Bridging the electronic health information highway and promoting interoperability for Medicaid providers

The Centers for Medicare and Medicaid Services (CMS) recently expanded the scope of the Health Information for Economic and Clinical Health Act (HITECH) 90/10 funding available to encourage the adoption and promote the use of electronic health record (EHR) technology and health information exchange (HIE). This new funding source provides Medicaid agencies with the ability to accelerate the exchange of information across the continuum of Medicaid providers and gather important clinical and administrative data elements for robust program planning; improvements in quality of care; and managing costs. [More]

Consumer assistance for open enrollment 2017

This year, for the first time since the health insurance marketplace began, states will not have the support of consumer assistance funding from the Centers for Medicare and Medicaid Services (CMS) to educate the public about marketplace plan offerings. Without federal funding, many states are scrambling to find ways to assist consumers in the upcoming open enrollment period. [More]

CMS releases report on ACA health insurers’ payment trends

The Centers for Medicare and Medicaid Services (CMS) released a report on August 11, 2016, entitled, “Changes in ACA Individual Market Costs from 2014 to 2015: Near-Zero Growth Suggests an Improving Risk Pool.” The report states that per member per month (PMPM) paid claims for health insurers in the individual market under the Affordable Care Act (ACA) fell 0.1 percent on average from 2014 to 2015, perhaps due to a broader, healthier ACA risk pool in 2015 than in 2014. [More]

Proposed rule clarifying limit on Medicaid DSH Payments

In the August 15, 2016 Federal Register, the Center for Medicare and Medicaid Services (CMS) published a proposed rule (81 Fed. Reg. 53980) clarifying that Medicaid Disproportionate Share Hospital (DSH) payments under section 1923(g)(1)(A) of the Social Security Act (SSA) should be limited to uncompensated care costs. [More]

JAMA reports on Medicaid expansion research findings

On August 8, 2016, the Journal of the American Medical Association published a report entitled, “Changes in Utilization and Health among Low-Income Adults after Medicaid Expansion or Expanded Private Insurance.” The report analyzes access to care, utilization of services, and self-reported health status among low-income adults in three states that have taken different approaches under the Affordable Care Act (ACA): a traditional Medicaid expansion, a “private option” Medicaid expansion, and non-expansion. [More]

CMS designates regions to participate in CPC+ primary care model

On August 1, 2016, the Centers for Medicare and Medicaid Services (CMS) announced that 14 geographic regions across the United States will participate in the five-year, multi-payer Comprehensive Primary Care Plus (CPC+) model to be launched on January 1, 2017. The designated regions include metropolitan areas such as Philadelphia and Kansas City as well as entire states such as Arkansas, Colorado, Michigan, New Jersey, Ohio, and Rhode Island, where states and payers have documented strong multi-payer collaboration as of June 2016. CMS also opened the CPC+ application process for primary care practices in the designated regions on August 1, 2016 and estimates that up to 5,000 such practices serving 3.5 million persons will participate in 2017-2021. [More]

CMS proposes new bundled payment models

On July 25, 2016, the Centers for Medicare and Medicaid Services (CMS) proposed new episode payment models (EPMs) for three acute care conditions that are very common among aged Medicare beneficiaries: acute myocardial infarction, coronary artery bypass, and hip/femur fractures. The first two EPMs would apply in 98 metropolitan statistical areas (MSAs) throughout the United States that would be randomly selected. The third would apply in 67 designated MSAs. Each of the EPMs would be tied to critical quality of care metrics validated by distinguished organizations such as the National Quality Foundation (NQF). [More]

CMS proposes changes in payment rules for outpatient care

On July 6, 2016, the Centers for Medicare and Medicaid Services (CMS) proposed changes in Medicare payment methods under the hospital outpatient prospective payment system (hospital outpatient PPS) and the ambulatory surgical center (ASC) payment system. The proposed Medicare rules would have a substantial impact in 2017 on “off campus” ambulatory facilities, incentive payments for adoption and “meaningful use” of electronic health records (EHRs), and the hospital value-based purchasing (VBP) program. [More]

Legislation to address opioid use receives bipartisan support

Child welfare agencies have identified substance misuse and abuse as the leading reason for the significant increase in abuse and neglect reports, and the subsequent removal of children from their homes. Overdoses from heroin, prescription drugs, and opioid pain relievers in 2014 surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control. Injury-related deaths reached their highest levels of the 21st century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. [More]