need for Continued Improvement.” Six members of the U.S. Senate and the House of Representatives asked GAO to examine Medicaid data challenges based on estimates that there were about $36.3 billion in improper Medicaid payments in Federal fiscal year 2016. [More]