CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [More]

House passes 21st Century Cures bill

On November 30, 2016, the U.S. House of Representatives passed an amended “21st Century Cures” bill by a 392-26 vote. The bill covers a diverse range of topics, such as: medical research, development of drugs and medical devices, interoperability of electronic health record systems, and mental health/substance use disorder (MH/SUD) programs. [More]

Centers for Medicare and Medicaid Services issues new guidance

The Centers for Medicare and Medicaid Services (CMS) released a draft of its 2018 Letter to Issuers in the Federally-Facilitated Marketplaces (Letter) on November 10, 2016. The Letter – updated annually - 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]

PCG sponsors statewide Delivery System Reform Incentive Payment symposium

It seems entirely fitting that the historic Syracuse Marriott Downtown was the setting for New York’s second annual Statewide Delivery System Reform Incentive Payment (DSRIP) Learning Symposium from September 20 to September 22. The hotel’s renovation was completed just weeks before the event, with an eye toward preserving the workmanship of the past and melding it with 21st century upgrades and innovation. In many ways, that mission is mirrored by the New York State Department of Health in its devotion to time-honored quality of care and its dedication to modernizing the healthcare delivery system through the DSRIP project. [More]

Highlights from the annual NAMD conference

The National Association of Medicaid Directors (NAMD) held its annual conference in Virginia last week to discuss the hot healthcare topics facing state Medicaid programs. No surprises about which topics are at the top Medicaid Directors' minds these days: (1) Delivery System and Payment Reforms; (2) IT Systems; and (3) Mental Health and Substance Abuse issues (i.e., integration). All of these are inter-related, of course -- the delivery system and payment reforms will, for many states, focus on the behavioral health populations and providers, which tend to have higher overall Medicaid costs, and in order to implement these reforms robust IT systems will be needed. [More]

Massachusetts wins CMS renewal of demonstration waivers

On November 4, 2016, the Commonwealth of Massachusetts won approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year renewal of its $52.4 billion MassHealth demonstration waiver program. The waiver renewal authorizes MassHealth to pioneer an innovative Medicaid accountable care organization (ACO) model, under which ACOs will partner with community-based organizations to integrate health care and social services, to address social determinants of health, and to achieve patient-centered, outcomes-based care. The renewal includes $1.8 billion in new, up-front investments under a delivery system reform incentive program (DSRIP) initiative to support transition throughout the Commonwealth to the new ACO model, under which provider-led ACOs will be accountable for costs and quality of care. [More]

New York’s Delivery System Reform Incentive Payment (DSRIP) program: Transitioning to payments based on performance measures

On April 14, 2014, the Centers for Medicaid and Medicare Services (CMS) approved New York state’s groundbreaking DSRIP program through their Medicaid 1115 waiver amendment, allowing the state’s Department of Health (DOH) to reinvest $8 billion of federal savings generated by Medicaid Redesign Team (MRT) reforms. NY’s DSRIP incentive payments promote community-level collaborations in the form of “Performing Provider Systems” (PPSs) that implement innovative projects focused on system transformation, clinical improvement and population health improvement, with an overall statewide goal of reducing avoidable hospital use by 25 percent, over the program’s five years. [More]

NEJM article analyzes ACA coverage increases

On October 27, 2016, the New England Journal of Medicine (NEJM) published an article entitled, “Disentangling the ACA’s Coverage Effects – Lessons for Policymakers.” Citing an ample body of evidence that 20 million Americans have gained coverage as the rate of uninsured Americans has dropped from 16 percent to 9 percent as a result of the Affordable Care Act (ACA), the article disaggregates those covered gains for 2014... [More]

Insights from the annual National Academy of State Health Policy Conference - #NASHPCONF16

From October 17th to 19th, members of PCG’s Health Policy team attended the annual National Academy of State Health Policy (NASHP) Conference in Pittsburg, PA. The theme for this year’s event was “Where Ideas and Action Converge,” with particular focus on Delivery System Reform Incentive Payment (DSRIP) waivers, Medicaid expansion and payment and delivery system reform innovation. In addition to presentations highlighting the innovative efforts in states under waiver and grant programs, discussions led by state and national policy makers on health care’s more headline grabbing topics (e.g., opiate abuse, ever-growing prescription drug costs, etc.). were weaved through the three-day agenda. [More]

HHS estimates 22 percent increase in 2017 ACA premiums

On October 24, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE), issued a report estimating that premiums for health plans offered through health insurance Exchanges will be about 22 percent higher on average for 2017 than they were for 2016. That estimate is based on ASPE’s comparison of 2017 to 2016 premiums for 38 states using the (Federal Exchange) website in both years, as well as state-reported premium data made available to ASPE by four states and the District of Columbia, representing 60 percent of consumers enrolled in State-based Exchanges (SBEs). [More]