Alleviating Emergency Medical Services’ Fiscal Challenges”

State budgets are under significant pressure and Emergency Medical Service (EMS) providers are facing declining reimbursement in response to serving as the public health care safety net. Many fiscal challenges exist for over-burdened departments and the prospects for addressing these inequities are dim. Healthcare systems and EMS ambulance transport providers are struggling to find alternative funding sources because of the decreasing reimbursement dollars from private and public insurance. This overall sentiment is evidenced by an article posted on the EMSWorld Website, which highlights the challenges faced by the EMS provider community. [More]

GAO-17-129: HHS Has Taken Steps to Support States' Oversight of Psychotropic Medications, but Additional Assistance Could Further Collaboration

The Government Accounting Office (GAO) completed another report (GAO-17-129) exploring how states are addressing the huge percent of children prescribed psychotropic medications while in foster care. Surveys conducted between 2008 and 2011 by the Administration for Children and Families (ACF) found that 18 percent of foster care children were taking a psychotropic medication. ACF further defined the group and discovered that children in group homes or residential treatment facilities were taking psychotropic medications at a significantly higher rate (48 percent) than children living in nonrelative foster homes or formal kinship care (14 percent). [More]

CMS proposes rules to stabilize health insurance markets

On February 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued draft proposed regulations intended to stabilize the individual and small group health insurance markets under the Affordable Care Act (ACA). The proposed rules would shorten the open enrollment period for 2018, amend standards on special enrollment periods, increase pre-enrollment verification of eligibility on the HealthCare.gov website, allow health insurance issuers to apply consumers’ payments to past unpaid debts for coverage, increase allowable variations in the actuarial value (AV) calculations, offer more flexibility in substantiating provider network adequacy, and facilitate insurers’ compliance with essential community provider (ECP) standards. [More]

CMS issues final 2018 Marketplace guidance

The Centers for Medicare and Medicaid Services (CMS) finalized its annual Notice of Benefit and Payment Parameters for 2018 (NBPP) and its 2018 Letter to Issuers in the Federally-Facilitated Marketplaces (Letter) on December 16, 2016. As is typical, the NBPP addresses a breadth of issues relative to health plan regulation as well as Marketplace operations. The Letter provides operational and technical guidance for issuers seeking to offer Qualified Health Plans (QHPs) and Standalone Dental Plans (SADPs) on Federally-Facilitated Marketplaces (FFMs) and State-Based Marketplaces on the Federal Platform (SBM-FPs). [More]

Pride and Passion

Since graduating from Bentely College in 2002, Matt Sorrentino has risen from a business analyst in the Boston office to becoming a manager in the Austin office, but always within the Health practice area. The erstwhile finance major helped to establish PCG’s presence in Texas in 2004, and since then has focused on helping state Medicaid programs increase revenue and improve outcomes for patients. [More]

GAO releases report on CMS oversight of Medicaid expenditures

On February 6, 2017, the U.S. Government Accountability Office (GAO) issued a report on the Medicaid program entitled, “Program Oversight Hampered by Data Challenges, Underscoring the Need for Continued Improvement.” Six members of the U.S. Senate and the House of Representatives asked GAO to examine Medicaid data challenges based on estimates that there were about $36.3 billion in improper Medicaid payments in Federal fiscal year 2016. [More]

Hawaii receives approval of 1332 State Innovation Waiver submission

Hawaii requested a 1332 State Innovation Waiver in order to preserve the state’s Prepaid Health Care Act (Prepaid) by exempting the state from requirements related to the Small Business Health Options Program (SHOP). Since the enactment of Prepaid in 1974, employers in Hawaii have been required to provide health insurance coverage that meets the evolving standards of Prepaid to employees working 20 hours or more per week, with some exceptions. In 2011, more than 480,000 non-union employees and their dependents were covered under employer-sponsored Prepaid-compliant plans. [More]

Roundup of federal health policy developments

The debate over the future of the Affordable Care Act (ACA) is well-underway and there are a number of significant developments that warrant a closer look. Here we provide a roundup of recent developments.

Administrative Action
Upon entering office, President Trump signed two Executive Orders. The first, on January 20, entitled... [More]

The House considers health policy bills

As debate continues over the future of the Affordable Care Act (ACA), the House has held hearings on four piecemeal bills aimed at making incremental changes to the ACA:

- The State Age Rating Flexibility Act of 2017 would expand permissible age rating bands to 5:1 (currently 3:1) under the ACA or a different ratio adopted by the state. [More]

The Obamacare Replacement Act

Senator Rand Paul introduced the Obamacare Replacement Act on January 25th, which would repeal much of Title 1 of the Affordable Care Act (ACA), including:

• Most consumer protections (except as outlined below)
• Rating restrictions
• Rate review requirements
• Essential Health Benefits
• Medical loss ratio requirements
• Individual and employer coverage mandates [More]