HHS finalizes ACA non-discrimination rules


On May 18, 2016, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), finalized rules in the Federal Register on non-discrimination under federally-funded health care programs and activities. The final rules implement section 1557 of the Affordable Care Act (ACA), which broadly prohibits discrimination based on race, color, national origin, sex, age, or disability, in order to advance health care equity and reduce health care disparities. The final rules reflect OCR’s evaluation of 24,875 public comments on proposed rules that were published on September 8, 2015. [More]


PCG provides program validation for innovative pay-for-success program aimed at reducing recidivism


In 2012, the Commonwealth of Massachusetts launched a pay-for-success program aimed at reducing recidivism among juvenile and adult offenders while improving the lives of hundreds of high-risk young men, saving taxpayer dollars, and strengthening communities. Referred to as the Massachusetts Juvenile Justice Pay for Success Project, this program was the third large-scale implementation of a pay-for-success model according to a Harvard Business School (HBS) case study entitled, “Massachusetts Pay for Success Contracts: Reducing Juvenile and Young Adult Recidivism.” [More]


Supreme Court returns ACA contraceptive cases to lower courts in hope of compromise resolution


In an opinion issued on May 16, 2016, the U.S. Supreme Court remanded to the lower courts challenges by a number of nonprofit religious organizations to the contraceptive coverage requirement contained in the Affordable Care Act (ACA). Without expressing any “view on the merits of the case,” the Supreme Court vacated and sent back the cases to the Courts of Appeal indicating the possibility of the parties reaching a compromise, based upon supplemental briefs that were ordered to be submitted. The action was viewed as an attempt to avoid a 4-4 split decision by the Supreme Court, which would result in different outcomes in different states. [More]


Examining the final Medicaid and CHIP managed care rules: summary and webinar


Members of PCG's Health Innovation Policy Information Technology ("HIPIT") team have released a summary of the final Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Rules promulgated by the Centers for Medicaid and Medicare Services (CMS) at the end of April. [More]


SME moderates important child welfare panel


On May 17, American Enterprise Institute (AEI) hosted a conference, “Preventing harm to children through predictive analytics,” focused on examining predictive analytics in child welfare. PCG Subject Matter Expert (SME) Judge James Payne (Human Services – Indianapolis) moderated the first of two panels during AEI’s conference. [More]


U.S. District Court Judge rules in favor of the House against Administration’s funding of subsidies under the ACA


On May 12, 2016, Federal District Court Judge Rosemary M. Collyer of the District of Columbia District ruled in favor of the House of Representatives in its challenge against the Obama administration’s funding of subsidies under the Affordable Care Act (ACA). Judge Collyer ruled that Congress had not provided specific authority for the U.S. Department of Health and Human Services (HHS) to fund the subsidies provided under section 1402 of the ACA, which are intended to assist low-income individuals to pay for insurance premiums for coverage acquired under the exchanges. [More]


CMS extends Texas’ 1115 Medicaid waiver program for 15 months


The Center for Medicare and Medicaid Services (CMS) has agreed to grant the Texas Health and Human Services Commission (HHSC) a 15 month extension through December 2017 of its section 1115 Medicaid waiver program. The waiver relates to the state’s Uncompensated Care and Delivery System Reform Incentive Program (DSRP) and will continue existing program funding levels. [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]


CMS outlines transition to new Medicare payment system for clinical practitioners


On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) issued proposed rules to implement the Merit-Based Incentive Payment System (MIPS) authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals Medicare’s sustainable growth rate (SGR) formula, replaces three prior Medicare incentive programs, and outlines steps toward new performance incentives and penalties in 2019 and beyond for physicians and other clinical practitioners. [More]

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Categories:Health and Human Services


CMS outlines steps toward VBP for nursing facilities


On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) published proposed rules in the Federal Register on Medicare reimbursement for skilled nursing facilities. The proposed rules address inflation and productivity adjustments for these facilities under the current Medicare prospective payment system (PPS), quality of care reporting requirements, and a step-by-step transition to a new, value-based purchasing (VBP) system offering incentives to improve quality of care. For the fiscal year beginning October 1, 2016, aggregate Medicare payments to these facilities will increase $800 million as compared to the prior year, about 2.1 percent overall, based mainly on 2.6 percent inflation adjustments partially offset by -0.5 percent productivity adjustments. Nursing facilities that don’t meet CMS quality of care reporting requirements will subsequently face -2.0 percent offsets in annual PPS updates per the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT). [More]