CMMI Announces $666 Million in State Health Care Innovation Awards

 

The U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (CMMI) announced on December 16, 2014 that it is authorizing $623 million in “model testing” awards to 11 states and $43 million in “model design” awards to 17 states, three territories, and the District of Columbia. CMMI has approved the awards under section 3021 of the Affordable Care Act (ACA). These “model testing” and “model design” awards complete “round two” in CMMI’s State Innovation Models (SIM) initiative. [More]

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CMS Issues Final Rule Re: Hospital-Specific Limitation

 

In the December 3, 2014 Federal Register (79 Fed. Reg. 71679), the Centers for Medicare & Medicaid Services (CMS) issued a final rule authorizing a service-specific basis for defining the uninsured, for the purpose of determining the hospital-specific limitation on disproportionate share hospital (DSH) payments. Under section 1923(g) of the Social Security Act, DSH payments to hospitals are limited to the uncompensated costs of providing hospital services to individuals who are Medicaid eligible or have no health insurance (or other source of third party coverage) for the services furnished during the year. [More]

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CMS Proposes Changes in Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the December 8, 2014 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Under the MSSP, Medicare providers and suppliers that participate in a qualifying ACO receive traditional Medicare Part A and Part B fee-for-service payments, the ACO drives collaboration, and the ACO has an opportunity to earn “shared savings” bonus payments for each ACO “performance period” if it achieves MSSP savings targets and performance standards under quality measures for that period. [More]

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New Child Welfare White Paper by Judge James Payne Now Available

 

The latest in our whitepaper series by PCG Human Services’ Judge James Payne, “Beyond Quick Fixes: What Will It Really Take to Improve Child Welfare in America?” is now available. Click here to view paper No. 4 in the series: “Agency Priorities – Keep Focused and Don’t Get Lost in the Chaos!” [More]

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D.C. Circuit Decides Not to Proceed with En Banc Review of ACA Subsidies Case Pending U.S. Supreme Court Decision in KING V. BURWELL

 

On November 10, 2014, the D.C Circuit Court of Appeals agreed not to proceed with its en banc review of HALBIG v. BURWELL, 758 F.3d 390 (D.C. Cir. 2014), which had held that subsidies provided for under the Affordable Care Act (ACA) were to be restricted to states which opted to establish their own Health Benefit Exchanges. [More]

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Kaiser Reports on 2015 QHP Premium Changes

 

The Henry J. Kaiser Family Foundation (Kaiser) released on November 17, 2014 a report on changes in premiums for qualified health plans (QHPs) offered through Health Benefit Exchanges (Exchanges) in all 50 states and the District of Columbia. The report shows modest increases in 2015 premiums, as compared with 2014, on average for all QHPs across all geographic rating areas in the United States. Premiums for “silver” level coverage (medium cost-sharing, medium premiums) will increase about two percent on average, while premiums for “bronze” level coverage (higher cost-sharing, lower premiums) will increase about four percent on average. [More]

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GAO Issues Report on Transparency of CMS Websites for Consumers

 

The U.S. Government Accountability Office (GAO) released a report on November 18, 2014 entitled, “Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers.” GAO found that five Centers for Medicare and Medicaid Services (CMS) websites launched over 12 years – Nursing Home Compare (1998), Dialysis Compare (2001), Home Health Compare (2005), Hospital Compare (2005), and Physician Compare (2010) – do not use language consumers understand, do not present data in ways meaningful to consumers, and do not help consumers collect information they need to make informed, value-based decisions about their care. While the CMS websites can motivate providers to improve quality of care, research shows that providers and consumers look at data differently. [More]

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HHS OIG Releases Work Plan for Federal Fiscal Year 2015

 

As the new Federal Fiscal Year began on October 1, 2014, a work plan was released that outlines the engagements planned throughout the year. The Office of Inspector General (OIG) was created was created “to protect the integrity of US Department of Health and Human Services (HHS) programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal health care laws.” [More]

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HHS Revises Exchange Enrollment Projections for Upcoming Enrollment Period

 

The U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) released an analysis on November 10, 2014 projecting that 9.0 – 9.9 million persons will have coverage through Exchanges by the end of the upcoming November 15, 2014 – February 15, 2015 open enrollment period. The Congressional Budget Office (CBO) had estimated in April 2014 that the number of persons covered through Exchanges would reach 13 million persons in 2015, 24 million persons in 2016, and a plateau of 25 million persons by 2017. [More]

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US Supreme Court to Review ACA Tax Credit Authority

 

The U.S. Supreme Court announced on November 7, 2014 that it will review King v. Burwell, in which the U.S. Court of Appeals for the Fourth Circuit upheld an Internal Revenue Service regulation allowing advance premium tax credits (APTCs) for low-income individuals and families enrolling in qualified health plans (QHPs) through “Federally-facilitated Exchanges (FFEs).” [More]

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