The U.S. Department of Health and Human Services and the U.S. Department of Agriculture released additional guidance to all state health and human service agencies on January 23 on cost allocation plans and advance planning documents on eligibility systems serving multiple state health and human services programs. The new letter clarifies guidance provided on August 10 that design and development costs for new eligibility systems needed to implement health programs (Medicaid, the Children’s Health Insurance Program, and state-operated health insurance exchanges) under the Affordable Care Act (ACA) may be allocated in their entirety among those programs, even if the new eligibility systems also benefit other income-related programs (per a limited exception to OMB Circular A-87 section C. 3. cost allocation principles). [More]

The Congressional Budget Office (CBO) released a report on January 18 outlining key findings and lessons learned from six disease management/care coordination projects and four value-based purchasing projects under Medicare research and demonstration authority. Rigorous independent evaluations have been completed on the projects, which were implemented before 2008. The first six demonstration projects, involving 34 separate programs, showed that factors such as the extent and type of care management were important determinants as to whether the programs actually achieved reductions in hospital admissions and net reductions in Medicare program spending after accounting for the extra care management fees under the projects. Only four of the 34 programs achieved reductions in hospital admissions greater than 15 percent. [More]

Governor John Kasich’s Office of Health Transformation announced on January 9 that it is launching an initiative in partnership with Ohio stakeholders to change Ohio’s public and private health care business models from those based on volume of services to those based on value and performance. As part of that effort, the Ohio Department of Job and Family Services announced that Ohio’s Medicaid program is considering, in order to more effectively drive reforms in Ohio’s health care delivery system, pay-for-performance standards aligned with those of other major health care purchasers such as the Ohio Public Employees Retirement System (OPERS), GE, Xerox, 3M, FedEx, and eBay. [More]

Massachusetts received approval from the Centers for Medicare and Medicaid Services (CMS) on December 20 for the renewal and extension of its MassHealth demonstration waiver program through June 30, 2014. The Commonwealth’s goals under the demonstration program include maintaining near-universal health coverage; redirecting health care spending away from episodic uncompensated care in high cost settings to more cost-effective health insurance coverage; accomplishing delivery system reforms fostering person-centered care planning, better care coordination, chronic disease management, and improved treatment outcomes; and promoting payment reforms to incentivize providers to focus on quality of care and achieving results for patients rather than generating service volume. [More]

The U.S. Department of Health and Human Services announced on December 16 that it is accepting comments from states on a new proposed approach to implement section 1302 of the Affordable Care Act (ACA), which requires that “qualified health plans” that will offer coverage in 2014 through health insurance exchanges cover at least “essential health benefits.” Section 1302 requires that such benefits include items and services in at least ten broadly defined categories (emergency, hospitalization, maternity and new-born care, ambulatory, rehabilitative/habilitative, prescription drugs, pediatric, preventive/wellness and chronic disease management, mental health/substance abuse, and laboratory services). [More]

CMS announced on December 19 that it has selected the first 32 health care organizations nationwide to participate in the Pioneer Accountable Care Organization (ACO) program. The Pioneer ACO program is designed to test a rapid transition to outcomes-based contracting and is an accelerated version of ACO model in the Medicare Shared Savings Program under section 3022 of the Affordable Care Act (ACA). The inaugural class of Pioneer ACOs consists of distinguished medical organizations with the ability to show what actually can be achieved through better coordinated, patient-centered care for Medicare fee-for-service beneficiaries. [More]

The Centers for Medicare and Medicaid Services (CMS) issued guidelines and application instructions on December 21 for the Independence at Home (IAH) demonstration program under section 3024 of the Affordable Care Act (ACA). This three-year Medicare initiative will offer a comprehensive range of primary care services in the homes of beneficiaries with multiple chronic conditions and functional limitations. It is designed to test whether home-based primary care models can help reduce hospitalizations, improve patient and caregiver satisfaction, improve quality of care, and reduce expenditures for persons who need help in their own homes to manage multiple health issues. [More]

The Centers for Medicare and Medicaid Services (CMS) released final rules on December 13 on the Consumer Operated and Oriented Plan (CO-OP) provisions under section 1322 of the Affordable Care Act (ACA). Section 1322 authorizes up to $3.8 billion in federal loans to foster the creation of consumer-governed private non-profit health insurance issuers that will offer qualified health plan coverage through health insurance exchanges by January 2014. [More]

The Centers for Medicare and Medicaid Services (CMS) approved the "Texas Healthcare Transformation and Quality Improvement" demonstration proposal on December 12. CMS approved Medicaid waivers under section 1115 of the Social Security Act for the period December 12, 2011 through September 30, 2016. Prior section 1915(b) and 1915(c) waivers have been consolidated under the global section 1115 budget neutrality limit. [More]

The Centers for Medicare and Medicaid Services (CMS) released final rules on December 7 concerning CMS release of standardized extracts of Medicare Part A, B, and D claims data. The final rules are effective January 6, 2012. The rules implement section 10332 of the Affordable Care Act (ACA) requiring CMS to release such data extracts to qualified organizations to support measurement and analysis of provider performance. Qualified organizations must demonstrate the capability to combine the Medicare extracts with Medicaid and other claims data and to generate statistically valid reports using recognized performance measures such as those endorsed by the National Quality Forum (NQF). [More]