HHS issues 2016 Exchange enrollment data


On November 12, 2015, the U.S. Department of Health and Human Services (HHS) issued data on the first week of the 2016 open enrollment period (November 1, 2015 – November 7, 2015) for qualified health plans (QHPs) under the Affordable Care Act (ACA). This initial “snapshot” shows that 3,180,777 persons visited the Healthcare.gov website, 1,153,270 persons completed their eligibility applications, and 543,098 eligible persons selected a QHP in the first week. [More]


New York designs capitated Medicare/Medicaid plan for persons with developmental disabilities


The New York State Department of Health (DOH), the New York State Office for People with Developmental Disabilities (OPWDD), and the Centers for Medicare and Medicaid Services (CMS) formally agreed on November 5, 2015 to implement an innovative demonstration project integrating Medicare and Medicaid services for adults with intellectual and developmental disabilities. Service integration will be achieved through a capitated managed care organization (MCO). [More]


GAO releases report on efforts to keep children in family-based care


On November 9, 2015, the Government Accountability Office (GAO) released an in-depth report addressing the use of congregate care for children in the foster care system. Defined differently in most states, congregate care, in its simplest form (when referring to the foster care system), is care that is not family-based (e.g. group homes, residential treatment facilities, etc.). [More]


California wins preliminary approval of Medi-Cal 2020


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) released a letter to the California Department of Health Care Services (DHCS) on October 31, 2015 outlining agreement, in principle, regarding California’s new, five-year Medicaid delivery system reform demonstration waiver proposal, entitled “Medi-Cal 2020.” [More]


HHS finalizes rules on Medicaid payment reviews


On November 2, 2015, the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the Federal Register on Medicaid payment reviews. The finalized rules require states perform data analyses to determine whether Medicaid payment rates will sufficiently enlist enough providers to ensure that health care is available to Medicaid recipients in the state. [More]


New budget legislation contains provider Medicare cuts


Congress passed new budget legislation, the Bipartisan Budget Act of 2015 (H.R. 1314), which the President signed into law on Monday, November 2, 2015 before the November 3rd debt ceiling deadline. The legislation raises the federal debt limit through March 2017 and contains or maintains certain Medicare cuts for providers. [More]


HHS AFCARS data reveals changes in foster care


Last month, the Department of Health and Human Services (HHS) released the 2014 Adoptions and Foster Care Analysis and Reporting System (AFCARS) data which revealed significant shifts in the foster care report. Following the more than decade-long trend of decreasing numbers of children in the system (in 1999, there were 567,000 children in the system compared to 397,000 in 2012, down approximately 30 percent), the 2013 and 2014 data both revealed increasing numbers. [More]


Texas, Kansas, and Louisiana sue HHS and IRS claiming provider insurance fees imposed by the ACA are unconstitutional


On October 22, 2015, the states of Texas, Kansas, and Louisiana filed a complaint in the U.S. District Court for the Northern District of Texas, Wichita Falls Division, against the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), alleging that a provision of the Affordable Care Act (ACA), which imposes a health insurance fee on all providers, including, by extension, managed care organizations, is unconstitutional. (Case 7:15-cv-00151-0 Document 1 filed 10/22/15). [More]

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HHS estimates 7.5 percent increase in 2016 Exchange premiums


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued a report on October 26, 2015 estimating that the cost of premiums for qualified health plans offered through health insurance Exchanges will be about 7.5 percent higher on average for 2016, compared to 2015 premiums. The HHS projections take into account premium rate filings for 37 states that will be using the HealthCare.gov website for the annual open enrollment period to be launched on November 1, 2015 for coverage beginning January 1, 2016. [More]


CMS awards grants to healthcare networks to help transform clinical practice


On September 29, the Centers for Medicare & Medicaid Services (CMS) awarded grants totaling $685 million to 39 national and regional collaborative healthcare transformation networks and supporting organizations as part of the agency’s Transforming Clinical Practice Initiative (TCPI). According to CMS, the awards are intended to provide more than 140,000 clinicians “with tools and support needed to improve quality of care, increase patients’ access to information, and spend dollars more wisely.” [More]

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