CMS finalizes rules on new Medicare payment methodologies for clinicians

On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) issued final rules to implement a new Quality Payment Program which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). The new program is authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). That landmark bipartisan legislation: repealed Medicare’s flawed sustainable growth rate (SGR) formula, replaced three prior Medicare incentive programs, consolidated Medicare quality reporting requirements beginning in 2017, and authorized new pay-for-performance adjustments beginning in 2019 for eligible clinicians paid under the Medicare Part B physician fee schedule. [More]

CMS overhauls long term care standards

On October 4, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register on Medicare/Medicaid standards that are applicable to long term care (LTC) facilities. The amendment is the most comprehensive upgrade of those standards since 1991. The new standards address issues examined at the White House Conference on Aging in July 2015 for a proposed rule which elicited nearly 10,000 public comments at the time. [More]

HHS proposes new rules on Medicaid fraud control units

On September 20, 2016, the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), jointly proposed new rules governing state Medicaid fraud control units (MFCUs). The proposed rules would require that MFCUs and state Medicaid agencies establish, review, and periodically update memoranda of understanding (MOUs) on coordination between these state agencies. [More]

PCG gears up for the 2017 SXSWedu Conference

After a positive and inspiring experience at the 2016 SXSWedu conference, we are gearing up for 2017. The 2017 SXSWedu conference takes place in Austin from March 6-9, 2017. PCG's own Tony Brown has joined the Advisory Board for a second year in a row. The 2016 conference drew more than 7,500 participants with over 38 countries represented. Recognized as a convergence of innovators and creative thinkers, SXSWedu brings the industry leaders and up-and-comers in education together to foster learning and collaboration in an energetic environment. The conference boasts a diverse mix of registrants and attendees including K-12 and higher education professionals, business leaders, policy makers, and non-profit directors. [More]

GAO report examines cybersecurity under HHS programs

On September 26, 2016, the U.S. Government Accountability Office (GAO) publicly released a report entitled “Electronic Heath Information: HHS Needs to Strengthen Security and Privacy Guidance and Oversight.” The report examines rapid increases from 2009 through 2015 in breaches of personal health information, culminating in 56 major breaches affecting 113,181,615 health records in 2015. [More]

Proposed Benefit and Payment Parameters 2018 Released

This year, the Centers for Medicare and Medicaid Services (CMS) released its annual proposed Notice of Benefit and Payment Parameters earlier than in prior years in order to provide more market certainty. The draft regulations, which were released last week and published in the federal register on September 6, outline changes to operations and rules for health insurance Marketplaces and the commercial health insurance market generally for 2018. [More]

HHS report shows Medicaid expansion affects QHP premiums

On August 25, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE), released a report showing that premiums for qualified health plans (QHPs) offered through Exchanges were on average about seven percent lower in 2015 for states that had expanded Medicaid for persons with incomes up to 138 percent of the Federal poverty level (FPL) versus states that had not. As actuarial risk pools, hence premiums, vary based on many local area factors, the report focuses on QHP benchmark premiums in 94 paired counties on opposite sides of borders between expansion states and non-expansion states that had used Federal exchanges in 2015. [More]

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]