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]

U.S. District Court in Connecticut certifies nationwide class of Medicare beneficiaries in challenge to “observation status”

On July 31, 2017, the U.S. District Court for the District of Connecticut certified a nationwide class of Medicare beneficiaries who desire to challenge their placement on “observation status” during their hospital stays. Alexander v. Price, No. 3:11-cv-1703 (D. Conn. July 31,2017).

The plaintiffs in this long-running action argue that the decision to categorize Medicare beneficiaries as outpatients on observation status rather than inpatients should be subject to administrative review. Currently, Medicare does not allow beneficiaries to appeal this determination. [More]

Developments in Section 1332 State Innovation Waivers

Halfway through the first year that states are eligible to implement Section 1332 Waivers, and with states seeking to stabilize their markets in the face of uncertainty at the Federal level, the pace is picking up on Section 1332 Waivers. In recent weeks, there have been two major developments on this front with the Federal government approving Alaska’s waiver request and Iowa submitting an unprecedented emergency and abbreviated Section 1332 Waiver request. More details on both of those developments are below. Additionally, the Federal agencies made a preliminary determination on June 20th that Minnesota’s Section 1332 Waiver application is complete starting the clock on review and approval. [More]

The latest news from D.C.

Following the failure in the Senate to pass various legislative proposals – the Better Care Reconciliation Act (the Senate version of repeal and replace), the straight repeal option, or the “skinny repeal” bill – last week, Senate leadership has continued to say that they are moving on to other agenda items for now. However, there still seem to be daily updates from D.C. Several new proposals have come to the forefront in the past week. Senators Cassidy and Graham have proposed block granting Affordable Care Act (ACA) funding (including related to premium tax credits and cost-sharing reductions) to the states, providing them with the [More]

White House issues report on the opioid epidemic

On July 31, 2017, the White House posted the initial findings and recommendations of its Commission on Combatting Drug Abuse and the Opioid Crisis.
The Commission cites evidence that:
• 142 Americans die from drug overdoses per day.
• Only 10 percent of the 21 million persons with a substance use disorder (SUD) are receiving appropriate treatment for it.
• Over 40 percent of persons with an SUD also have a mental health disorder but less than half of them are receiving appropriate treatment for either disorder.
• About 80 percent of new heroin users begin with prescription opioids. [More]

Putting State Innovation Model (SIM) dollars to work

The SIM initiative seeks to advance and accelerate state delivery system and payment reform efforts. Under Section 3021 of the Affordable Care Act (ACA), SIM grants may be awarded to states and territories that demonstrate a comprehensive plan that transforms the delivery system, aligning with the “triple aim” objectives of reducing costs, improving quality, and population health.
To date the Centers for Medicare and Medicaid Innovation (CMMI) has issued a total of 38 SIM awards to 34 states, three territories, and the District of Columbia, for model design and testing. The initiatives underway in SIM grant models touch 61% of the population.
These awards are broken into: [More]

Data Analytics and the Fight Against Opioid Abuse

The opioid epidemic in this country has gained a lot of attention in recent months. Its deadly effects are making their way into almost every news cycle across the country. A recent report by the Center for Disease Control and Prevention (CDC) contains some very staggering statistics, and an on-going pattern in the rise of American deaths related to prescription opioids. The report cites over 183,000 deaths attributable to prescription opioid overdoses since 1999. The number of which has quadrupled in that 16-year timeframe. [More]

National Academy of Medicine outlines strategies for high-need patients

On July 6, 2017, the National Academy of Medicine released a valuable report entitled, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health.” The report describes key characteristics of high-need patient populations, tools that can be adopted to identify evidence-based models of care for them, and strategies to promote successful implementation of such models in collaboration with a broad range of stakeholders at the federal, state, and community level. It stresses the importance of behavioral health issues, social determinants of health, and community-based supports for high-need patients who often struggle at home with functional limitations associated with aging, disabilities, and a wide range of long-term diseases examined in the report. [More]

Update on the Senate’s efforts to Repeal parts of the ACA

After releasing the Better Care Reconciliation Act at the end of last week, leadership in the U.S. Senate announced this week that it will not be voting on the bill before the July 4th Congressional recess as planned. Instead efforts are underway to overhaul the bill, with a vote is expected sometime after the recess. Senate Majority Leader Mitch McConnell has said that he intends to submit a new version of the bill to be scored by the Congressional Budget Office today. [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]