PCG creates summary of the House-passed health care bill

The American Health Care Act (“the bill”) passed the House of Representatives on May 4, 2017. As outlined in greater detail in the PCG summary, the bill does not repeal the Affordable Care Act (ACA) in full, but rather proposes changes primarily focused on the ACA’s insurance affordability, Medicaid expansion, coverage requirements and revenue provisions. It also proposes changes to Medicaid funding more generally and allows states to waive medical underwriting prohibitions. [More]

States continue to pursue Section 1332 State Innovation Waivers

With repeal of the Affordable Care Act (ACA) stalled, states are increasingly considering Section 1332 Waivers as a way to expand upon or customize the ACA to best address the unique circumstances within the state. Alaska and Oklahoma are the two most recent states to take formal steps toward State Innovation Waivers, both states following on the heels of the recent Section 1332 Waiver approval granted to Hawaii, which we summarized in the February edition of Health Policy News. [More]

What you need to know about modularity

If you work in state Medicaid or health information technology (HIT), chances are you have seen the term modularity discussed with increasing frequency lately. Countless articles have been written about it, and it has been a focus at some of the largest Medicaid and HIT conferences over the past year including MESC, HIMSS, and the Health IT Connect Summit. For all of the coverage it has gotten, defining what modularity truly means has been an ongoing debate among states, the Centers for Medicare and Medicaid Services (CMS), and the vendor community. [More]

CMS releases final Market Stabilization Rule

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final Patient Protection and Affordable Care Act; Market Stabilization Rule. The final rule is aimed at stabilizing the individual and small group markets by tightening enrollment standards and providing increased flexibility related to standards for Qualified Health Plans (QHPs), as outlined in detail below. The final rule also seeks to provide greater deference to state regulation of health insurance. [More]

GAO examines telehealth in federal programs

On April 14, 2017, the U.S. Government Accountability Office (GAO) released a report to Congress on coverage and payment rules for telehealth and remote patient monitoring under Medicare, state Medicaid programs, and health care programs operated by the Department of Defense (DOD) and the Department of Veterans’ Affairs (VA). The report examines rules across those agencies’ programs and outlines recent initiatives to improve care for high-risk patients. [More]

U.S. Supreme Court rejects West Virginia’s challenge to Obama administration’s decision not to enforce certain provisions of the Affordable Care Act (ACA)

On Monday, April 17, 2017, the U.S. Supreme Court declined to take up West Virginia’s challenge to the decision by the Obama administration not to enforce certain mandates of the ACA following the cancellation of millions of plans by insurance companies in 2013. (West Virginia, Ex Rel. Morrisey v. Dept. of H & HS, 16-721, 4/17/17). [More]

The Importance of Forecasting Market Demand

As States continue to face constrained budgets, it is incumbent upon agency leadership to fine-tune their short- and long-term budgeting processes. PCG has found that forecasting market demand is a way state leaders to accurately allocate scarce government resources. Market forecasting makes a strong case for fiscal support because it relies heavily on a data driven decision making. It also offers state leaders a strategy that is non-partisan, and a level of transparency that appeals to both constituents and legislators. Ultimately, forecasting market demand ensures that the commitment of public funds will benefit the broader community. [More]

HHS encourages Governors to consider state innovation waivers

On March 13, 2017, the U.S. Secretary of Health and Human Services (HHS) released a letter to all governors outlining the parameters under which states can obtain waivers under section 1332 of the Affordable Care Act (ACA). HHS notes that state innovation waivers to implement high-risk pools and state-operated reinsurance programs may be an important opportunity to lower health insurance premiums for consumers, to improve health insurance market stability in the state, and to increase consumer choice. [More]