U.S. Supreme Court upholds Affordable Care Act in KING v. BURWELL by 6 to 3 vote

 

On Thursday, June 25, 2015, the U. S. Supreme Court by a 6 to 3 vote upheld the federal government’s interpretation (i.e., the regulation of the Internal Revenue Service) of the Affordable Care Act (ACA) that the subsidies awarded under provisions of the ACA could be provided regardless of whether the states granting the subsidies had a state health benefits exchange or a federal exchange operating therein. [More]

 

CMS has paid out about $1.3 billion to settle Medicare appeals claims

 

On June 11, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that the agency has settled Medicare appeals claims with more than 1900 hospitals. CMS paid out approximately $1.3 billion pursuant to a settlement policy announced in August 2014 to help reduce a backlog of patient status claim denials pending in the appeals process. [More]

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HHS approves three additional state-based Exchanges

 

The U.S. Department of Health and Human Services (HHS) notified the Governors of Arkansas, Delaware, and Pennsylvania on June 15, 2015 that HHS has conditionally approved the establishment of state-based health insurance exchanges (Exchanges) by those states. The conditional approvals for Delaware and Pennsylvania are for state-based individual and small business Exchanges in 2016. The conditional approval for Arkansas is for a state-based small business Exchange in 2016 and an individual Exchange in 2017. [More]

 

Florida legislature reaches agreement on hospital funding for one year

 

Florida legislators agreed to end a conflict about funding for hospitals for one year by increasing Medicaid reimbursement rates for hospitals. The Low Income Pool program (LIP) funded by a section 1115 project was scheduled to end June 30, but the Center for Medicare and Medicaid Services (CMS) did agree to continue the program at a reduced funding level from $2.2 billion to $1 billion for one year and $600 million thereafter. [More]

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CMS Finalizes New Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the June 9, 2015 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Medicare providers and suppliers that participate in a qualifying ACO under the MSSP receive traditional Medicare Part A and Part B fee-for-service payments but the ACO has an opportunity to earn “shared savings” bonus payments if it achieves MSSP savings targets and quality benchmarks. [More]

 

White House Releases Report on Benefits of Medicaid Expansion

 

The White House has released a report entitled, “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.” The report estimates that if the 22 states that have not yet expanded Medicaid chose to do so, some 4,299,000 persons in those states would gain coverage; 1,021,000 more persons would report a usual source of care; 491,000 more persons would receive all needed care; hundreds of thousands more persons would receive recommended preventive screenings (626,400 more persons would receive cholesterol screenings, 163,400 more women would receive mammograms, etc.); [More]

 

U.S. Supreme Court rejects Maine’s attempt to end Medicaid coverage for young adults

 

On Monday, June 8, 2015, the U.S. Supreme Court refused to review a decision by the First Circuit Court of Appeals, which upheld a decision by the Centers for Medicare & Medicaid Services (CMS) rejecting a plan by Mary Mayhew, Maine’s top health official, to cease Medicaid coverage for 6000 19- and 20-year-olds. [More]

 

Policy and Practice article examines turnover and training in the human services field

 

Boston, MA, June, 2015 – PCG Human Services employment and public assistance program expert Brian Howells co-authored an article regarding the 21st Century needs of the human services workforce in the April, 2015 edition of Policy and Practice Magazine, a publication of the American Public Human Services Association. The article examines the issues of turnover and training in the human services field. Read the article here. [More]

 

Hearing Held in Lawsuit by House Against Federal Government’s Implementation of ACA

 

On Thursday, May 28, 2015, a hearing was held in Federal District Court in Washington, D.C. to determine whether the U.S. House of Representatives has legal standing to sue the federal government with respect to its implementation of the Affordable Care Act (ACA). Media reports indicate that U.S. District Court Judge Rosemary M. Collyer was “skeptical” of the government’s position and seemed unlikely to dismiss the case, House of Representatives v. Burwell. [More]

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HHS Proposes New Medicaid/CHIP Quality Improvement Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued proposed rules on May 26, 2015 which would require state Medicaid agencies to draft and implement comprehensive strategies for assessing and improving quality of care for Medicaid beneficiaries. [More]