Resource Link


Connecting the community to regulatory
information, education, and resources.

In the News

Listed below is recent news for Medicare and Medicaid. For the most current news and announcements, delivered right to your email, become a member! Contact us for more information.

Breaking News | Upcoming Events | Federal and State Health Care Reform | CMS & HHS Releases | Community Provider News | Other Releases | Archive

Username:
Password:

Upcoming Events

3/22/18 - HPMS PACE Quality Monitoring Module Training 

Thursday, March 22, 2018, 2:00 – 3:30 pm ET

Toll free dial in: 1-877-267-1577

Access code: 999 738 861

 
The HPMS PACE Quality Monitoring Module will be released on April 2, 2018 and will combine PACE Level I and II data, which will now be collectively known as "PACE Quality Data." Beginning April 2, 2018, PACE organizations must use the HPMS module to report all Quarter 2 PACE Quality Data and may no longer use the portal for these submissions. However, the portal will remain available for PACE Organizations to provide responses to previously submitted PACE Level II events and to ask policy questions.
 

Open Door Forum: Medicare Advantage Value-Based Insurance Design Model

CY 2019 Application Cycle

Wednesday, December 13, 2:00 p.m. – 3:00 p.m. EST

The Medicare Advantage Value-Based Insurance Design (VBID) Model team will host an open door forum on Wednesday, December 13 from 2:00 - 3:00 p.m. EST to discuss the recently announced opportunity to apply for the CY 2019 VBID Model.

Click here to register


CMS Meaningful Measures Initiative Webinar

Tuesday, November 28, 1:00 p.m. – 2:00 p.m. EST

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma recently announced a new approach to quality measurement, called “Meaningful Measures.” The Meaningful Measures Initiative will involve identifying the highest priorities to improve patient care through quality measurement and quality improvement efforts.

Click here to register


Interdisciplinary Care Teams for Older Adults Webinar

Thursday, December 7, 12:00 p.m. – 1:30 p.m. EST

By working in a team of skilled professionals, interdisciplinary care teams (ICT) provide comprehensive assessment and management of care for older adults. Effective ICTs use a person-centered approach that prioritizes the individual’s needs. This webinar will explain key members within ICTs and identify common challenges and best practices for ICTs working with older adults. Presenters will also address the importance of clinical, psychosocial, long-term care, behavioral and community-based support for older adults, particularly Medicare-Medicaid beneficiaries.

Click here to register


Medicare Diabetes Prevention Program (MDPP) Expanded Model Expansion Conference Call

Tuesday, December 5, 1:30 p.m. – 3:00 p.m. EST

The CY 2018 Medicare Physician Fee Schedule final rule includes the expansion of the Medicare Diabetes Prevention Program (MDPP) Expanded Model starting in 2018. During this call, CMS experts will provide a high-level overview of the finalized policies. A question and answer session will follow the presentation.

Read More


Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call

Thursday, September 7, 2017 from 1:30 - 3:00 PM Eastern Time

During this call, learn about the new Facility Assessment Tool to help identify and develop the specific assessment of your facility. Also, find out about frequently asked questions related to revision of the State Operations Manual Appendix PP for Phase 2 of the Reform of Requirements for Long-Term Care Facilities final rule. A question and answer session follows the presentation.

Read More


IMPACT Act: Medicare Spending Per Beneficiary Measures Call

Wednesday, September 6, 2017 from 1:30 - 3:00 PM Eastern Time

During this call, CMS and measure developers present information on the adopted Medicare Spending per Beneficiary Post-Acute Care (PAC) resource use measures, focusing on the components of each measure, as well as public reporting. A question and answer session follows the presentation. The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires the development of resource use measures for PAC providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals.

Read More


Federal and State Health Care Reform

11/13/18 –  CMS Announces New Medicaid Demonstration Opportunity to Expand Mental Health Treatment Services

CMS letter to State Medicaid Directors outlines new opportunities for states to receive payment for residential treatment services

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors that outlines both existing and new opportunities for states to design innovative service delivery systems for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). The letter includes a new opportunity for states to receive authority to pay for short-term residential treatment services in an institution for mental disease (IMD) for these patients. CMS believes these opportunities offer states the flexibility to make significant improvements on access to quality behavioral health care.

Read More


11/08/18 –  CMS Proposes Changes to Streamline and Strengthen Medicaid and CHIP Managed Care Regulations

Proposed Rule Continues Commitment to Promote Flexibility, Strengthen Accountability, and Maintain and Enhance Program Integrity in Medicaid and CHIP

Today, the Centers for Medicare & Medicaid Services (CMS) is proposing significant regulatory revisions to streamline the 2016 managed care regulatory framework. The changes reflect a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility, and innovation in care delivery. While the 2016 managed care final rule was a substantial and comprehensive rewrite of the Medicaid and Children’s Health Insurance Program (CHIP) regulatory structure, it included provisions that many states and stakeholders identified as unnecessarily prescriptive and as adding unnecessary costs and administrative burden to state Medicaid programs without contributing to the improvement of health outcomes.

Read More


11/07/18 –  Trump Administration Issues Final Rules Protecting Conscience Rights in Health Insurance

Today, the Departments of Health and Human Services, Treasury, and Labor released two final rules to provide conscience protections for Americans who have a religious or moral objection to health insurance that covers contraception methods. Under the Affordable Care Act, employer-provided health insurance plans are required to cover certain “preventative services” – which were defined through guidance by the Obama Administration as including all contraception methods approved by the Food and Drug Administration, including methods viewed by many as abortifacients, and sterilization procedures.

Read More


11/07/18 –  HHS activates aid for uninsured citizens of the Commonwealth of the Northern Mariana Islands needing medicine after Super Typhoon Yutu

Uninsured citizens of the Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory, are eligible for no-cost replacements of critical medications lost or damaged by Super Typhoon Yutu. This relief comes from the Emergency Prescription Assistance Program (EPAP), managed by the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).

Read More


11/07/18 –  Fact Sheet: Final Rules on Religious and Moral Exemptions and Accommodation for Coverage of Certain Preventive Services Under the Affordable Care Act

On November 7, 2018 the Departments of Health and Human Services, Treasury, and Labor (the Departments) announced two final rules, on display at the Federal Register, that provide conscience protections to Americans who have a religious or moral objection to health insurance that covers contraceptive methods, including certain contraceptives that many view as abortifacients, and/or sterilization procedures.

Read More


10/30/18 – Kaiser Family Foundation - With One Hand, Administration Boosts ACA Marketplaces, Weakens Them With Another

By Julie Appleby

In the span of less than 12 hours last week, the Trump administration took two seemingly contradictory actions that could have profound effects on the insurance marketplaces set up by the Affordable Care Act.

Read More


10/1/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, September 2017 to September 2018

Read More


10/1/18 – The Commonwealth Fund – The Affordable Care Act’s Impact on Small Business

By David Chase and John Arensmeyer

Small-business owners have seen significant gains in health care coverage for themselves and their employees thanks to the Affordable Care Act. Though efforts to repeal the law failed in 2017, the current administration continues to take steps that undermine the law’s progress. In recent months, new rules have been announced that allow more groups to establish association health plans and extend the length of short-term health insurance plans. These changes are likely to impact the stability of the marketplaces and coverage rates for the small-business community.

Read More


9/18/18 – The Commonwealth Fund - Study: State-Level Individual Mandates Would Reduce Number of Uninsured by Nearly 4 Million in 2019; Health Plan Premiums Would Fall 12 Percent

Montana, West Virginia, North Dakota, and Kentucky would see the largest percentage increases in coverage

Close to 4 million Americans would gain health insurance, and premium costs would drop an average of nearly 12 percent, if every state joined Massachusetts and New Jersey in enacting state-level individual mandates. These mandates would replace the Affordable Care Act’s (ACA) penalty for not having health insurance, a fee that Congress eliminated, effective 2019. That’s according to a new Commonwealth Fund/Urban Institute report by the Urban Institute’s Linda Blumberg, Matthew Buettgens, and John Holahan examining what would happen if all states adopted their own individual insurance mandates.

Read More

Click here to view full article


9/4/18 – Kaiser Health News – A Texas Lawsuit Being Heard This Week Could Mean Life or Death for the ACA

By Julie Rovner

Wednesday is looking like yet another pivotal day in the life-or-death saga that has marked the history of the Affordable Care Act.

Read More


8/30/18 – MedPAC Comment on CMS’s Proposed Rule on the CY 2019 Home Health PPS Update and 2020 Case Mix Refinements

The Medicare Payment Advisory Commission (MedPAC) appreciates the opportunity to submit comments on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare and Medicaid Programs; CY2019 home health prospective payment system rate update and 2020 case-mix adjustment methodology refinements; home health value-based purchasing model; home health quality reporting requirements; home infusion therapy requirements; and training requirements for surveyors of national accrediting organizations,” Federal Register, vol. 83, no. 134, p. 32340 (July 12, 2018). We appreciate your staff’s efforts to administer and improve the Medicare program for beneficiaries and providers, particularly given the considerable demands on the agency. 

Read More


8/17/18 – Kaiser Family Foundation – Tracking Section 1332 State Innovation Waivers

Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. As states explore ways to address access and affordability issues in their individual and small group markets, they are increasingly turning to 1332 waivers.

Read More


8/7/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, July 2017 to July 2018

Read More


8/6/18 – Kaiser Health News – Medicaid Expansion Making Diabetes Meds More Accessible to Poor, Study Shows

By Pauline Bartolone

Low-income people with diabetes are better able to afford their medications and manage their disease in states that expanded Medicaid under the Affordable Care Act, a new study suggests.

Read More

 


7/31/18 – Kaiser Family Foundation – Enrollment in the Individual Insurance Market Continued to Fall in the First Quarter of 2018, With the 12 Percent Overall Decline Concentrated in Off-Exchange Plans

Enrollment in the individual insurance market continued to shrink in the first quarter of 2018, declining by 12 percent compared to the first quarter of 2017, according to a new analysis from the Kaiser Family Foundation. The decline was concentrated in off-exchange plans where enrollees are not eligible for Affordable Care Act subsidies and have had to pay the full cost of recent premium increases.

Read More

Click here to view the analysis

 


7/19/18 – Kaiser Health News – California’s ACA Rates to Rise 8.7% Next Year

By Chad Terhune and Pauline Bartolone

Premiums in California’s health insurance exchange will rise by an average of 8.7 percent next year, marking a return to more modest increases despite ongoing threats to the Affordable Care Act.

Read More


06/20/18 – ICRC - Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Designing an Integrated Summary of Benefits Document

By Erin Weir Lakhmani

States are increasingly contracting with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to better integrate Medicare and Medicaid benefits for dually eligible enrollees in order to increase care coordination and improve beneficiaries’ experience of care. D-SNPs whose enrollees are also enrolled in aligned Medicaid managed care (MMC) or managed long-term services and supports (MLTSS) plans can receive their Medicare and Medicaid benefits in a seamless, coordinated manner.1 In these arrangements, member materials that describe both Medicare and Medicaid benefits in an integrated, understandable way are an important component in improving the beneficiary experience. States can start to improve member materials by using contractual requirements to ensure that Medicare and Medicaid benefit information for aligned plans is incorporated into a single, streamlined Summary of Benefits (SB) document.

Read More


06/20/18 – ICRC - Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches

By Paul Montebello

Beneficiaries who are dually eligible for Medicare and Medicaid often experience difficulties accessing durable medical equipment (DME), such as wheelchairs, in a timely manner. Whether Medicare or Medicaid covers a specific item may be unclear. Medicaid usually is the “payer of last resort,” which means that DME suppliers generally must obtain a Medicare denial before Medicaid will pay. For higher cost items, waiting for a Medicare denial can create an access problem, especially for lower-income beneficiaries. To address this issue, some states, such as Illinois, California, and Connecticut, have developed procedures for provisional prior authorization from Medicaid for such items. States may supplement these procedures by posting lists of DME items that Medicare consistently denies as non covered, and allow DME suppliers to bill Medicaid directly for these items without first billing Medicare. This can make it more likely that suppliers will provide DME to dually eligible beneficiaries in a timely way, with less confusion and uncertainty about who will pay and when.

Read More


06/05/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, May 2017 to May 2018

Read More


06/05/18 – ICRC - How States Can Better Understand their Dually Eligible Beneficiaries: A Guide to Using CMS Data Resources

By Danielle Chelminsky

The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office (MMCO) regularly reports data on Medicare-Medicaid dually eligible beneficiary demographics, service utilization, spending, and other characteristics that can give states a more comprehensive view of this population. States can use these data to design, develop, monitor, and improve programs in their state to better meet the specific needs of dually eligible beneficiaries. This technical assistance tool shows states how to use these data to create tables, graphs, and figures and interpret their meaning for a wider audience of stakeholders. Using data effectively can help state decision makers and external stakeholders to better understand dually eligible beneficiaries in their state and improve the programs that serve them.

Read More


05/09/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, April 2017 to April 2018

Read More


05/09/18 – ICRC – Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Promoting Aligned Enrollment

By Erin Weir Lakhmani, Mathematica Policy Research and Alexandra Kruse, Center for Health Care Strategies

States are increasingly seeking ways to better integrate care for people dually eligible for Medicare and Medicaid, who are among the highest need and most expensive populations in either program due to a high prevalence of multiple chronic conditions, physical and behavioral health disabilities, and need for long-term services and supports (LTSS).1 A good option for states looking to integrate care for dually eligible beneficiaries is to use contracting strategies that maximize the opportunity for Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and Medicaid managed care (MMC) plans to have aligned
enrollment—the beneficiary is enrolled in a D-SNP and MMC offered by the same parent company in the same geographic area (aligned plans).
 

05/08/18 – Kaiser Health News - How The Farm Bill Could Erode Part Of The ACA

By Julie Appleby

Some Republican lawmakers continue to try to work around the federal health law’s requirements. That strategy can crop up in surprising places. Like the farm bill.

Read More


03/29/18 – Kaiser Family Foundation – State and Federal Contraceptive Coverage Requirements: Implications for Women and Employers

By Laurie Sobel, Alina Salganicoff and Ivette Gomez

Contraceptive Coverage under the Affordable Care Act (ACA) has made access to the full range of contraceptive methods affordable to millions of women. Since it was first issued in 2012, this provision has been controversial and has been the focus of two major cases that have reached the Supreme Court. Following the Hobby Lobby ruling, the Obama Administration took the stand that almost all women had an entitlement to the contraceptive benefit and developed an “accommodation” to assure they would still get coverage, even if their employer had religious objections to contraception. The Trump Administration, in contrast, has prioritized the rights of employers, and in October 2017, issued regulations that significantly broadened the exemption to nearly any employer with a religious or moral objection. The new regulations have been challenged by 8 states and have been blocked from being implemented pending the outcome of the litigation.

Read More


03/28/18 – Kaiser Family Foundation – The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review

By Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga

A substantial body of research has investigated effects of the Medicaid expansion under the Affordable Care Act (ACA) on coverage; access to care, utilization, affordability, and health outcomes; and various economic measures. This issue brief summarizes findings from 202 studies of the impact of state Medicaid expansions under the ACA published beginning in January 2014 (when the coverage provisions of the ACA went into effect) and updates earlier versions of this brief with studies through February 2018.1 More recent studies continue to support earlier findings but provide additional findings in key areas, including expansion’s effects on health outcomes, access to services and medications for behavioral health and other needs, and providers’ financial stability.

Read More

Click here to view appendix


03/21/18 – The Commonwealth Fund – How Did State-Run Health Insurance Marketplaces Fare in 2017

By Justin Giovannelli and Emily Curran

Issue: Sixteen states and the District of Columbia manage their own health insurance marketplaces under the Affordable Care Act. These states, which were broadly supportive of health reform, chose to run their marketplaces to exert greater control over their insurance markets and tailor the portals to suit local needs. Though federal policy changes and political uncertainty around the ACA in 2017 have posed challenges across the country, states that operate their own marketplaces had greater flexibility than others to respond.
 
Goal: To understand how states on the forefront of health reform perceived and responded to federal policy changes and political uncertainty in 2017.
 
Methods: Structured interviews with the leadership staff of 15 of the 17 state-run marketplaces.
 
Findings and Conclusions: Respondents unanimously suggested that federal administrative actions and repeal efforts have created confusion and uncertainty that have negatively affected their markets. The state-run marketplaces used their broader authority to reduce consumer confusion and promote stable insurer participation. However, their capacity to deal with federal uncertainty has limits and respondents stated that long-term stability requires a reliable federal partner.
 

03/14/18 – The Commonwealth Fund – Do Medicare Advantage Plans Respond to Payment Changes? A Look at the Data from 2009 to 2014

By Stuart Guterman, Laura Skopec and Stephen Zuckerman

Issue: Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare.
 
Goal: Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased.
 
Methods: Analysis of Medicare data on MA plan bids, net of rebates.
 
 

03/13/18 – Kaiser Family Foundation - Overview: 2017 Kaiser Women’s Health Survey

By Usha Ranji, Caroline Rosenzweig, Ivette Gomez, and Alina Salganicoff

Health care is a central component of women’s lives, affecting their ability to care for themselves and their families, play a part in their communities, and participate in the workforce and earn a living. Access to comprehensive, affordable, and high quality care is essential for women to address their health care needs – which change across their lifespans. Women’s access to care is shaped by a wide range of factors, including federal and state health care policies. The passage of the Affordable Care Act (ACA) in 2010 marked a significant change in the availability and affordability of coverage and care for millions of formerly uninsured women and men.

Read More

Click here to view methodology


03/07/18 – The Commonwealth Fund – Medicaid Payment and Delivery Reform: Insights from Managed Care Plan Leaders in Medicaid Expansion States

By Sara Rosenbaum, Rachel Gunsalus, Maria Velasquez, Shyloe Jones, Sara Rothenberg, and J. Zoe Beckerman

 
Issue: Managed care organizations (MCOs) are integral to Medicaid payment and delivery reform efforts. In states that expanded Medicaid eligibility under the Affordable Care Act, MCOs have experienced a surge in enrollment of adults with complex needs.
 
Goal: To understand MCO experiences in Medicaid expansion states and learn about innovations related to access to care, care delivery, payment, and integration of health and social services to address nonmedical needs.
 
Methods: Interviews with leaders of 17 MCOs in 10 states that have seen large Medicaid enrollment growth and have undertaken payment and delivery reforms.
 

03/06/18 – The Commonwealth Fund – Competition and Premium Costs in Single-Insurer Marketplaces: A Study of Five Rural States

By Jon R. Gabel, Heidi Whitmore, Matthew Green, and Sam Stromberg

Issue: In 2017, five states — Alabama, Alaska, Oklahoma, South Carolina, and Wyoming — had only one issuer participating in their health care marketplaces, limiting consumer choice and competition among insurers.
 
Goal: Examine the history of participation in the individual market from 2010 (before the Affordable Care Act was enacted) to 2017, and analyze premium changes among marketplace plans.
 
Methods: Robert Wood Johnson Foundation’s HIX Compare, which provides national data on the marketplaces from 2014 to 2017.
 

03/01/18 – Kaiser Health News – Tens of Thousands of Medicaid Recipients Skip Paying New Premiums

By Phil Galewitz

When Arkansas lawmakers debated in 2016 whether to renew the state’s Medicaid expansion, many Republican lawmakers were swayed only if some of the 300,000 adults who gained coverage would have to start paying premiums.

Read More


03/01/18 – The Commonwealth Fund - Americans’ Views on Health Insurance at the End of a Turbulent Year

By Sara A. Collins, Munira Z. Gunja, Michelle M. Doty, and Herman K. Bhupal

The Affordable Care Act’s 2018 open enrollment period came at the end of a turbulent year in health care. The Trump administration took several steps to weaken the ACA’s insurance marketplaces. Meanwhile, congressional Republicans engaged in a nine-month effort to repeal and replace the law’s coverage expansions and roll back Medicaid.

Read More

Click here to view chartpack

Click here to review press release


02/28/18 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, February 2017 to February 2018 

Read More


01/31/18 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State,  January 2017 – January 2018  

Read More


01/31/2018 - ICRC – How States Can Better Understand their Medicare-Medicaid Enrollees: A Guide to Using CMS Data Resources

By Danielle Chelminsky

This technical assistance tool presents an overview of the various data sources available on the CMS Medicare-Medicaid Coordination Office (MMCO) website that may be useful to states in designing, developing, and refining programs that serve Medicare-Medicaid enrollees. CMS regularly publishes data collected from states, health plans, and other sources on its website. The data include Medicare-Medicaid enrollee eligibility categories, demographics, service utilization, and spending that states can use to better understand the specific needs and characteristics of this population as they develop, operate, monitor, and refine programs that serve Medicare-Medicaid enrollees in their state.

Read More


01/31/2018 - ICRC – How States Can Monitor Dual Eligible Special Needs Plan Performance: A Guide to Using CMS Data Resources

By Danielle Chelminsky

This resource guide presents an overview of the various data sources available on the Centers for Medicare & Medicaid Services (CMS) website that may be useful to states in designing, developing, refining, and monitoring programs that use contracts with D-SNPs to coordinate Medicare and Medicaid services for Medicare-Medicaid enrollees. CMS regularly reports data collected from health plans and other sources, and publishes guidance documents on its website. The data include health plan enrollment, quality measures, compliance information, payment information and other useful information that states can use as to monitor performance of the D-SNPs with which they contract.

Read More


01/18/18 – MedPAC – January 2018 MedPAC and MACPAC Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid

This data book is a joint project of the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC). The data book presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage. Dual-eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes. This population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy.

Read More


01/18/18 – CHCS – Medicaid Accountable Care Organizations: State Update

Many states have begun to implement Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. Currently, 11 states have active Medicaid ACO programs, and at least 11 more are pursuing them.

Read More


01/17/18 – Kaiser Family Foundation – Medicaid: What to Watch in 2018 from the Administration, Congress, and the States

By Robin Rudowitz

Medicaid provides health insurance coverage for about one in five Americans and is the largest payer for long-term care services in the community and nursing homes. Efforts in 2017 to repeal and replace the Affordable Care Act (ACA) and cap federal financing for Medicaid were unsuccessful but help to set the stage for 2018. As 2018 begins, there is a focus on administrative actions using Medicaid Section 1115 demonstration waivers, state actions on Medicaid expansion, and funding for the Children’s Health Insurance Program (CHIP) and other federal health care priorities.  Medicaid in 2018 is also likely to continue to be part of both federal and state budget deliberations. Pressures to control the federal deficit may reignite efforts to reduce or cap federal Medicaid spending.  In addition, Governors will soon release proposed budgets for state FY 2019 that will need to account for uncertainty around CHIP and Medicaid, changes in the economy and the effects of the recent tax legislation as well as funding for rising prescription drugs and initiatives to combat the opioid epidemic. This brief examines these issues.

Read More


01/05/18 – The Commonwealth Fund – Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients

By Ruben Amarasingham, Bin Xie, Albert Karam, Nam Nguyen, and Bianca Kapoor 

Issue: Our health care and social services delivery systems are not well-equipped to effectively manage patients with multiple chronic diseases and complex social needs such as food, housing, or substance abuse services. Community-level efforts have emerged across the nation to integrate the activities of disparate social service organizations with local health care delivery systems. Evidence on the experiences and outcomes of these programs is emerging, and there is much to learn about their approaches and challenges.
 
Goal: Profile and classify burgeoning initiatives, understand common challenges, and surface solutions to address those challenges.
 
Methods: Mixed-methods approach, including literature search, surveys, semistructured interviews with program leaders, and consultation with expert panels.
 
Findings and Conclusions: We categorized cross-sector community partnerships in four dimensions. We also identified five common challenges: inadequate strategies to sustain cost-savings, improvement, and funding; lack of accurate and timely measurement of return on investment; lack of mechanisms to share potential savings between health care and social services providers; lack of expertise to integrate multiple data sources during health care or social services provision; and lack of a cross-sector workflow evidence base.
 
 
 

01/05/18 – The Commonwealth Fund – How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries

By Amber Willink, Cathy Schoen and Karen Davis

Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs.
 
Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates.
 
Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values.
 
Findings and Conclusions: Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.
 

01/02/18 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, December 2016 to December 2017 

Read More


12/20/17 – CHCS – Strengthening Medicaid Long-Term Services and Supports in an Evolving Policy Environment: A Toolkit for States

By Stephanie Anthony, Arielle Traub, Sarah Lewis, Cindy Mann, Alexandra Kruse, Michelle Herman Soper, and Stephen A. Somers

Long-term services and supports (LTSS) enable more than 12 million people to meet their personal care needs and live with dignity and independence in a variety of community and institutional settings. With Medicaid LTSS expenditures of more than $140 billion annually and the aging population projected to grow 18 percent by 2020, the increasing demand for LTSS is putting more pressure on Medicaid at both the federal and state levels.

Read More

Click here to view the full toolkit


12/15/17 – Michigan Retirement Research Center – The Effect of Affordable Care Act Medicaid Expansion on Post-Displacement Labor Supply among the Near-Elderly

By Chichun Fang 

Expanded health-insurance coverage under the Affordable Care Act (ACA) provides alternative channels to obtain health-insurance coverage outside employment, which in theory may affect whether people want to work, how much they work, and the sorting of individuals into jobs.
Although health insurance exchanges are available in all states, ACA Medicaid expansion is only available in states that chose to expand Medicaid coverage. The state-level variation in timing of
Medicaid expansion provides a quasi-experiment setting that can be used to examine how health insurance coverage affected labor supply. In this paper, I study how Medicaid expansion affects the labor supply and re-employment outcomes of displaced (involuntarily unemployed) workers who are near-elderly, low-income, nonmarried, childless, and nondisabled. Data from 2011-2016 waves of monthly Current Population Survey (CPS) as well as 2010-2016 waves of Displaced
Workers Survey (DWS) are used. Results from a discrete-choice model using the CPS suggest that, some displaced workers in expansion states became less likely to exit unemployment to employment while some others became more likely to exit unemployment to not-in-labor-force immediately following Medicaid expansion. While robustness tests suggest this may partly be attributed to state-level idiosyncrasies, my results reject large and persistent effect of Medicaid expansion on unemployment exits. The DWS does not have enough statistical power to identify the difference in re-employment outcomes between displaced workers in expansion and nonexpansion states.
 

12/14/17 – The Commonwealth Fund – What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016

By Susan L. Hayes, Sara R. Collins, David Radley, and Douglas McCarthy 

Issue: Given uncertainty about the future of the Affordable Care Act, it is useful to examine the progress in coverage and access made under the law.
 
Goal: Compare state trends in access to affordable health care between 2013 and 2016.
 
Methods: Analysis of recent data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System.
 
Findings and Conclusions: Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states. Among children, uninsured rates declined by at least 2 percentage points in 33 states. There were reductions of at least 2 percentage points in the share of adults age 18 and older who reported skipping care because of costs in the past year in 36 states and D.C., with greater declines, on average, in Medicaid expansion states. The share of at-risk adults without a recent routine checkup, and of nonelderly individuals who spent a high portion of income on medical care, declined in at least of half of states and D.C. These findings offer evidence that the ACA has improved access to health care for millions of Americans. However, actions at the federal level — including a shortened open enrollment period for marketplace coverage, a failure to extend CHIP funding, and a potential repeal of the individual mandate’s penalties — could jeopardize the gains made to date.
 
 
 
 

12/06/17 – The Commonwealth Fund – Is the Affordable Care Act Helping Consumers Get Health Care?

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March-June 2017

By Munira Z. Gunja, Sara R. Collins and Herman K. Bhupal

With the Affordable Care Act (ACA)’s open enrollment period for marketplace plans under way, most attention has focused on the cost of this coverage. But what about consumers’ views about the doctors covered by their insurance and their ability to get timely care from primary care physicians and specialists?

Read More

Click here to view the chartpack


12/06/17 – CHCS – Advancing Medicare and Medicaid Integration: Key Program Features and Factors Driving State Investment

By Alexandra Kruse, Stephanie Gibbs and Leah Smith

Today, there are more than 11 million individuals who receive services from both Medicare and Medicaid. For these dually eligible beneficiaries, care is often fragmented across a wide array of medical, behavioral health, and long-term care providers. All of these services and supports need to be coordinated effectively to improve care for this population, yet Medicare and Medicaid offer otherwise uncoordinated systems of care with different eligibility criteria, benefits, provider networks, and enrollment processes.

Read More

Click here to view the infographic


11/30/17 – Avalere – Plans with More Restrictive Networks Comprise 73% of Exchange Market

Deductibles Remain High, Nearing $4,000 on Average for Silver Plans

By Caroline F. Pearson and Elizabeth Carpenter

New analysis from Avalere finds that plans with more restrictive networks, including health maintenance organizations (HMOs) and exclusive provider organizations (EPOs), continue to dominate the exchange market, with 73% of the 2018 market comprised of restrictive network plans, up from 68% in 2017 and 54% in 2015. Only 27% of plans are Preferred Provider Organizations (PPO) or Point of Service (POS) plans, which typically cover care with a broader network.

Read More


11/21/17 – The Commonwealth Fund – Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not

By Allen Dobson, Joan Da Vanzo, Randy Haught, and Phap-Hoa Luu

Issue: Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability.
 
Goal: To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not.
 
Methods: Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins.
 
Findings and Conclusions: Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.
 

Kaiser Family Foundation – Explaining Health Care Reform: Questions About Health Insurance Subsidies

Health insurance can be expensive, and is therefore often out of reach for lower and moderate income families, particularly if they are not offered health benefits at work. To make coverage obtainable for families that otherwise could not afford it and to encourage broad participation in health insurance, the Affordable Care Act (ACA) includes provisions to lower premiums and out-of-pocket costs for people with low and modest incomes. The adequacy of this assistance will be a key determinant of how many people ultimately gain coverage and whether or not lower-income people will be able to use the health insurance they obtain.

Read More


10/25/2017 – Kaiser Health News – Federal Judge Denies Bid to Force Feds to Resume ACA Subsidies

By Ngoc Nguyen

A federal judge Wednesday denied a petition to immediately reinstate Affordable Care Act subsidies that President Donald Trump suspended earlier this month.

Read More


Kaiser Family Foundation

Estimates of Eligibility Coverage for ACA Coverage Among the Uninsured in 2016

By Rachel Garfield, Anthony Damico, Julia Foutz, Gary Claxton, and Larry Levitt

Despite historic coverage gains under the Affordable Care Act (ACA), more than 27 million people in the United States remain without insurance coverage.1 Recent debate over the future of the ACA has led to uncertainty about whether and how ACA coverage will be maintained. The public reports confusion about the future of the law, and outreach to help inform people about coverage options is more limited than in past years. Still, millions of currently uninsured people are eligible for ACA coverage under current law, and given upcoming open enrollment, it is helpful to understand how many people could potentially gain ACA coverage. In addition, the administration has indicated to states that it is open to state Medicaid waiver proposals, which may lead some states that have not yet expanded Medicaid under the ACA to develop Medicaid expansion waivers and further extend coverage. Understanding how many people might be eligible for coverage under the ACA or could be reached with policy changes can inform these policy discussions.

Read More

Click here to view Technical Appendix A

Click here to view Technical Appendix B

Click here to view Technical Appendix C


10/25/2017 – The Commonwealth Fund – Medicaid Payment and Delivery System Reform: Early Insights from 10 Medicaid Expansion States

By Sara Rosenbaum, Sara Schmucker, Sara Rothenberg, Rachel Gunsalus, and J. Zoe Beckerman  

Issue: Expanded Medicaid enrollment under the Affordable Care Act has heightened the importance of states’ roles as principal purchasers of health care for low-income and medically vulnerable populations. Concurrently, the federal government has augmented states’ purchasing tools.
 
Goal: To examine the evolution of payment and delivery system reform in 10 ACA Medicaid expansion states.
 
Methods: Analysis of state managed care policies, including a detailed review of purchasing documents as well as interviews with senior agency officials in 10 states.
 
Findings and Conclusions: States have made health system reform a core element of their Medicaid expansions, with the aim of improving access, quality, efficiency, and population health. States have sought to incorporate evidence-based practice and payment strategies, with an emphasis on populations likely to benefit from improved care management and on better integration of treatment for physical and behavioral health problems. Seven of 10 are directly engaged in provider payment and delivery system reform. Agencies noted the importance of experienced provider networks in addressing complex health and social needs, along with managed care’s role in quality improvement and payment reform. States embrace their roles as payers and health care innovators, identifying stability of both coverage and the underlying federal policy environment as key factors.
 
 

10/24/2017 – The Commonwealth Fund – Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care

By Elizabeth Edwards 

Issue: As states consider how to effectively control Medicaid costs, many are looking to integrate behavioral and medical care, including long-term services and supports, particularly for individuals with complex needs.
 
Goal: To summarize how recent federal regulations are encouraging an integrated approach to behavioral and physical health care.
 
Findings and Conclusions: Two recent federal rules issued in 2016 are facilitating the transition to integrated care models: the Medicaid managed care rule and the Medicaid managed care mental health parity rule. These changes may not spell the end of fragmented systems, but they certainly do not support a status quo approach to care. While the regulations do not specifically address integrated care, they should facilitate and, in some instances, encourage, state movement to integrated care for Medicaid participants.
 

10/11/2017 – Kaiser Health News – California Slaps Surcharge on ACA Plans as Trump Remains Coy on Subsidies

By Chad Terhune

California’s health exchange said Wednesday it has ordered insurers to add a surcharge to certain policies next year because the Trump administration has yet to commit to paying a key set of consumer subsidies under the Affordable Care Act.

Read More


10/11/2017 – The Commonwealth Fund – Cuts to the ACA’s Outreach Budget Will Make It Harder for People to Enroll

By Shanoor Seervai

At a recent concert in Clearwater, Florida, Jodi Ray was proud to recognize the lead singer — a previously uninsured man in his forties, whom she helped get health coverage. Ray, who directs a navigator program that helps individuals enroll in health insurance in Florida, guided him through the process of buying a plan through the Affordable Care Act’s (ACA) health insurance marketplace.

Read More


10/11/2017 – The Commonwealth Fund – How Have Health Insurers Performed Financially under the ACA’s Market Rules?

By Michael J. McCue and Mark A. Hall

The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers’ transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving.

Read More


10/11/2017 – Kaiser Family Foundation – Survey: Adjusting to Sudden Reduction in Federal Funds, ACA Navigators Expect to Decrease Services

New Report Compares Navigator Funding Changes with Their Reported Performance Metrics – Many navigator organizations responsible for helping consumers understand and sign up for health coverage in 2018 Affordable Care Act (ACA) marketplaces say steep federal funding reductions that recently took effect will likely force them to limit their geographic service area, cut back outreach and public education, lay off staff members, and curtail other assistance, according to a new Kaiser Family Foundation survey of such programs.

Read More

Click here to view data note


09/28/2017 – ICRC – Key Medicare Advantage Dates and Action Items for States Contracting with Dual Eligible Special Needs Plans

Many states are exploring strategies to integrate the financing and delivery of services for individuals dually eligible for Medicare and Medicaid. Through their Medicaid agency contracts with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), states have the opportunity to integrate care for dually eligible beneficiaries.

Read More


09/26/2017 – Avalere – Updated Analysis: Revised Graham-Cassidy Bill Would Reduce Federal Funding to States by $205B

By Chris Sloan and Richard Kane

This version of the bill would lead to a reduction in federal funding to states by $205B through 2026 and more than $4T over a 20-year period.

Read More


09/25/2017 – Kaiser Family Foundation – Public Opinion on ACA Replacement Plans: Interactive

This interactive tracks the public’s views of the Affordable Care Act replacement plans over the past several months. By collecting data from various surveys of adults in the U.S. conducted by Kaiser and others, we show how the public’s views have changed or remained stable as Congress considers major changes to the U.S. health care system and details of the plans have emerged from the House and the Senate. The interactive nature of the tool also allows users to explore how views vary by party identification, a key factor in people’s views of the ACA and plans to replace it, as well as among supporters of President Trump.  Access a downloadable table of the poll results.

Read More

Click here to view a downloadable table of the poll results


09/25/2017 – Kaiser Family Foundation – The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review

By Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artigo

A substantial body of research has investigated effects of the Medicaid expansion under the Affordable Care Act (ACA) on coverage, access to care, and various economic measures. These findings can inform understanding of the broader effects of the ACA and ongoing debate over ACA repeal, including the Medicaid expansion.

Read More

Click here to view the Appendix


09/13/2017 – Kaiser Family Foundation – Section 1115 Medicaid Demonstration Waivers: A Look at the Current Landscape of Approved and Pending Waivers

By Elizabeth Hinton, MaryBeth Musumeci, Robin Rudowitz, and Larisa Antonisse

Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law, and can have a significant impact on program financing. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS) (see Appendix A). As of September 2017, there are 33 states with 41 approved waivers1 and 18 states with 21 pending waivers (see Appendix B and C for detailed tables).2 3 This brief answers basic questions about Section 1115 waiver authority and discusses the current landscape of approved and pending demonstration waivers (Figure 1).

Read More


09/07/2017 – The Commonwealth Fund - Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage?

Findings from the Commonwealth Funds Affordable Care Act Tracking Survey, March-June 2017

By Sara R. Collins, Munira Z. Gunja and Michelle M. Doty

Issue: After Congress’s failure to repeal and replace the Affordable Care Act, some policy leaders are calling for bipartisan approaches to address weaknesses in the law’s coverage expansions. To do this, policymakers will need data about trends in insurance coverage, reasons why people remain uninsured, and consumer perceptions of affordability.
Goal: To examine U.S. trends in insurance coverage and the demographics of the remaining uninsured population, as well as affordability and satisfaction among adults with marketplace and Medicaid coverage.
Methods: Analysis of the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017.
Findings and Conclusions: The uninsured rate among 19-to-64-year-old adults was 14 percent in 2017, or an estimated 27 million people, statistically unchanged from one year earlier. Uninsured rates ticked up significantly in three subgroups: 35-to-49-year-olds, adults with incomes of 400 percent of poverty or more (about $48,000 for an individual), and adults living in states that had not expanded Medicaid. Half of uninsured adults, or an estimated 13 million, are likely eligible for marketplace subsidies or the Medicaid expansion in their state. Four of 10 uninsured adults are unaware of the marketplaces. Adults in marketplace plans with incomes below 250 percent of poverty are much more likely to view their premiums as easy to afford compared with people with higher incomes. Policies to improve coverage include a federal commitment to supporting the marketplaces and the 2018 open enrollment period, expansion of Medicaid in 19 remaining states, and enhanced subsidies for people with incomes of 250 percent of poverty or more.
 
 
 
 
 
 
 

09/05/2017 – The Commonwealth Fund – A Glimmer of Bipartisanship on the ACA

By David Blumenthal, M.D.

With the eclipse of Republican efforts to repeal and replace the Affordable Care Act (ACA), bipartisan approaches to improving the law are having a moment in the sun. This week, Senators Lamar Alexander (R-Tenn.) and Patti Murray (D-Wash.) are cosponsoring hearings before the Senate Health, Education, Labor and Pensions (HELP) committee on bipartisan solutions to stabilizing private health insurance markets. The Problem-Solvers — a new caucus of House Democrats and Republicans — are similarly at work on a cross-party package of reforms. Eight governors have released a bipartisan plan, as has a group of health policy experts with mixed party affiliations.

Read More


08/30/2017 – ICRC – Technical Assistance Tool – August 2017

Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working With Managed Care Delivery Systems

By Melanie Au, Claire Postman and James Verdier

A growing number of states are integrating physical and behavioral health services for beneficiaries dually eligible for Medicare and Medicaid. These beneficiaries not only have complex needs, but must also navigate between separate programs (Medicare and Medicaid) and care delivery systems (physical and behavioral health) for their services. This brief explores the experience of six states that have achieved varying levels of behavioral health and physical health integration or collaboration for dually eligible beneficiaries within a managed care environment. States are implementing their models of integration (e.g., comprehensive carve-in models, specialty plans for beneficiaries with serious mental illness, hybrid models, and coordinated carve-out models) through contracts with Medicare-Medicaid Plans or Medicaid managed care plans that are aligned with Medicare Advantage Dual Eligible Special Needs Plans.
 
 

08/16/2017 – Kaiser Family Foundation - Section 1115 Medicaid Expansion Waivers: A Look at Key Themes and State Specific Waiver Provisions

By MaryBeth Musumeci, Elizabeth Hinton, and Robin Rudowitz

Seven states currently are implementing the Affordable Care Act’s (ACA) Medicaid expansion to low income adults up to 138% of the federal poverty level (FPL, $16,643 per year for an individual in 2017) in ways that extend beyond the flexibility provided by the law through Section 1115 demonstration waivers. While the future of federal legislation affecting the Medicaid expansion is unclear at this time, Section 1115 Medicaid expansion waiver activity continues as states submit amendments, extensions, and new waivers. While no decisions on expansion waivers have been issued under the new Administration to date, the Administration’s March, 2017 letter to state governors signaled some potential policy changes beyond what has been approved in the past. This issue brief focuses on approved (Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire) and pending (Arkansas, Kentucky, Indiana, Iowa, and Massachusetts) Section 1115 waivers that implement the ACA’s Medicaid expansion. 

Read More


08/11/2017 – Kaiser Family Foundation - Kaiser Health Tracking Poll – August 2017: The Politics of ACA Repeal and Replace Efforts

By Ashley Kirzinger, Bianca DiJulio, Bryan Wu, and Mollyann Brodie

The August Kaiser Health Tracking Poll finds that the majority of the public (60 percent) say it is a “good thing” that the Senate did not pass the bill that would have repealed and replaced the ACA. Since then, President Trump has suggested Congress not take on other issues, like tax reform, until it passes a replacement plan for the ACA, but six in ten Americans (62 percent) disagree with this approach, while one-third (34 percent) agree with it.

Read More

Click here to read the topline and methodology


08/10/2017 – Kaiser Family Foundation - An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges

By Rabah Kamal, Cynthia Cox, Care Shoaibi, Brian Kaplun, Ashley Semanskee, and Larry Levitt

Each year insurers submit filings to state regulators detailing their plans to participate on the Affordable Care Act marketplaces (also called exchanges). These filings include information on the premiums insurers plan to charge in the coming year and which areas they plan to serve. Each state or the federal government reviews premiums to ensure they are accurate and justifiable before the rate goes into effect, though regulators have varying types of authority and states make varying amounts of information public.

Read More


07/28/2017 – CHCS - Medicaid Accountable Care Organization Shared Savings Programs: Options for Maximizing Provider Participation and Program Sustainability

By Rachael Matulis

Many states that have successfully launched Medicaid accountable care organization (ACO) programs in recent years have adopted a shared savings payment model. A general issue with shared savings programs is that they typically use a total cost of care (TCoC) benchmark that is based at least in part on an ACO’s historical spending, which means that health systems with higher costs and more waste may be more likely to share in savings than more efficient providers. A related concern is that as ACOs achieve cost savings, there may be a threat of payment cuts down the road, given that payment rates are often based on historic costs and use.

Read More


07/25/2017 – The Kaiser Family Foundation - Using Medicaid to Wrap Around Private Insurance: Key Questions to Consider

By MaryBeth Musumeci, Robin Rudowitz, and Rachel Garfield

The Senate is currently considering the Better Care Reconciliation Act (BCRA). This bill goes beyond repeal and replacement of the Affordable Care Act (ACA) to make major changes in Medicaid program financing that would reduce federal funding by $756 billion from 2017-2026 and lead to 15 million fewer people covered by Medicaid by 2026, according to the latest Congressional Budget Office estimate.  Most of this reduction is due to changing federal Medicaid financing to a per capita cap beginning in 2020 and eliminating the enhanced federal matching funds for the ACA’s Medicaid expansion by 2024.

Read More


07/19/2017 – Kaiser Family Foundation - Better Care Reconciliation Act (BCRA): State-by-State Estimates of Reductions in Federal Medicaid Funding

By Rachel Garfield, Robin Rudowitz, and Allison Valentine

The Senate recently considered legislation called the Better Care Reconciliation Act of 2017 (BCRA), proposed on June 22, 2017 and revised on July 13, 2017. This bill differs in some ways from the American Health Care Act (AHCA) that passed in the House in May 2017 but maintains a similar overall framework in its treatment of Medicaid. While referred to as legislation to repeal and replace the Affordable Care Act (ACA), both the BCRA and the AHCA make more fundamental changes to Medicaid by phasing out the enhanced federal matching funds for the ACA Medicaid expansion and by setting a limit on federal funding through a per capita cap or, at state option, a block grant for some enrollees.

Read More


07/19/2017 – Kaiser Family Foundation - State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion

By Rachel Garfield and Robin Rudowitz

The Senate is currently considering the Obamacare Repeal Reconciliation Act of 2017. While there are a number of provisions that affect Medicaid, the primary change would be the elimination of the statutory authority to cover childless adults up to 138% FPL ($16,643 for an individual in 2017) as well as an elimination of the enhanced match rate for the Medicaid expansion.

Read More


07/11/2017 – ICRC - Preventing Improper Billing of Medicare-Medicaid Enrollees in Managed Care: Strategies for States and Dual Eligible Special Needs Plans

By Claire Postman and James Verdier

Medicaid provides some degree of coverage for Medicare deductibles, copayments, and coinsurance amounts for about 85 percent of dually eligible beneficiaries. The vast majority of these Medicare-Medicaid enrollees are Qualified Medicare Beneficiaries and are protected from billing by any providers for unpaid Medicare cost-sharing. Although providers are prohibited from billing these protected beneficiaries for cost-sharing, improper billing continues to be an issue. The complexity of processing Medicare claims for cost-sharing, state policies concerning Medicare cost-sharing payments, and lack of provider awareness about billing prohibitions may contribute to the persistence of this issue. This brief explores strategies that states and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) can use to streamline claims processing and communicate with providers and members in order to prevent instances of improper billing.

Read More


07/06/2017 – Kaiser Family Foundation - What Are the Implications for Medicare of the American Health Care Act and the Better Care Reconciliation Act?

By Juliette Cubanski and Tricia Neuman

An important question in the debate over proposals to repeal and replace the Affordable Care Act (ACA) is what might happen to the law’s many provisions affecting the Medicare program. The American Health Care Act (AHCA), which was passed by the House of Representative on May 4, 2017, and the Better Care Reconciliation Act (BCRA), released by Senate Republicans on June 22, 2017, would leave most ACA changes to Medicare intact, including the benefit improvements (no-cost preventive services and closing the Part D coverage gap), reductions to payments to health care providers and Medicare Advantage plans, the Independent Payment Advisory Board, and the Center for Medicare and Medicaid Innovation.

Read More


06/26/2017 – Kaiser Family Foundation - Premiums Under The Senate Better Care Reconciliation Act

By Gary Claxton, Anthony Damico, Larry Levitt, and Cynthia Cox

The Senate Better Care Reconciliation Act (BCRA) would make significant changes to the amounts that people pay for nongroup coverage and for the care they receive under the Affordable Care Act (ACA). The tables below provide estimates of how premiums after taking into account tax credits would change for people currently enrolled in the federal and state marketplaces.

Read More


06/26/2017 – Congressional Budget Office - H.R. 1628, Better Care Reconciliation Act of 2017

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives.

Read More


06/26/2017 – CHCS - Medicaid Managed Long-Term Services and Supports Programs: State Update

Medicaid is the nation’s largest payer of long-term services and supports (LTSS), funding these services for nearly five million Americans. An increasing number of state Medicaid agencies — 22 as of July 2017 — are providing LTSS through capitated contracts with managed care organizations, with roughly 1.2 million individuals enrolled in comprehensive managed care plans that include LTSS or managed LTSS-only plans. These managed LTSS (MLTSS) programs cover services like personal care, home-delivered meals, and transportation that are used by children and adults with functional limitations and/or chronic illnesses who need assistance with bathing, dressing, shopping, and housework, as well as other activities.

Read More


06/14/2017 – The Commonwealth Fund - The American Health Care Act: Economic and Employment Consequences for States

By Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian Bruen

The American Health Care Act (AHCA), passed by the U.S. House of Representatives, would repeal and replace the Affordable Care Act. The Congressional Budget Office indicates that the AHCA could increase the number of uninsured by 23 million by 2026.

Read More

Click here to read the Appendices

Click here to read the State Fact Sheet


06/13/2017 – CHCS - Medicaid Accountable Care Organizations: State Update

Across the country, states are exploring the viability of Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. Currently, 10 states have active Medicaid ACO programs, and at least 13 more are pursuing them.

Read More


06/12/2017 – CHCS - Medicaid Health Homes: Implementation Update

Medicaid health homes, made possible under Section 2703 of the Affordable Care Act, provide states with a mechanism to support better care management for people with complex health needs with the goal of improving health outcomes and curbing costs. As of June 2017, 21 states and the District of Columbia have 32 approved Medicaid health home models in operation. 

Read More


06/11/2017 – Integrated Care Resource Center - State and Health Plan Strategies to Grow Enrollment in Integrated Managed Care Plans for Dually Eligible Beneficiaries

By James Verdier and Danielle Chelminsky, Mathematica Policy Research

States and health plans that provide Medicare and Medicaid services to dually eligible beneficiaries can work together to achieve the levels of enrollment that are needed to support effective health plan coordination of these services. States can support enrollment growth through program design decisions, marketing support, and beneficiary education. Health plans have an especially important role in retaining and growing their enrollment in an environment in which enrollment for Medicare services is voluntary. They must consistently demonstrate that they can provide better access to and coordination of Medicare and Medicaid services than other alternatives and ensure enrollees’ timely and appropriate care. Plans’ ability to retain enrollment can be monitored through a standardized measure of voluntary disenrollment from the plan that is reported each year in the Centers for Medicare & Medicaid Services star ratings system for Medicare managed care plans.

Read More


06/05/2017 – Kaiser Family Foundation - How ACA Repeal and Replace Proposals Could Affect Coverage and Premiums for Older Adults and Have Spillover Effects for Medicare

By Tricia Neuman, Karen Pollitz, and Larry Levitt

Now that the House has passed its bill to repeal and replace the Affordable Care Act (ACA), Senate negotiators face a number of policy decisions that could be of particular interest to older adults who are not quite old enough for Medicare.  Prior to the ACA, adults in their fifties and early 60s were arguably most at risk in the private health insurance market.  They were more likely than younger adults to be diagnosed with certain conditions, like cancer and diabetes, for which insurers denied coverage.  They were also more likely to face unaffordable premiums because insurers had broad latitude (in nearly all states) to set high premiums for older and sicker enrollees.

Read More


05/31/2017 – Kaiser Family Foundation - Poll: Public Views the ACA More Favorably Than Congress’ Plan to Replace It, Though Republicans Favor the Replacement

Majority Says the Senate Either Should Make Major Changes or Not Pass The House Bill At All, While About a Third Want the Senate to Pass It As Is or With Only Minor Changes

Most (55%) of the public holds an unfavorable view of the Congressional plan that would repeal and replace the Affordable Care Act, and the same share (55%) want the Senate either to make major changes to the House-passed bill or not pass it all, finds the latest Kaiser Health Tracking Poll.

Read More

Click here to read the Kaiser Health Tracking Poll


05/30/2017 – The Commonwealth Fund - High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long Term

By Deborah Lorber

The American Health Care Act (AHCA), recently passed by the U.S. House of Representatives, would segregate people with preexisting health conditions from the broader insurance pool and place these potentially costly patients into high-risk pools. Prior to the Affordable Care Act, 35 states had high-risk pools, but these programs were not effective in making insurance affordable or accessible. In a commentary for Annals of Internal Medicine, Commonwealth Fund grantee Jean P. Hall, Ph.D., considers the problems of high-risk pools and why restoring them would be “a huge step backward for American health care policy.” 

Read More


05/24/2017 – Congressional Budget Office – Cost Estimate H.R. 1628 American Health Care Act of 2017

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of H.R. 1628, the American Health Care Act of 2017, as passed by the House of Representatives. CBO and JCT estimate that enacting that version of H.R. 1628 would reduce the cumulative federal deficit over the 2017-2026 period by $119 billion. That amount is $32 billion less than the estimated net savings for the version of H.R. 1628 that was posted on the website of the House Committee on Rules on March 22, 2017, incorporating manager’s amendments 4, 5, 24, and 25. (CBO issued a cost estimate for that earlier version of the legislation on March 23, 2017.)

Read More


05/17/2017 – Kaiser Family Foundation - Data Note: Medicaid’s Role in Providing Access to Preventive Care for Adults

By Leighton Ku, Julia Paradise, and Victoria Thompson

Medicaid, the nation’s public health insurance program for people with low income, covers 74 million Americans today, including millions of low-income adults. The Affordable Care Act (ACA) expanded Medicaid to nonelderly adults with income up to 138% of the federal poverty level (FPL), and, in the 32 states (including DC) that implemented the expansion, more than 11 million adults have gained Medicaid as a result. Chronic illness is prevalent in the adult Medicaid population. Preventive care, including immunizations and regular screenings that permit early detection and treatment of chronic conditions, improves the prospects for better health outcomes. This Data Note focuses on Medicaid’s role in providing access to preventive care for low-income adults.

Read More


05/12/2017 – CHCS - Demonstrating the Value of Medicaid Managed Long-Term Services and Supports Programs

By Camille Dobson, Stephanie Gibbs, Adam Mosey, and Leah Smith

States are increasingly implementing Medicaid managed long-term services and supports (MLTSS) programs to accomplish goals including rebalancing spending from institutional care to home- and community-based services, improving beneficiary experience, and better managing costs. But there is relatively limited evidence of the value of these efforts.

Read More


05/10/2017 – CHCS - Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs

States interested in using an accountable care organization (ACO) model for Medicaid populations must think critically about which metrics are best-suited to promote enhanced access and care coordination and encourage provider accountability for these outcomes. There is considerable variety in state Medicaid ACO measurement approaches related to access, quality, clinical, and cost goals. Quality measure requirements for ACOs can range from simple collection and reporting to advanced expectations involving achievement thresholds, benchmark comparisons, and/or rates of improvement over time. Methodologies to calculate performance-based payments can range similarly in complexity.

Read More


04/27/2017 – The Commonwealth Fund - Medicaid Provides Equal- Or Better-Quality Health Insurance Coverage Than Private Plans As Well As More Financial Protection

Commonwealth Fund’s Biennial Health Insurance Survey Finds People with Medicaid Have Better Access to Health Care Than the Uninsured and Fewer Medical Bill Problems

Having Medicaid is not only substantially better than being uninsured, but it provides enrollees with health insurance that on most measures is as good as or, in some cases, better than private coverage, according to new a Commonwealth Fund report. Medicaid is currently the nation’s largest health insurer, covering more than 70 million people, about 12 million of whom enrolled when 31 states and the District of Columbia expanded eligibility for the program under the Affordable Care Act (ACA).

Read More

Click here to veiw the issue brief.

Click here to view the chartpack.

Click here to view Appendix Table 1.


04/26/2017 – Kaiser Family Foundation - Poll: Majority Opposes Hard-Ball Negotiating Tactics to Replace the Affordable Care Act, But Republicans Support It

Three Quarters of Public, Including Half of Trump Backers, Want President and Congress to Make the Law Work

With President Trump and Congress continuing to discuss repealing and replacing the Affordable Care Act, a majority of the public opposes using hard-ball tactics as a way to force Democrats in Congress to negotiate a replacement, the latest Kaiser Health Tracking Poll finds.  President Trump recently suggested that his administration and Congress could push Democrats to negotiate a replacement to the Affordable Care Act by stopping payments for the law’s cost-sharing reductions, which experts say would likely cause insurers to raise premiums or stop offering coverage through the ACA’s marketplaces.

Read More

Click here to view the Kaiser Health Tracking Poll.


04/25/2017 – Kaiser Family Foundation - Federal Government Could See Net Increase of $2.3 Billion in Costs in 2018 if ACA Cost-Sharing Reduction Payments Eliminated

On Average, Premiums for Silver Plans Would Need to Rise 19% to Offset Lack of Funding for Cost-Sharing Reductions, Triggering Tax Credit Increases

Ceasing payments for the Affordable Care Act’s (ACA) cost-sharing reduction program could save $10 billion, but cost an additional $12.3 billion in premium tax credits – an estimated net increase of $2.3 billion, or 23 percent, in federal spending on marketplace subsidies – in 2018, if insurers continue to participate in ACA marketplaces, according to a new analysis from the Kaiser Family Foundation.

Read More

Click here to view the issue brief


04/24/2017 – Kasier Family Foundation - Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion

By Julia Paradise

The Medicaid program covers more than 74 million Americans, or 1 in 5, including low-income pregnant women, children, and parents, seniors, people with disabilities, and, in Medicaid expansion states, nearly all low-income nonelderly adults. Most states today rely heavily on risk-based managed care organizations to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and addresses differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.

Read More


04/21/2017 – Kaiser Family Foundation - Analysis: Insurer Financial Indicators Show Signs of Stabilizing After Transition to ACA Marketplaces

A new Kaiser Family Foundation analysis of key insurer financial indicators suggests that the individual insurance market showed signs of stabilizing in 2016, although profitability remained below the level of performance prior to the opening of the Affordable Care Act’s insurance marketplaces.  The new analysis tracks insurer financial performance in the individual market through two key indicators: average medical loss ratios (the share of health premiums paid out as claims) and average gross margins per member per month (the average amount by which premium income exceeds claims costs per enrollee in a given month).

Read More

Click here to view that data note


04/20/2017 – Avalere - Medicaid Per Capita Caps Could Cut Funding for Dual Eligible Beneficiaries

Capping Medicaid Funding Could Also Shift Costs To Medicare

By Caroline F. Pearson and Tiernan Meyer

New modeling from Avalere finds that proposals to limit per capita federal Medicaid funding growth based on medical inflation could lead to a $44 billion spending cut for dual eligible beneficiaries—or people who qualify for both Medicaid and Medicare—over the next 10 years. Capped funding proposals have been included as part of recent Affordable Care Act (ACA) repeal conversations in Congress. While the future of these legislative initiatives remains uncertain, policymakers are expected to continue considering Medicaid reforms, which could have a significant effect on beneficiaries, states, and Medicare.

Read More

Click here to view the full analysis


04/19/2017 – The Commonwealth Fund - Essential Facts About Health Reform Alternatives: Continuous Coverage Requirement

Proposed alternatives to the Affordable Care Act (ACA) would require Americans to continuously carry health insurance coverage or be penalized with higher premiums. Under the American Health Care Act (AHCA)—the Republican bill introduced in the U.S. House of Representatives and subsequently withdrawn—people whose insurance coverage lapsed for more than 63 days would be charged a 30 percent premium surcharge every month for 12 months when they repurchase coverage. This penalty was intended to encourage people to maintain coverage and ensure the stability of insurance markets.

Read More


04/12/2017 – The Commonwealth Fund - Substantial Physician Turnover and Beneficiary “Churn” in a Large Medicare Pioneer ACO

A study of one of the nation’s largest Medicare accountable care organizations (ACOs) found that participating physicians see a relatively small number of patients who are actually part of the ACO population: less than 5 percent of a typical patient panel consists of ACO patients. The ACO also experiences substantial physician turnover. And when physicians leave the ACO, most of their attributed beneficiaries leave as well.

Read More


04/11/2017 – The Commonwealth Fund - Essential Facts About Health Reform Alternatives: Medicaid Per Capita Caps

To lower government spending on Medicaid, some conservatives have proposed limiting the federal contribution to each enrollee’s health coverage. The American Health Care Act, the Republican-backed bill recently introduced into the U.S. House of Representatives as a replacement for the Affordable Care Act (ACA), includes a provision that would transition federal Medicaid funding to a per person basis by 2020. 

Read More


04/06/2017 - Kaiser Family Foundation - Governor’s Proposed Budgets for FY 2018: Focus on Medicaid and Other Health Priorities

By Larisa Antonisse, Elizabeth Hinton, Robin Rudowitz, Kathleen Gifford, and Nicole McMahon

This report provides Medicaid highlights from governors’ proposed budgets for state fiscal year (FY) 2018, which runs from July 1, 2017 through June 30, 2018 in most states. Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider. As of the 2017 legislative session, 31 governors are from the same party as their legislatures (24 Republican and 7 Democratic states) and 18 governors are from different parties than their legislatures. As governors were issuing proposed budgets for FY 2018, federal lawmakers were debating the American Health Care Act (AHCA) which included major changes to the ACA as well as fundamental reforms for the structure and funding of the Medicaid program. While the AHCA failed to pass in the House, discussions on Medicaid reform are likely to continue at the federal level.

Read More


04/04/2017 – Kaiser Family Foundation - Three Quarters of the Public, Including a Majority of Trump Supporters, Want President Trump to Try to Make the Affordable Care Act Work 

Most Say President Trump and Republicans Are Responsible for the ACA Now, Not President Obama and Democrats

Despite divided views about the Affordable Care Act, three-fourths of the public (75%) say President Trump and his administration should do what they can to make the law work, while one in five (19%), including 38 percent of Republicans, say the Administration should do what it can to make the law fail so they can replace it later, the latest Kaiser Health Tracking Poll finds.  Fielded after the U.S. House cancelled its March 24 vote on a plan to repeal and replace the Affordable Care Act supported by President Trump and House Speaker Paul Ryan, the poll finds majorities of Democrats (89%) and independents (78%), and half of Republicans (51%) want the Trump Administration to make the law work, as do a majority of President Trump’s supporters (54%).

Read More

Click here to view the Kaiser Health Tracking Poll


04/03/2017 – CHCS - Practice Transformation Assistance in State Innovation Models

By Katherine Heflin and Anna Spencer

The federal State Innovation Model (SIM) initiative is striving to achieve statewide multi-payer care delivery and payment reforms for roughly 80 percent of the population within participating states. To realize this goal, SIM states and territories are helping health care providers transform their practices to be more patient-centered, while improving patient outcomes and reducing health care spending.

Read More


03/20/2017 – CHCS - Update on Medicare-Medicaid Integration

Over 11 million individuals across the United States are eligible for both Medicare and Medicaid. These people, known as Medicare-Medicaid enrollees or dually eligible beneficiaries, often have significant health and social service needs, making them among the nation’s highest-need, highest-cost populations.  As of March 2017, over 750,000 dually eligible beneficiaries are enrolled in programs that integrate Medicare and Medicaid.
 

CMS & HHS Releases

10/30/18 – HHS Announces the Official Opening of the Health Sector Cybersecurity Coordination Center

On Monday, October 29, the Deputy Secretary of the Department of Health and Human Services (HHS), Eric Hargan, announced the official dedication of the Health Sector Cybersecurity Coordination Center (HC3) at an official opening ceremony in the Hubert H. Humphrey building.  As part of October’s National Cybersecurity Awareness Month, and in coordination with the Administration’s rollout of the National Cyber Strategy, the opening underscores HHS’ commitment to support and improve the health sector’s cybersecurity defenses.

Read More


10/26/18 – CMS Acts to Help with Typhoon Yutu Emergency Response

Agency waivers to take effect in the Northern Mariana Islands

The Centers for Medicare & Medicaid Services (CMS) today announced that the agency has acted to support the Northern Mariana Islands in response to Typhoon Yutu. This week, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in the Northern Mariana Islands. With the PHE in effect, CMS has taken several actions to provide immediate relief to those impacted by the typhoon. The actions will include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.

Read More


10/26/18 – CMS Proposes to Modernize Medicare Advantage, Expand Telehealth Access for Patients

Proposed rule would strengthen the popular system for private health insurance plans to provide Medicare coverage, increase plan flexibility to offer telehealth benefits, and improve coordination for dual-eligible beneficiaries

In a proposed rule issued today, the Centers for Medicare & Medicaid Services (CMS) took action to build upon the Administration’s ongoing efforts to modernize the Medicare Advantage and Part D programs, which provide seniors with Medicare health and prescription drug coverage through private plans. The changes proposed today would allow plans to cover additional telehealth benefits and would make other much-needed updates, including for individuals who are eligible for Medicare Advantage special needs plans.
 

10/25/18 – HHS Advances Payment Model to Lower Drug Costs for Patients

The International Pricing Index (IPI) Model would lower costs for physician-administered drugs by resetting Medicare payments based on international prices and introducing competition

On Thursday, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced and sought input on a new “International Pricing Index” (IPI) payment model to reduce what Americans pay for prescription drugs.

Read More


10/23/18 – CMS model addresses opioid misuse among expectant and new mothers

Goals are to improve quality of care, increase access to treatment based on state-specific needs, and reduce expenditures

Today the Centers for Medicare & Medicaid Services (CMS) announced the Maternal Opioid Misuse (MOM) model, an important step in advancing the agency’s multi-pronged strategy to combat the nation’s opioid crisis. The model addresses the need to better align and coordinate care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the MOM model has the potential to improve quality of care and reduce expenditures for mothers and infants.
 
 

10/22/18 – Trump Administration announces State Relief and Empowerment Waivers to give states the flexibility to lower premiums and increase choices for their health insurance markets

States could develop innovative solutions to help their consumers combat skyrocketing premiums and limited plan options

Today, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of the Treasury (collectively, the Departments) issued new guidance so states can move their insurance markets away from the one-size-fits-all rules and regulations imposed by the Affordable Care Act (ACA) and increase choice and competition within their insurance markets. The new guidance grants states more flexibility to design alternatives to the ACA and to give Americans more options to get health coverage that better meets their needs. Under this new policy, states will be able to pursue waivers to improve their insurance markets, increase affordable coverage options for their residents, and ensure that people with pre-existing conditions are protected. These waivers are called State Relief and Empowerment Waivers to reflect this new direction and opportunity.

Read More

Click here to view fact sheet


10/19/18 – CMS Responding to Suspicious Activity in Agent and Broker Exchanges Portal

Earlier this week, CMS staff detected anomalous activity in the Federally Facilitated Exchanges, or FFE’s Direct Enrollment pathway for agents and brokers. The Direct Enrollment pathway, first launched in 2013, allows agents and brokers to assist consumers with applications for coverage in the FFE.

Read More


10/18/18 – HHS Activates Aid for Uninsured Floridians Needing Medicine after Hurricane Michael

Thousands of uninsured Floridians are eligible for no-cost replacements of critical medications lost or damaged by Hurricane Michael. This relief comes from the Emergency Prescription Assistance Program (EPAP), managed by the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).

Read More


10/18/18 – HHS awards $293 million to expand primary health care workforce

Today, the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) announced $293 million in awards to primary health care clinicians and students through the National Health Service Corps (NHSC) and Nurse Corps programs.

Read More


10/16/18 - Remarks by Administrator Seema Verma at the America’s Health Insurance Plans (AHIP) 2018 National Conference on Medicare

(As prepared for delivery – October 16, 2018)

Thank you. I am honored to be with you and welcome to your nation’s capital.

Read More


10/16/18 - ONC and OCR Bolster the Security Risk Assessment (SRA) Tool with New Features and Improved Functionality

Patients expect not only quality health care to keep them healthy, but also trust that their most sensitive health information will be protected from threats and vulnerabilities that could lead to the compromise of one’s health information.  An enterprise-wide risk analysis is not only a requirement of the HIPAA Security Rule, it is also an important process to help healthcare organizations understand their security posture to prevent costly data breaches.  What is an enterprise-wide risk analysis?  It is a robust review and analysis of the risks to the confidentiality, integrity, and availability of electronic health information -- across all lines of business, in all facilities, and in all locations.

Read More


10/15/18 - Important New Medicare Card Mailing Update — Wave 7 Begins, Wave 5 Ends

CMS has started mailing new Medicare cards to people with Medicare who live in Wave 7 states and territories including: Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, and the Virgin Islands.
 

10/15/18 - CMS Administrator Seema Verma Statement on Drug Industry Price Transparency Announcement

Read More


10/15/18 - HHS Secretary Azar Comments on Drug Industry Price Transparency Announcement 

Health and Human Services Secretary Alex Azar issued the following statement regarding pharmaceutical companies’ announcement that they would be providing access to more information on drug prices.
 
 

10/15/18 - CMS Proposes to Require Manufacturers to Disclose Drug Prices in Television Ads

Proposed rule would further the Trump Administration’s commitment to lower prescription drug prices by requiring companies to list prices for prescription drugs covered in Medicare or Medicaid

As part of the agency’s ongoing efforts to empower patients and lower prescription drug prices, the Centers for Medicare & Medicaid Services proposed today to require that prescription drug manufacturers post the Wholesale Acquisition Cost (WAC) for drugs covered in Medicare or Medicaid in direct-to-consumer television advertisements.
 
 

10/15/18 - Anthem Pays OCR $16 Million in Record HIPAA Settlement Following Largest U.S. Health Data Breach in History

Anthem, Inc. has agreed to pay $16 million to the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) and take substantial corrective action to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules after a series of cyberattacks led to the largest U.S. health data breach in history and exposed the electronic protected health information of almost 79 million people.

Read More


10/12/18 - Readout of Secretary Azar’s Community Pharmacy and Patient Roundtable in Pittsburgh 

Today, Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services Chief of Staff Paul Mango traveled to Pittsburgh, Pennsylvania to participate in a roundtable discussion at Spartan Pharmacy. The discussion included community pharmacists and their senior patients and covered the legislation recently signed by President Trump banning pharmacy gag clauses.
 

10/12/18 - CMS announces 2019 Medicare Parts A & B premiums and deductibles

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.

Read More


10/11/18 - HHS Secretary Azar declares public health emergency in Georgia due to Hurricane Michael

Health and Human Services (HHS) Secretary Alex Azar today declared a public health emergency in Georgia due to damage from Hurricane Michael. The declaration follows President Trump’s emergency declaration for the state and gives the HHS Centers for Medicare & Medicaid Services beneficiaries and their healthcare providers and suppliers greater flexibility in meeting emergency health needs.
 

10/11/18 - CMS Acts to help with Hurricane Michael Emergency Response

Agency waivers to take effect in Georgia

The Centers for Medicare & Medicaid Services (CMS) today announced that the agency has acted to support Georgia in response to Hurricane Michael. Today, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in Georgia. With the PHE in effect, CMS has taken several actions to provide immediate relief to those impacted by the hurricane. The actions will include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.

Read More


10/11/18 - HHS awards $2.34 billion in grants to help Americans access HIV/AIDS care and medication

Today, the U.S. Department of Health and Human Services announced that approximately $2.34 billion in Ryan White HIV/AIDS Program grants were awarded to cities, counties, states, and local community-based organizations in fiscal year (FY) 2018. This funding through the Health Resources and Services Administration (HRSA) supports a comprehensive system of HIV primary medical care, medication, and essential support services to more than half a million people living with HIV in the United States.
 
 

10/11/18 - Premiums on the Federally-facilitated Exchanges drop in 2019

Administration’s actions provide some relief from skyrocketing premiums

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for second lowest cost silver plans (SLCSP) for the 2019 coverage year will drop by 1.5 percent, the first time average premiums have dropped since the implementation of the Federally- facilitated Exchange in 2014. Tennessee being the largest with a 26.2 percent reduction. These premium reductions along with increased issuer participation strongly suggest that the numerous actions taken by the Trump administration to stabilize the market are working.

Read More


10/10/18 - HHS Secretary Azar Praises Results of President Trump’s Leadership on Drug Pricing 

On Wednesday, President Trump signed legislation that bans pharmacy gag clauses, which prevent pharmacists from informing patients when they can pay less out of pocket for a prescription drug, in both private insurance plans and in Medicare prescription drug plans.
 

10/10/18 - Medicare provides continued access to high-quality health coverage choices in 2019

CMS releases Star Ratings for 2019 Medicare Advantage and Part D prescription drug plans ahead of Medicare Open Enrollment

Today, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries continue to have access to high-quality health choices for their Medicare coverage as the agency releases the Star Ratings for the 2019 Medicare Advantage and Part D prescription drug plans.
 

10/10/18 - HHS expands corporate partnership to protect against health security threats

A strategic partnership will expand between the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) and Johnson & Johnson of New Brunswick, New Jersey.  The expansion will focus on the development of innovative products to combat the potentially deadly health effects of chemical, biological, radiation and nuclear threats, emerging infectious diseases and antimicrobial resistant infections.
 

10/10/18 - CMS Takes Steps to help with Hurricane Michael Emergency Response

Agency waivers to take effect in Florida

The Centers for Medicare & Medicaid Services (CMS) today announced steps taken by the agency to support Florida in response to Hurricane Michael. Yesterday, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in Florida. With the PHE in effect, CMS has taken several actions to provide immediate relief to those impacted by the hurricane. The actions will include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.
 

 


10/09/18 - HHS Secretary Azar declares public health emergency in Florida due to Hurricane Michael

Following President Trump’s emergency declaration for Florida, Health and Human Services Secretary Alex Azar today declared a public health emergency in the state as Hurricane Michael makes landfall. The declaration gives the HHS Centers for Medicare & Medicaid Services beneficiaries and their healthcare providers and suppliers greater flexibility in meeting emergency health needs.
 

10/09/18 - CMS Announces Participants in New Value-Based Bundled Payment Model

Participation is robust in Administration’s Bundled Payments for Care Improvement-Advanced model, which is designed to improve quality and reduce costs for inpatient & outpatient care

Today, the Centers for Medicare & Medicaid Services (CMS) announced that 1,299 entities have signed agreements with the agency to participate in the Administration’s Bundled Payments for Care Improvement – Advanced (BPCI Advanced) Model.  The participating entities will receive bundled payments for certain episodes of care as an alternative to fee-for-service payments that reward only the volume of care delivered.
 

10/04/18 - CMS to Strengthen Oversight of Medicare’s Accreditation Organizations

Agency’s website will increase transparency into Accrediting Organization performance, and CMS will streamline and strengthen the validation of Accrediting Organization surveys

Today, the Centers for Medicare & Medicaid Services (CMS) took action to improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.
 
 

10/03/15 - CMS Accelerates Innovation and Promotes Patient Access to Medical Technology 

Reforms to Medicare’s Local Coverage Determination process will increase transparency and patient engagement in order to ensure that Medicare beneficiaries have access to the latest therapies and devices

Today, as part of broader efforts to modernize the Medicare program and bring the latest technologies and innovations to Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) announced changes to the way contractors decide which technologies are covered by publishing a revision to Medicare’s Program Integrity Manual.
 

10/1/18 - CMS announces new streamlined user experience for Medicare beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families.

Read More


9/28/18 - Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Enrollment projected to increase while plans offer new types of supplemental benefits - Today, the Centers for Medicare & Medicaid Services (CMS) announced that, on average, Medicare Advantage premiums will decline while plan choices and new benefits increase. In addition, Medicare Advantage enrollment is projected to reach a new all-time high with more than 36 percent of Medicare beneficiaries projected to be enrolled in Medicare Advantage in 2019. This news comes as the agency releases the benefit and premium information for Medicare health and drug plans for the 2019 calendar year.
 
 

9/27/18 - Remarks by Administrator Seema Verma at the 2018 Medicaid Managed Care Summit

(As prepared for delivery – September 27, 2018)

It is great to be back in front of a room full of professionals dedicated to improving the lives of Medicaid beneficiaries. For me, it’s a little like coming home. I see the faces of the people out working on the front lines, of transforming the American health care system, working to making Medicaid a stronger and more sustainable program.
 
 

 


9/21/18 - CMS Awards Funding for Quality Measure Development

Agency funds new partnerships to develop meaningful measures for the Medicare Quality Payment Program - The Centers for Medicare & Medicaid Services (CMS) today awarded seven organizations new cooperative agreements to partner with the agency in developing, improving, updating, or expanding quality measures for Medicare’s Quality Payment Program (QPP). These cooperative agreements, authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), represent the first funding initiative supporting public-private efforts to develop measures for the Quality Payment Program. Through these partnerships, CMS will work closely with external organizations—such as clinical professional organizations and specialty societies, patient advocacy groups, educational institutions, independent research institutions, and health systems—to develop and implement measures that offer the most promise for improving patient care.

Read More


9/17/18 – SPEECH: Remarks by Administrator Seema Verma about the Burden Reduction Proposed Rule

(As prepared for delivery – September 17, 2018)

Good Morning everyone, and thank you for being here.  Special thanks to Dr. Gregory Argyros, CEO of MedStar Washington Hospital Center, for hosting us at this beautiful hospital, and Rick Pollack, President and CEO from the American Hospital Association for joining us.
 

9/19/18 – New Medicare Card – Progress Updates

CMS continues to successfully mail newly-designed Medicare cards with the new Medicare number and we are excited to share important progress updates with you.

Read More


9/17/18 – First Comprehensive HHS Data Sharing Report Released

Today, the Office of the Chief Technology Officer published a comprehensive report of the data sharing environment at the U.S. Department of Health & Human Services (HHS). The report explores the challenges of sharing data between HHS agencies: https://www.hhs.gov/idealab/data-insights/
 
 
 

 


9/17/18 – CMS Proposes to Lift Unnecessary Regulations and Ease Burden on Providers 

Proposed rule driven by agency’s Patients Over Paperwork initiative, expected to save U.S. healthcare facilities $1.12 billion per year

Today, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule to relieve burden on healthcare providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities. Collectively, these updates would save healthcare providers an estimated $1.12 billion annually. Taking into account policies across rules finalized in 2017 and 2018 as well as this and other proposed rules, savings are estimated at $5.2 billion.
 
 
 

9/14/18 – SAMHSA’s Annual Mental Health, Substance Use Data Provide Roadmap for Future Action

Today the Substance Abuse and Mental Health Services Administration released the 2017 National Survey on Drug Use and Health (NSDUH). The annual survey comprises highly anticipated data that help provide a statistical context for the country’s opioid crisis and other behavioral health matters.

Read More


9/14/18 – CMS Continues Efforts to help with Hurricane Florence Emergency Response

Agency waivers take effect in Virginia- The Centers for Medicare & Medicaid Services (CMS) today announced efforts underway to support Virginia in response to Hurricane Florence. This week, Health and Human Services Secretary Alex Azar declared a public health emergency in Virginia. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to all those affected by the hurricane along the east coast. The actions include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.
 

9/13/18 – OCR Issues Guidance to Help Ensure Equal Access to Emergency Services and the Appropriate Sharing of Medical Information During Hurricane Florence

As Hurricane Florence makes landfall, the HHS Office for Civil Rights (OCR) and its federal partners remain in close coordination to help ensure that emergency officials effectively address the needs of at-risk populations as part of disaster response.  To this end, emergency responders and officials should consider adopting, as circumstances and resources allow, the following practices to help make sure all segments of the community are served.
 
 

9/13/18 – SPEECH: Remarks by Administrator Seema Verma at the FT Pharma Pricing and Value Summit

(As prepared for delivery – September 13, 2018)

Good afternoon, and thank you for the kind introduction.  It’s a pleasure to be with you today.  I know it’s commonly said that you “save the best for last,” but let’s be real, that’s not always true. Who here watches the closing ceremony of the Olympics? Don’t worry, I’m not going to take up much of your time, I know that I’m standing in between you and cocktail hour, plus you’ve already heard from a handful of great speakers, including my boss Secretary Azar. However there are some things we are doing at CMS that I would like to share with you this afternoon.

Read More


9/13/18 – CMS offers broad support for North Carolina and South Carolina with Hurricane Florence preparation

The Centers for Medicare & Medicaid Services (CMS) today announced efforts underway to support North Carolina and South Carolina in response to Hurricane Florence. Earlier this week, Health and Human Services Secretary Alex Azar declared public health emergencies (PHE) in both states. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Hurricane Florence. CMS has waived certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; created special enrollment opportunities for individuals to access healthcare immediately; and taken steps to ensure dialysis patients obtain critical life-saving services.

Read More


9/12/18 – Grants Awarded for the Federally-Facilitated Exchange Navigator Program

Today, the Centers for Medicare & Medicaid Services (CMS) awarded $10 million in Navigator grant awards to 39 organizations who will serve as Navigators in Federally-facilitated Exchange states. These awards will support the work of organizations that offer assistance to consumers navigating, shopping for, and enrolling in health insurance coverage for 2019.

Read More


9/12/18 – CMS Details Additional Process for Providing Relief for Consumers from Individual Mandate

Today’s announcement provides American consumers with the additional option to claim a hardship exemption from the individual mandate

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new, more streamlined way for consumers to claim a hardship exemption from the tax penalty imposed for not maintaining health coverage for 2018 on their federal income tax returns, making it easier for taxpayers across the nation to claim their exemption. Of the $3 billion the Internal Revenue Service (IRS) collected from taxpayers in individual mandate penalties in 2015, over 5 million households, or nearly 80 percent, earned $50,000 a year or less.  The individual mandate penalty is yet another example of how the ACA hurts low and middle income Americans the most, and today’s action reflects our commitment to minimize the impact of Obamacare’s failures.
 
 
 

9/11/18 – HHS Awards $21 Million to Support Health Center Participation in NIH’s All of Us Research Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new, more streamlined way for consumers to claim a hardship exemption from the tax penalty imposed for not maintaining health coverage for 2018 on their federal income tax returns, making it easier for taxpayers across the nation to claim their exemption. Of the $3 billion the Internal Revenue Service (IRS) collected from taxpayers in individual mandate penalties in 2015, over 5 million households, or nearly 80 percent, earned $50,000 a year or less.  The individual mandate penalty is yet another example of how the ACA hurts low and middle income Americans the most, and today’s action reflects our commitment to minimize the impact of Obamacare’s failures.

Read More

 

 


9/4/18 – Data Support Considerations in Medicaid Accountable Care Organization Programs

Medicaid accountable care organizations (ACOs) need data on their attributed populations to successfully improve health outcomes and manage patients’ total cost of care. This includes data on members’ health status; emergency department and inpatient utilization; and risk scores, ideally accounting for social risk factors — such as homelessness, past incarceration, and child protection involvement. State Medicaid agencies have developed a number of approaches to provide data to organizations participating in Medicaid ACO programs. 

Read More


9/4/18 – Tools for Supporting Social Service and Health Care Partnerships to Address Social Determinants of Health

Health care and community-based organizations (CBOs) across the country are increasingly working together to better address the root causes of poor health among low-income and vulnerable populations. Through support from Kaiser Permanente Community Health, the Center for Health Care Strategies and Nonprofit Finance Fund collaborated to identify new strategies and resources to facilitate effective CBO-health care partnerships, building on work done under the Partnership for Healthy Outcomes project made possible by the Robert Wood Johnson Foundation. 

Read More


8/29/18 – Indication-Based Formulary Design Beginning in Contract Year (CY) 2020

CMS Action Will Ensure Medicare Enrollees Receive Individualized Drug Treatment Targeted to Meet Their Needs

Today, the Centers for Medicare & Medicaid Services (CMS) announced additional flexibilities in the Medicare Part D program to allow for innovative formulary design as a valuable approach to expand drug choices and address the challenge of high drug costs for seniors and government programs. As part of the agency’s ongoing efforts to deliver on President Trump’s promises outlined in the HHS drug pricing blueprint, CMS will provide Medicare Part D plan sponsors with additional formulary management tools that will put patients’ needs first by facilitating access to broader formularies while also enabling sponsors to negotiate lower drug prices. Medicare Part D plan sponsors will have the choice of implementing indication-based formulary design beginning in CY 2020.

Read More

Click here to view the Next Generation ACO Model's First Evaluation Report

Click here to view "Findings at a Glance" document


8/28/18 – Medicaid Directors Selected for 2019 Class of the Medicaid Leadership Institute

National Initiative Enhances the Leadership Capacity of Medicaid Directors to Deliver High-Quality, Cost-Effective Health Care Services

The Center for Health Care Strategies (CHCS) today announced that Medicaid directors from six states — Idaho, Louisiana, Oklahoma, Rhode Island, Texas, and Virginia — have been competitively selected to participate as fellows in the 2019 class of the Medicaid Leadership Institute. CHCS directs this Robert Wood Johnson Foundation-funded initiative, which offers a unique opportunity for Medicaid directors from states across the country to develop the skills and expertise necessary to improve their Medicaid programs and impact key health outcomes in an ever-changing policy and financing environment.

Read More


8/27/18 – ACOs Taking Risk in Innovative Payment Model Generate Savings for Patients and Taxpayers

Today, the Centers for Medicare & Medicaid Services (CMS) released an evaluation report for the first performance year of the Innovation Center’s Next Generation Accountable Care Organization (ACO) Model showing promising early results. Results demonstrated the positive outcomes in terms of quality and costs when providers are responsible for managing to a budget.  For the 2016 performance year, the Next Generation ACO Model generated net savings to Medicare of approximately $62 million while maintaining quality of care for beneficiaries. As part of CMS’s recent “Pathways to Success” proposal, CMS proposed taking many principles from the Next Generation ACO Model and adopting them more broadly for ACOs in the Medicare Shared Savings Program.

Read More


8/23/18 – CMS Announces New Model to Address Impact of the Opioid Crisis for Children

Model to Focus on Children in Medicaid and CHIP Who Have Physical and Behavioral Health Needs, Including Substance Abuse

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new Innovation Center payment and service delivery model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs through care integration across all types of healthcare providers.

Read More

Click here to view a fact sheet on the InCK Model


8/22/18 – CMS Releases Formal Approach to Ensure Medicaid Demonstrations Remain Budget Neutral

Agency reinforces commitment to transparency and controlling costs; provides new tool

Today, the Centers for Medicare and Medicaid Services (CMS) released a letter to State Medicaid Directors that clearly describes CMS’s current approach to calculating budget neutrality expenditure limits for Medicaid section 1115 demonstration projects. Medicaid demonstration projects allow states to design innovative ways to better serve the nation’s more than 65 million Medicaid recipients. In response to longstanding concerns raised by the Government Accountability Office (GAO), this letter marks the first time that CMS has formally outlined how states must calculate budget neutrality for demonstration projects, in order to strengthen fiscal accountability. The guidance also comes a day after Administrator Seema Verma testified before the Senate Homeland Security and Government Accountability Committee on improper payments in the Medicaid program, which often result in higher federal spending.

Read More


8/22/18 – CMS Releases Formal Approach to Ensure Medicaid Demonstrations Remain Budget Neutral

Agency Reinforces Commitment to Transparency and Controlling Costs; Provides New Tool

Today, the Centers for Medicare and Medicaid Services (CMS) released a letter to State Medicaid Directors that clearly describes CMS’s current approach to calculating budget neutrality expenditure limits for Medicaid section 1115 demonstration projects. Medicaid demonstration projects allow states to design innovative ways to better serve the nation’s more than 65 million Medicaid recipients. In response to longstanding concerns raised by the Government Accountability Office (GAO), this letter marks the first time that CMS has formally outlined how states must calculate budget neutrality for demonstration projects, in order to strengthen fiscal accountability. The guidance also comes a day after Administrator Seema Verma testified before the Senate Homeland Security and Government Accountability Committee on improper payments in the Medicaid program, which often result in higher federal spending.

Read More


8/20/18 – 100 Days of Action on the President’s American Patients First Blueprint

“The President’s blueprint for lower drug prices is working, drug prices are coming down, and American patients are going to see the savings in their pocketbook.” — Secretary Alex Azar

Tomorrow, August 21, marks 100 days since the release of President Trump’s American Patients First Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs - PDF. In this short period of time, an unprecedented number of actions have been taken toward structurally rebuilding this entire segment of the economy to lead to enduring lower prices that are sustainable, support innovation, and put American patients first.

Read More

Click here to view the full report

 


8/20/18 – CMS Awards $8.6 Million in Funding to States to Help Stabilize Markets

The State Flexibility Grant Awards will Help States Strengthen the Private Health Insurance Market Through Innovative Measures

Today, the Centers for Medicare & Medicaid Services (CMS) awarded $8.6 million in funding to 30 states and the District of Columbia to provide State insurance regulators with the opportunity to enhance States’ ability to strengthen their respective health insurance markets through innovative measures that support market reforms and consumer protections under the Patient Protection and Affordable Care Act (PPACA). 

Read More

Click here to see the funding allocated to each state


8/16/18 – HHS Secretary Azar Meets with Specialty and Patient Groups Regarding Drug Pricing

On Wednesday, Secretary Alex Azar met with representatives of specialty-physician and patient groups to discuss the Trump Administration’s efforts to offer new tools for Medicare Advantage plans to negotiate lower drug prices for patients.

Read More


8/16/18 – CMS Streamlines Medicaid Review Process, Achieves Significant Reduction in Approval Times

Today, the Centers for Medicare and Medicaid Services (CMS) announced significant improvements in managing the Medicaid program in partnership with states.  Identified early as a priority for both the Trump Administration and the National Association of Medicaid Director’s (NAMD), CMS has implemented changes resulting in faster processing of state requests to make program or benefit changes to their Medicaid program through the state plan amendment (SPA) and section 1915 waiver review process.

Read More


8/15/18 – HHS Awards $125 Million to Support Community Health Center Quality Improvement

Today, the U.S. Department of Health and Human Services (HHS) announced $125 million in Quality Improvement grant awards to 1,352 community health centers across all U.S. states, territories and the District of Columbia. Funded by the Health Resources and Services Administration (HRSA), health centers will use these funds to continue to improve quality, efficiency, and the effectiveness of healthcare delivery in the communities they serve. This announcement comes during National Health Center Week, the annual celebration that highlights the critical role community health centers play in providing high-quality, affordable, primary healthcare. 

Read More


8/09/18 – Proposed Pathways to Success for the Medicare Shared Savings Program

On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (Shared Savings Program).  Referred to as “Pathways to Success,” this proposed new direction for the Shared Savings Program would redesign the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses), increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles. This proposed rule would also strengthen beneficiary engagement, ensure rigorous benchmarking, and help improve care for Medicare beneficiaries, with an emphasis on combatting opioid addiction and expanding the use of interoperable electronic health record technology among ACO providers/suppliers.  The proposed policies also include changes to address the additional tools and flexibilities for ACOs established by the Bipartisan Budget Act of 2018 (BBA of 2018), specifically in the areas of new beneficiary incentives, telehealth services, choice of beneficiary assignment methodology, and voluntary alignment refinements.

Read More


8/08/18 – CMS- 9919-P: Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule 

Read More


8/08/18 – CMS Issues Proposed Additional Rule to Address Risk Adjustment Program for the 2018 Benefit Year

Proposed Rule Seeks to Provide Certainty and Sustain Consumer Choices and Affordability - Today’s notice of proposed rulemaking, “Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule,” proposes to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula.

Read More


8/7/18 – Trump Administration Gives Medicare New Tools to Negotiate Lower Drug Prices for Patients

Today, delivering on proposals in President Trump’s American Patients First blueprint, HHS announced that Medicare Advantage plans will be able to use tools employed by private-sector insurers to negotiate lower prescription drug prices for patients.

Read More


8/07/18 – CMS Empowers Patients with More Choices and Takes Action to Lower Drug Prices

Today, the Centers for Medicare & Medicaid Services (CMS) delivered on President Trump’s promise to negotiate better deals for Medicare patients and create competition between drugs used to treat the same conditions, with more than half of the savings required to be passed on directly to patients. This action gives Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs and is an important step within the Administration’s larger agenda to provide patients with more choices when picking a Medicare Advantage plan that best meets their needs.
 
 
 

8/6/18 – SPEECH: Remarks by Administrator Seema Verma at the ONC Interoperability Forum in Washington, DC

(As prepared for delivery – August 6, 2018)

Thank you Dr. Rucker. It’s been a pleasure to partner with an innovative medical leader on the path to achieving true interoperability.

Read More

 


8/2/18 – HHS Announces Grantees for Title X Family Planning Program Services

Today, the U.S. Department of Health and Human Services (HHS) Office of Population Affairs announced the 96 grantees to whom HHS intends to award Title X family planning service grants for fiscal year 2018.  Twelve of the intended awards go to grantees who are new to Title X.

Read More

Click here to view a full list of intended grantees by area served

 


8/2/18 – CMS Finalizes Changes to Empower Patients and Reduce Administrative Burden

Changes in the Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule Will Advance Price Transparency and Electronic Health Records

Today, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to empower patients and advance the White House MyHealthEData initiative and the CMS Patients Over Paperwork initiative. This final rule and others issued earlier this week will help improve access to hospital price information, give patients greater access to their health information and allow clinicians to spend more time with their patients.

Read More

 


8/2/18 – Fiscal Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule CMS-1694-F

On August 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to help empower patients through better access to hospital price information, improve the use of electronic health records, and make it easier for providers to spend time with their patients. The final rule issued today updates Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

Read More


8/1/18 – CMS-9924-F: Short-Term, Limited-Duration Insurance

Read More


8/1/18 – CMS Finalizes Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit for FY 2019

On August 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1692-F) that updates fiscal year (FY) 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. In addition, this final rule updates the hospice quality reporting requirements.

Read More


8/1/18 – HHS News Release: Trump Administration Delivers on Promise of More Affordable Health Insurance Options

HHS Final Rule on Short-Term, Limited-Duration Insurance Brings More Flexibility and Choices to Consumers - On Wednesday, the departments of Health and Human Services, Labor and the Treasury issued a final rule to help Americans struggling to afford health coverage find new, more affordable options. The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total. This action will help increase choices for Americans faced with escalating premiums and dwindling options in the individual insurance market. 

Read More

Click here to view the final rule

Click here to view fact sheet

 


7/31/18 – Medicare Issues Fiscal Year 2019 Payment & Policy Changes for Skilled Nursing Facilities

On July 31, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1696-F] outlining Fiscal Year (FY) 2019 Medicare payment updates and quality program changes for skilled nursing facilities (SNFs).

Read More

 


7/31/18 – Medicare Part D Premiums Continue to Decline in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline. At a time when health insurance premiums are rising across-the-board, basic Part D premiums are expected to fall from $33.59 this year to $32.50 next year.

Read More

 


7/25/18 - CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule advances CMS commitment to increasing transparency and lowering drug prices

Today, the Centers for Medicare & Medicaid Services (CMS) took steps to strengthen the Medicare program with proposed changes to ensure that seniors can access the care they need at the site of care that they choose. In addition, as part of the agency’s ongoing efforts to lower drug prices as outlined in the President’s Blueprint, CMS included a Request for Information on how best to develop a model leveraging authority provided to the agency under the Competitive Acquisition Program (CAP) to strengthen negotiations for prescription drugs
 
 

07/24/18 - CMS Adopts the Methodology for the Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act for the 2017 Benefit Year

Final rule addresses the collection of risk adjustment charges and making of payments for the 2017 benefit year

Today, the Centers for Medicare and Medicaid Services (CMS) posted a final rule that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers related to the 2017 benefit year. This important step fills a void created by a federal district court’s vacating of the previously issued methodology, and enables the agency to resume the CMS-operated risk adjustment program in the individual and small group markets. 
 
 

07/24/18 - CMS Welcomes New Leadership Team, Makes Additional Staffing Announcement

Today, the Centers for Medicare & Medicaid Services (CMS) announced several new additions to the agency’s leadership team, as well as changes to the portfolios of senior staff in the Office of the Administrator. Since arriving in March 2017, Administrator Seema Verma has been committed to building an experienced and well-qualified team with a broad range of backgrounds and expertise. Today, Administrator Verma welcomes Paul Mango as CMS’s Chief Principal Deputy Administrator and Chief of Staff and Chris Traylor as the agency’s Deputy Administrator for Strategic Initiatives. In addition, the Administrator promoted Deputy Chief of Staff Brady Brookes to Deputy Administrator and Deputy Chief of Staff. 
 

07/23/18 - New Medicare Card Mailing Update – Wave 4 Begins, Wave 2 Ends

CMS started mailing new Medicare cards to people with Medicare who live in Wave 4 states: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont. We continue to mail new cards to people who live in Wave 3 states, as well as nationwide to people who are new to Medicare.
 

07/17/18 - A Letter to Doctors from CMS Administrator Seema Verma

Dear Doctor,
 
Thank you for the difference you make in your patients’ lives. Many of our nation’s best and brightest students go into medicine – the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.
 

7/12/18 – Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for the Calendar Year 2019

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.

Read More


7/12/18 – The Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration

The Centers for Medicare & Medicaid Services (CMS) is announcing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. The MAQI Demonstration will be tested under the authority of Section 402 of the Social Security Amendments of 1967 (as amended).

Read More


7/12/18 – CMS Proposes Historic Changes to Modernize Medicare and Restore the Doctor-Patient Relationship

Proposed Changes to the Medicare Physicians Fee Schedule and Quality Payment Program Would Streamline Clinician Billing and Expand Access to High-Quality Care

Today, the Centers for Medicare & Medicaid Services (CMS) proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes.

Read More

 


07/10/18 – CMS Proposes Rule Change to Protect Medicaid Provider Payments

Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicaid Provider Reassignment regulation that would eliminate state’s ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute. This proposed regulatory change is designed to ensure that taxpayer dollars dedicated to providing healthcare services for low-income vulnerable Americans are not siphoned away for other purposes.

Read More


07/09/18 – Summary Report on Permanent Risk Adjustment Transfers for the 2017 Benefit Year

On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating CMS’s use of the statewide average premium in the risk adjustment transfer formula for the 2014 – 2018 benefit years pending further explanation of CMS’s reasons for operating the risk adjustment program in a budget neutral manner in those years. The government has moved the court to reconsider its decision and CMS is currently awaiting the court’s ruling.

Read More


07/07/18 – United States District Court Ruling Puts Risk Adjustment On Hold

On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating use of the statewide average premium by the Center for Medicare & Medicaid Services (CMS) in the risk adjustment transfer formula established under section 1343 of the Patient Protection and Affordable Care Act for the 2014 – 2018 benefit years, pending further explanation of CMS’s reasons for operating the program in a budget neutral manner in those years. The ruling prevents CMS from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved.

Read More


07/06/18 – Guidance on Annual Eligibility Redetermination and Re-enrollment for Exchange Coverage for 2019 and Later Years

45 CFR 155.335(a)(2) provides that a Health Insurance Exchange has three options to redetermine eligibility for enrollment in a qualified health plan (QHP) through the Exchange and insurance affordability programs on an annual basis. 45 CFR 155.335(a)(2)(ii) provides that one of these options is a set of alternative procedures specified by the Secretary for the applicable benefit year.

Read More


07/02/18 – Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market

Reports show individual market erosion and increasing taxpayer liability

Today, the Centers for Medicare and Medicaid Services (CMS) released three reports that provide important information on the current condition of the Federal and State-based Exchanges and state individual health insurance markets. Taken together, these reports show that state markets are increasingly failing to cover people who do not qualify for federal subsidies even as the Exchanges remain relatively stable. Steps taken by CMS in 2017, as the reports show, improved the performance of the Exchanges and began addressing market stability issues. However, serious problems persist. Rising premiums have left unsubsidized people with poor health coverage options and dramatically increased the federal cost of premium subsidies.

Read More


07/02/18 – CMS Takes Action to Modernize Medicare Home Health

CMS Action for Home Health Agencies Puts Value Over Volume and Advances MyHealthEData Initiative- Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.

Read More 

Click here to view fact sheet


06/29/18 – CMS Advances Demonstration to Waive MIPS Requirements for Clinicians in Certain At-Risk Medicare Advantage Plans

Today, the Centers for Medicare & Medicaid Services (CMS) is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk. CMS seeks public comment on the information collection burdens associated with the demonstration, which is under consideration for formal approval.

Read More

 


06/27/18 – CMS Approves State Proposal to Advance Specific Medicaid Value-Based Arrangements with Drug Makers

First-of-its-kind approval for Oklahoma Medicaid will drive value

Today, the Centers for Medicare & Medicaid Services (CMS) issued the first-ever approval of a state plan amendment proposal to allow the state of Oklahoma to negotiate supplemental rebate agreements involving value-based purchasing arrangements with drug manufacturers that could produce extra rebates for the state if clinical outcomes are not achieved. The state plan amendment proposal submitted by Oklahoma will be the first state plan amendment permitting a state to pursue CMS-authorized supplemental rebate agreements involving value-based purchasing arrangements with manufacturers.

Read More

Click here to view the state plan amendment


06/20/18 – CMS Seeks Public Input on Reducing the Regulatory Burdens of the Stark Law

Today, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking recommendations and input from the public on how to address any undue impact and burden of the physician self-referral law (also known as the “Stark Law”), focusing in part on how the law may impede care coordination, a key aspect of systems that deliver value.

Read More


06/20/18 - CMS Announces Agency’s First Blue Button 2.0 Developer Conference

Today, the Centers for Medicare & Medicaid Services (CMS) announced it is hosting the first-ever Blue Button® 2.0 Developer Conference. This event is being held in Washington, D.C. at the General Services Administration national headquarters on Monday, August 13, 2018. The Blue Button® 2.0 Developer Conference will provide a networking opportunity that brings together developers to learn, build software, and share insights on how Medicare claims data can be leveraged to improve health outcomes. In addition, the conference will help further advance the work of the MyHealthEData, a government wide initiative led by the White House Office of American Innovation.
 
 

 


06/19/18 - Michigan Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (Calendar Years 2015 – 2016)

The Medicare-Medicaid Financial Alignment Initiative (FAI) seeks to better serve people who are dually eligible for Medicare and Medicaid by testing person-centered, integrated care models. In order to ensure that dually eligible individuals receive high quality care and to encourage quality improvement, both Medicare and Medicaid withheld a percentage of their respective components of the capitation rate to each Medicare-Medicaid Plan (MMP) participating in a capitated model demonstration under the FAI. MMPs are eligible for repayment of the withheld amounts subject to their performance on a combination of CMS Core and State-Specific quality withhold measures.

Read More


06/18/18 – Judge Rules in Favor of OCR and Requires a Texas Cancer Center to Pay $4.3 Million in Penalties for HIPAA Violations

A U.S. Department of Health and Human Services Administrative Law Judge (ALJ) has ruled that The University of Texas MD Anderson Cancer Center (MD Anderson) violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules and granted summary judgment to the Office for Civil Rights (OCR) on all issues, requiring MD Anderson to pay $4,348,000 in civil money penalties to OCR. This is the second summary judgment victory in OCR’s history of HIPAA enforcement and the $4.3 million is the fourth largest amount ever awarded to OCR by an ALJ or secured in a settlement for HIPAA violations.

Read More

 


06/15/18 – SAMHSA Announces $930 Million Funding Opportunity to Combat the Opioid Crisis

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the Department of Health and Human Services (HHS), is now accepting applications for $930 million in State Opioid Response Grants. SAMHSA will distribute funds to states and territories in support of their ongoing efforts to provide prevention, treatment and recovery support services to individuals with opioid use disorder.

Read More

 


06/15/18 – HHS Makes $350 Million Available to Fight the Opioid Crisis in Community Health Centers Nationwide

Today, the Department of Health and Human Services (HHS) announced the availability of $350 million in new funding to expand access to substance use disorder and mental health services at community health centers across the nation.  These funds will support health centers in implementing and advancing evidence-based strategies, including expanded medication-assisted treatment (MAT) services, and are expected to be awarded in September of this year by HHS’s Health Resources and Services Administration (HRSA).

Read More


06/11/18 – CMS Leverages Medicaid Program to Combat the Opioid Crisis - States Provided Guidance in Designing Treatment Options for Opioid Epidemic

Today, the Centers for Medicare & Medicaid Services CMS released guidance aimed at building on our commitment to partner with states to ensure that they have flexibilities and the tools necessary to combat the opioid crisis.  This new guidance provides information to states on the tools available to them, describes the types of approaches they can use to combat this crisis, ensures states know what resources are available, and articulates promising practices for addressing the needs of beneficiaries facing opioid addiction. Notably, CMS released an Informational Bulletin that provides states with information they can use when designing approaches to covering critical treatment services for Medicaid eligible infants with Neonatal Abstinence Syndrome (NAS). Additionally, CMS issued a letter to states on how they may best use federal funding to enhance Medicaid technology to combat drug addiction and the opioid crisis.

Read More


06/05/18 – Declines in Hospital-Acquired Conditions Save 8,000 Lives and $2.9 Billion in Costs

National efforts to improve patient safety showing continued progress

Data released today by the Agency for Healthcare Research and Quality (AHRQ) show continued progress in improving patient safety, a signal that initiatives led by the Centers for Medicare & Medicaid Services (CMS) are helping to make care safer. National efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to the report.
 
 

06/04/18 – CMS Unveils Scorecard to Deliver New Level of Transparency within Medicaid and CHIP Program

New Scorecard highlights CMS’s commitment to a new era of accountability in Medicaid by monitoring and publishing state and federal Medicaid and CHIP outcomes

Today, the Centers for Medicare & Medicaid Services (CMS) released the first ever Medicaid and Children’s Health Insurance Program (CHIP) Scorecard, a central component of the Administration’s commitment to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes. For the first time, CMS published state Medicaid and CHIP quality metrics along with federally reported measures in a Scorecard format.

Read More

Click here to view fact sheet

Click here to view scorecard


05/30/18 – SAMHSA announces $196 million funding opportunity for opioid treatment grants to hardest-hit states and tribes

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the Department of Health and Human Services (HHS) is now accepting applications for $196 million to treat opioid use disorder through its Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program.

Read More


05/22/18 – HHS Announces Proposed Update to Title X Family Planning Grant Program

The U.S. Department of Health and Human Services (HHS) is issuing a proposal to update the regulations governing the Title X family planning program, which focuses on serving low-income Americans. The proposed update to the regulations ensures compliance with statutory program integrity provisions governing the program and, in particular, the statutory prohibition on funding “programs where abortion is a method of family planning.” (42 U.S.C. § 300a-6) The proposed update to the regulations, which were last revised 18 years ago, would also make notable improvements designed to increase the number of patients served and improve their quality of care.

Read More


05/15/18 – Drug Spending Information Products Fact Sheet

Today, the Centers for Medicare & Medicaid Services (CMS) announced the release of updated information products that provide greater transparency on drug spending in the Medicare and Medicaid programs. CMS is releasing updated versions of the Drug Spending Dashboards and the annual update to the Part D Prescriber Public Use File. These tools and resources, which provide data through 2016, focus on giving consumers, researchers, and other stakeholders across the healthcare system the information they need to understand drug prescribing in CMS programs, with a particular focus on spending.

Read More


05/17/18 – CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

Part of the continued roll-out of American Patients First, CMS sends letter to Part D plans explaining that gag clauses that keep patients from knowing how to get the best deal are completely unacceptable

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called “gag clauses” are unacceptable, as part of the Administration-wide “American Patients First” initiative to lower prescription drug costs.
 

05/16/18 – Care Coordination Data Snap Shot for the Capitated Model

Read More


05/16/18 – Speech: Remarks by CMS Administrator Seema Verma at the Pharmacy Quality Alliance Annual Meeting (PQA18)

(as prepared)

Good afternoon, it’s a pleasure to be with you today. Pharmacists are on the front lines of patient care and have keen insight to the issues that patients face. We appreciate your hard work, and we look forward to working with you on a goal that I’m sure we share – ensuring that all patients can access their medications at an affordable price.
 
 

05/15/18 – CMS Unveils Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices

An important part of the American Patients First initiative, the Dashboards provide new information on changes in spending per drug over time

Today, the Centers for Medicare & Medicaid Services (CMS) released a redesigned version of the Drug Spending Dashboards. For the first time, the dashboards include year-over-year information on drug pricing and highlight which manufactures have been increasing their prices.

Read More


05/11/18 – Trump Administration Releases Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs

Today, the Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs.  Below is the blueprint’s introductory message from HHS Secretary Alex Azar.

Read More


05/11/18 – 2018 MMP Performance Data Technical Notes

Under the Medicare-Medicaid Financial Alignment Initiative (FAI) capitated model, the Centers for Medicare & Medicaid Services (CMS) is collecting a variety of measures that examine plan performance and the quality of care provided to enrollees. The Medicare-Medicaid Plan (MMP) performance data published here represent currently available data on MMP performance on certain Medicare Parts C and D quality measures as well as select CMS core and state-specific measures that MMPs are required to report. The data show MMP performance on quality measures during 2016 and the results of surveys of MMP enrollees conducted in 2016 or 2017. The measures are organized into six domains that track the potential domains under a future MMP star ratings system described in the Medicare-Medicaid Plan Quality Ratings Strategy published in November 2015.

Read More


05/08/18 – CMS Announces Agency’s First Rural Health Strategy

Interagency effort seeks to improve access and quality of care for rural Americans

Today, the Centers for Medicare & Medicaid Services (CMS) released the agency’s first Rural Health Strategy intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.

Read More

Click here to view the fact sheet


05/01/18 – Independence at Home Demonstration Announced: Shared Savings and Regression Methodologies Reports Posted 

 
 
 

05/01/18 – Members Appointed to New Pain Management Best Practices Inter-Agency Task Force

The U.S. Department of Health and Human Services (HHS) announced today the appointment of 28 members to the new Pain Management Best Practices Inter-Agency Task Force (Task Force).

Read More


04/27/18 – CMS Drives Patient-Centered Care over Paperwork in Proposals to Modernize Medicare and Reduce Burden

Proposed rules would advance administrative burden reduction, Medicare modernization, and the Meaningful Measures Initiative

Today, the Centers for Medicare & Medicaid Services (CMS) proposed transformative changes to the payment systems for services furnished by a range of medical facilities. The agency’s proposed payment rules also set out to continue to modernize Medicare through innovation in skilled nursing facility payment to drive value, advance meaningful quality measure reporting, and reduce paperwork and administrative costs.

Read More

Click here to view the CMS SNF PPS fact sheet

Click here to view the CMS IRF PPS fact sheet

Click here to view the Hospice Wage Index & Payment fact sheet

Click here to view the IPF fact sheet


04/26/18 – CMS Administrator Verma Unveils New Strategy to Fuel Data-driven Patient Care, Transparency

New Medicare Advantage data resource released

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced the agency’s new Data Driven Patient Care Strategy as part of the MyHealthEData initiative at the ninth annual Health Datapalooza conference in Washington, D.C. The strategy positions CMS to further support industry innovation in unleashing the power of data to inform patients’ healthcare decisions and transform the healthcare system by enhancing security and privacy, improving quality, increasing efficiency, and reducing costs.
 
 

04/25/18 – Secretary Azar, Surgeon General Adams Praise Private Sector Support for Naloxone Advisory

Following the early April release of the Surgeon General’s Advisory on Naloxone and Opioid Overdose, which recommended that opioid treatment providers prescribe or dispense naloxone to patients with elevated risk of overdose, two naloxone manufacturers (Adapt Pharma and kaleo, Inc.) announced this week that they will be partnering with the National Council on Behavioral Health to distribute 30,000 doses of donated naloxone to National Council members.

Read More

Click here to view the Surgeon General's Advisory


04/24/18 – HHS Takes New Steps in Secretary Azar’s Value-Based Agenda

On Tuesday, HHS’s Centers for Medicare & Medicaid Services (CMS) released the draft Fiscal Year 2019 Inpatient Prospective Payment System rule, which contains proposals to advance HHS Secretary Alex Azar’s agenda for moving to a healthcare system that pays for value, as well as a request for information regarding future value-based reforms.

Read More


04/24/18 – CMS Proposes Changes to Empower Patients and Reduce Administrative Burden

Changes in Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Would Advance Price Transparency and Interoperability

Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to empower patients through better access to hospital price information, improve patients’ access to their electronic health records, and make it easier for providers to spend time with their patients. The proposed rule issued today proposes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

Read More

Click here to view the fact sheet

Click here to view the proposed rule


04/23/18 – HHS Purchases Anthrax Antitoxin for Strategic National Stockpile

Acquisition Augments Anthrax Treatments Currently Stockpiled

The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) will purchase an anthrax treatment for $25.2 million from Elusys Therapeutics Inc. of Pine Brook, New Jersey, as part of the department’s ongoing national preparedness efforts.

Read More


04/23/18 – Feedback on New Direction Request for Information (RFI) Released, CMS Innovation Center’s Market-Driven Reforms to Focus on Patient-Centered Care

Request for Information on Provider Contracting Issued

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has released the comments submitted by patients, clinicians, innovators, and others in response to the CMS Innovation Center’s New Direction Request for Information (RFI). Last fall, CMS released the RFI to collect ideas on a new direction for the agency’s Innovation Center to promote patient-centered care and test market driven reforms that: empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. The Innovation Center is a central focus of the Administration’s efforts to accelerate the move from a healthcare system that pays for volume to one that pays for value and encourages provider innovation.

Read More

Click here to view the Direct Provider Contracting RFI


04/18/18 – HHS Provides States Second Installment of Grant Awards to Combat Opioid Crisis

57 Grant Awards Totaling an Additional $485 Million

Today, the Department of Health and Human Services (HHS) is releasing the second year of funding to 50 states, four U.S. territories, and the free associated states of Palau and Micronesia, totaling $485 million to continue the Nation’s efforts to combat the opioid crisis.

Read More


04/10/18 – HHS Sponsors its Largest Exercise for Moving Patients with Highly Infectious Diseases

The largest patient movement exercise in U.S. Department of Health and Human Services’ history began today to test the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.

Read More


04/09/18 – CMS Issues Final Payment Notice Rule to Increase Access to Affordable Health Plans for Americans Suffering from High Obamacare Premiums

Final Rule will Improve Program Integrity, Increase State Flexibility, and Reduce Regulatory Burdens

Today, the Centers for Medicare & Medicaid Services (CMS) issued the HHS Notice of Benefit and Payment Parameters for 2019. The final rule will mitigate the harmful impacts of Obamacare and empower states to regulate their insurance market. The rule will do this by advancing the Administration’s goals to increase state flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce unnecessary regulatory burdens imposed by the Patient Protection and Affordable Care Act.

Read More

Click here to view the Final Annual Issuer Letter

Click here to view the Hardship Exemption Guidance

Click here to view the Extended Transitional Policy Guidance

Click here to view the Payment Notice fact sheet associated with this rule

Click here to view the Final Notice on the Federal Register


04/06/18 – Health and Human Services and the Department of Justice Return $2.6 Billion in Taxpayer Savings from Efforts to Fight Healthcare Fraud

Departments Work to Stamp Out Pill Mills and Opioid Overprescribing

Health and Human Services Secretary Alex Azar and Attorney General Jeff Sessions today released a fiscal year (FY) 2017 Health Care Fraud and Abuse Control Program report showing that for every dollar the federal government spent on healthcare related fraud and abuse investigations in the last three years, the government recovered $4. Additionally, the report shows that the departments’ FY 2017 Takedown event was the single largest healthcare fraud enforcement operation in history.

Read More


04/04/18 – HHS Releases a New Resource to Help Individuals Access and Use Their Health Information

The US Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today released the ONC Guide to Getting and Using your Health Records, a new online resource for individuals, patients, and caregivers.

Read More


04/03/18 – CMS’ Final Report Shows 11.8 Million Consumers Enroll in Exchange Coverage Nationwide

This Marks Agency’s Most Cost Effective and Successful Open Enrollment to Date

The Centers for Medicare & Medicaid Services (CMS) today released the Final Enrollment Report for the 2018 Health Insurance Exchanges showing approximately 11.8 million consumers selected or were automatically re-enrolled in an Exchange plan in the 50 states, plus DC. This includes 8.7 million consumers in the 39 states using Healthcare.gov and 3 million consumers in State-based Exchanges. Compared to prior years, this year’s open enrollment was the agency’s most cost effective and successful experience for HealthCare.gov consumers to date. While the 2018 open enrollment period ran smoothly, Americans continue to experience skyrocketing premiums and limited choice.

Read More

Click here to view the full report


04/02/18 – CMS Lowers the Cost of Prescription Drugs for Medicare Beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices.

Read More

Click here to view a fact sheet on the 2019 Rate Announcement and Final Call Letter

Click here to view a fact sheet on the final rule


03/30/18 – Medicare Diabetes Prevention Program (MDPP) Expanded Model Announced: Enrollment Process Timeline and Supplier Requirements Checklist Posted

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

Read More


03/22/18 – CMS Proposes Regulation to Alleviate State Burden

Proposed Rule Furthers President Trump’s Commitment to “Cutting the Red Tape” by Relieving States of Burdensome Paperwork Requirements

Today, The Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) that would provide state flexibility from certain regulatory access to care requirements within the Medicaid program. Specifically, the NPRM would exempt states from requirements to analyze certain data and monitor access when the vast majority of their covered lives receive services through managed care plans. CMS regulations separately provide for access requirements in managed care programs. Additionally, the NPRM would provide similar flexibility to all states when they make nominal rate reductions to fee-for-service payment rates.

Read More


03/16/18 – CMS Finalizes Coverage of Next Generation Sequencing Tests, Ensuring Enhanced Access for Cancer Patients

A New Opportunity for Cancer Patients as Advanced Diagnostic Laboratory Tests Now Have Expanded Medicare Coverage

Today the Centers for Medicare & Medicaid Services (CMS) took action to advance innovative personalized medicine for Medicare patients with cancer. CMS finalized a National Coverage Determination that covers diagnostic laboratory tests using Next Generation Sequencing (NGS) for patients with advanced cancer (i.e., recurrent, metastatic, relapsed, refractory, or stages III or IV cancer). CMS believes when these tests are used as a companion diagnostic to identify patients with certain genetic mutations that may benefit from U.S. Food and Drug Administration (FDA)-approved treatments, these tests can assist patients and their oncologists in making more informed treatment decisions. Additionally, when a known cancer mutation cannot be matched to a treatment then results from the diagnostic lab test using NGS can help determine a patient’s candidacy for cancer clinical trials.
 
 

03/13/18 – HHS Announces Health Data Provenance Challenge Winners

The Department of Health and Humans Services Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 2 winners of the “Oh the Places Data Goes: Health Data Provenance” Challenge.
 
 

03/08/18 – Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma Statement on Enforcement Letter to Idaho

Today, CMS issued a letter to Idaho regarding its Bulletin No. 18-01, Provisions for Health Carriers Submitting State-Based Health Benefit Plans.

Read More

Click here to view the letter to Idaho


03/07/18 – Medicare Diabetes Prevention Program (MDPP) Expanded Model Announced: Guidance for Medicare Advantage Plans CY 2018 Document Posted

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

Read More


03/06/18 – Secretary Azar Statement on UnitedHealthcare Drug Discount Announcement

Health and Human Services Secretary Alex Azar issued the following statement today after UnitedHealthcare announced that they would be sharing manufacturer rebates and discounts with patients at the pharmacy.

Read More


03/06/18 – Speech: Remarks by CMS Administrator Seema Verma at the HIMSS18 Conference

Thank you Jared for that kind introduction. It has been an honor to work alongside visionaries like you; somebody who really understands at a very personal level as I do, the need and potential of innovation to better serve Americans. Having the Office of American Innovation involved is critical, and I’m grateful for Jared’s involvement, his hard work, and his leadership. It’s an honor to serve with him, and I am grateful for his service to our country.

Read More


03/06/18 – Trump Administration Announces MyHealthEData Initiative to Put Patients at the Center of the US Healthcare System

CMS Launches “Blue Button 2.0” Tool, Calls on All Health Insurers to Make Data Available to Patients

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced a new Trump Administration initiative – MyHealthEData – to empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.

Read More

Click here to view fact sheet


02/23/18 – HHS Announces the Availability of $260 Million to Fund the Title X Family Planning Program

The U.S. Department of Health and Human Services (HHS) announced the availability of $260 million in a new funding opportunity for the Title X family planning program to help improve and expand quality care. The funding opportunity will assist in the establishment and/or operation of voluntary family planning projects that will offer a broad range of family planning methods and services, including information, education and counseling related to family planning, preconception care, contraception, natural family planning and infertility services.

Read More


02/21/18 – Third-Party Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment Pathway and Related Oversight Requirements

Beginning with the Open Enrollment Period (OEP) for plan year (PY) 2019, the Centers for Medicare & Medicaid Services (CMS) is implementing an optional program to allow Direct Enrollment (DE) entities (qualified health plan [QHP] issuers and web-brokers) in the Federally-facilitated Exchange (FFE, also referred to as Marketplace) and State-based Exchanges on the Federal Platform (SBE-FPs) to integrate an application for Marketplace coverage through the FFE with the standalone eligibility service (SES) to host application and enrollment services on their own website. The SES is a suite of application program interfaces (APIs) that will allow partners to create, update, submit, and ultimately retrieve eligibility results for an application. The Enhanced Direct Enrollment (EDE) pathway will replace the proxy DE pathway that CMS allowed DE entities to use for PY 2018. CMS will not allow DE entities’ use of, nor will it support, the proxy DE pathway for PY 2019 and beyond.

Read More


02/20/18 – Trump Administration Works to Give Relief to Americans Facing High Premiums, Fewer Choices

Proposed Rule to Allow Short-Term, Limited Duration Coverage for Longer Periods Providing Increased Choice at a Lower Cost

In direct response to President Trump’s October 2017 Executive Order, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) issued a proposed rule today that is intended to increase competition, choice, and access to lower-cost healthcare options for Americans. The rule proposes to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months. The proposed rule, if finalized, will provide additional options to Americans who cannot afford to pay the costs of soaring healthcare premiums or do not have access to healthcare choices that meet their needs under current law.

Read More

Click here to view fact sheet


02/16/18 – Medicare Diabetes Prevention Program (MDPP) Expanded Model

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

Read More


02/14/18 – CMS Office of the Actuary Releases 2017 – 2026 Projections of National Health Expenditures

Today the independent CMS Office of the Actuary released the projected national health expenditures for 2017-2026.

Read More


02/02/18 – HHS Approves New Healthy Indiana Medicaid Demonstration

Indiana is Second State to Receive Waiver for Community Engagement Requirements

On Friday, U.S. Health and Human Services Secretary Alex Azar joined Indiana Governor Eric J. Holcomb to announce the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services approval of Indiana’s Section 1115 waiver, known as the Healthy Indiana Plan or HIP.

Read More

Click here to view waiver


02/02/18 – Online Provider Directory Review Report

The Centers for Medicare & Medicaid Services (CMS) completed its second round of Medicare Advantage (MA) online provider directory reviews between September 2016 and August 2017.  The review examined the accuracy of 108 providers and their listed locations selected from the online directories of 64 Medicare Advantage Organizations (MAOs), approximately one-third of MAOs, for a total of 6,841 providers reviewed at 14,869 locations. The review found that 52.20% of the provider directory locations listed had at least one inaccuracy.

Read More


02/01/18 – Five Breaches Add Up to Millions in Settlement Costs for Entity that Failed to Heed HIPAA’s Risk Analysis and Risk Management Rules

Fresenius Medical Care North America (FMCNA) has agreed to pay $3.5 million to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), and to adopt a comprehensive corrective action plan, in order to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. FMCNA is a provider of products and services for people with chronic kidney failure with over 60,000 employees that serves over 170,000 patients. FMCNA’s network is comprised of dialysis facilities, outpatient cardiac and vascular labs, and urgent care centers, as well as hospitalist and post-acute providers.

Read More


02/01/18 – CMS Proposes Medicare Advantage and Part D Payment and Policy Updates to Provide New Benefits for Enrollees, New Protections to Combat Opioid Crisis

Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes for the Medicare health and drug programs in 2019 that increase flexibility in Medicare Advantage that will allow more options and new benefits to Medicare beneficiaries, meeting their unique health needs and improving their quality of life. Furthermore, the proposal includes important new steps to ensure new patient-doctor-plan communication in combatting the opioid crisis.

Read More

Click here to view fact sheet


01/26/18 – 2016 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Critical Access Hospitals

The American Recovery and Reinvestment Act (ARRA) was enacted into law in 2009. It established incentive payments for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to promote the adoption and meaningful use of Certified Electronic Health Record Technology (CEHRT). Meaningful use is a term defined in the authorizing legislation and by CMS in regulation and describes the use of CEHRT that furthers the goals of information exchange among health care professionals and hospitals.

Read More


01/25/18 – The Newly-Executed MI Three-Way Contract 

Read More

Click here to view summary of contract changes


01/23/18 – VA, Health and Human Services Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts

Today, the U.S. Department of Veterans Affairs (VA) and Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) announced a partnership to share data, data analytics tools and best practices for identifying and preventing fraud, waste and abuse.

Read More


01/17/18 – CMS Announces Additional Special Enrollment Periods to Help Individuals Impacted by Hurricanes in Puerto Rico and the U.S. Virgin Islands

Agency Provides Extended Special Enrollment Periods for 2018 Medicare and Exchange Coverage

The Centers for Medicare & Medicaid Services (CMS) announced additional opportunities for individuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands to enroll in Medicare health and drug plans and health coverage through the Federal Health Insurance Exchange. CMS is providing these special enrollment periods so that certain individuals and families who were impacted can access health coverage on the Exchange and have additional time to join, drop, or switch Medicare health and prescription drug plans. CMS announced initial special enrollment period opportunities in September, this extends these opportunities through March 31, 2018.
 
 

01/11/18 – CMS Announces New Policy Guidance for States to Test Community Engagement for Able-Bodied Adults

Will Support States Helping Medicaid Beneficiaries Improve Well-Being and Achieve Self-Sufficiency

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.
 
 
 

01/10/18 – Bundled Payments for Care Improvement Advanced (BPCI Advanced) Voluntary Bundled Payment Model

To better support healthcare providers who invest in practice innovation, care redesign, and enhanced care coordination, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) has launched the Bundled Payments for Care Improvement Advanced (BPCI Advanced) voluntary bundled payment model. BPCI Advanced qualifies as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program.

Read More


01/09/18 – The Contract Year (CY) 2019 Medicare-Medicaid Plan (MMP) Service Area Expansion (SAE) Application

The Centers for Medicare & Medicaid Services (CMS) is seeking applications from existing Medicare-Medicaid Plans (MMPs) seeking to enter into additional counties in the current capitated financial alignment model demonstrations. Please submit your application according to the process described in Section 2.0.

Read More


01/05/18 – Draft Trusted Exchange Framework Released by HHS

Comment Period Through February 20, 2018

The Department of Health and Human Services today released the draft Trusted Exchange Framework, a significant step towards achieving interoperability, as required by the 21st Century Cures Act of 2016.

Read More

Click here to view the Draft Trusted Exchange Framework


01/05/18 – CY 2018 MMP Health Service Delivery (HSD) Criteria Reference Table

Network Adequacy Standards Criteria File for all States

This letter is a technical correction to the State Medicaid Director Letter (SMDL) that was published on December 27, 2017.

Read More


01/02/18 – CMS Launches Data Submission System for Clinicians in the Quality Payment Program

Website Makes it Easier for Clinicians to Submit Data by Offering One User-Friendly Site for All Submissions

Today, the Centers for Medicare & Medicaid Services (CMS) announced that doctors and other eligible clinicians participating in the Quality Payment Program can begin submitting their 2017 performance data using a new system on the Quality Payment Program website (qpp.cms.gov). The data submission system is an improvement from the former systems under the CMS legacy programs, which required clinicians to submit data on multiple websites. Now, eligible clinicians will use the new system to submit their 2017 performance data for the Quality Payment Program during the 2017 submission period which runs from January 2, 2018 to March 31, 2018, except for groups using the CMS Web Interface whose submission period is January 22, 2018 to March 16, 2018.

Read More

Click here to view fact sheet


12/28/17 – Final Weekly Enrollment Snapshot for 2018 Open Enrollment Period

Approximately 8.7M people selected or were automatically re-enrolled in plans using the HealthCare.gov platform during the 2018 open enrollment period.

Read More


12/28/17 – Failure to Protect the Health Records of Millions of Persons Costs Entity Millions of Dollars

Failure to protect the health records of millions of persons costs entity millions of dollars 21st Century Oncology, Inc. (21CO) has agreed to pay $2.3 million in lieu of potential civil money penalties to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and adopt a comprehensive corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. 21CO is a provider of cancer care services and radiation oncology. With their headquarters located in Fort Myers, Florida, 21CO operates and manages 179 treatment centers, including 143 centers located in 17 states and 36 centers located in seven countries in Latin America.

Read More

Click here to view the resolution agreement


12/28/17 – CMS Approves First 10-Year Section 1115 Demonstration Extension

Mississippi is First State to Receive 10-Year Section 1115 Program Extension Under New Policy

Today, CMS approved for Mississippi the first ever 10-year extension under the Medicaid program demonstration extension to provide further coverage of family planning services in the state. This will extend eligibility for women and men ages 13 through 44, with income up to 194 percent of the federal poverty level (FPL) that are not enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) or other creditable health insurance coverage that includes family planning services. Mississippi’s waiver will be the 25th demonstration action approved by CMS since January 21, 2017.

Read More


12/27/17 – 2019 Medicare Advantage Part 1 Advance Notice - Risk Adjustment

Today, the Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data.

Read More


12/21/17 – CMS Updates Website to Compare Hospital Quality

Agency Continues to Incorporate Feedback to Ensure Reliable Information is Reported

The Centers for Medicare & Medicaid Services (CMS) updated data on the Hospital Compare website and on data.medicare.gov to provide patients, families and all stakeholders with the information they need to compare the performance of hospitals where they seek medical care. Along with data on quality measures, CMS will also update the Overall Hospital Star Rating.

Read More


12/21/17 – Weekly Enrollment Snapshot: Week Seven – Week 7

Dec 10 – Dec 15, 2017

In the last week of Open Enrollment for 2018, 4,143,968 people selected plans using the HealthCare.gov platform or were automatically re-enrolled in a plan. As in past years, enrollment weeks are measured Sunday through Saturday.

Read More


12/21/17 – Federal Exchange Open Enrollment for 2018 Coverage, Most Cost Effective Saving Americans Millions of Dollars While Improving Customer Service and Access to Care

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the fifth open enrollment period for the Health Insurance Exchange was the most cost effective and smooth enrollment experience for consumers, releasing data that shows the highest rates of consumer satisfaction to date at a lower cost. Similar to previous years, there was a surge in the number of consumers contacting the call center and visiting HealthCare.gov during the final days. Despite the increase in volume, both HealthCare.gov and the call center operated optimally and for the first time, a waiting room did not need to be deployed online during the final days of open enrollment. This provided consumers with exceptional site availability when the greatest number of consumers were making plan selections.

Read More


12/19/17 – 2018 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Eligible Clinicians

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for certain eligible clinicians(eligible clinicians include doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors) that are not meaningful users of Certified Electronic Health Record (EHR) Technology. EPs that do not successfully demonstrate meaningful use for an EHR reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year. The Medicare payment adjustments sunset in 2018 for EPs pursuant to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Read More


12/18/17 – HHS Highlights Office for Civil Rights’ Ongoing Response to the Opioid Crisis, While Implementing the 21st Century Cures Act

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) today launched an array of new tools and initiatives in response to the opioid crisis, while implementing the 21st Century Cures Act (Public Law 114-255).  OCR continues its work to ensure that patients and their family members can get the information they need to prevent and address emergency situations, such as an opioid overdose or mental health crisis. At the same time, these tools and initiatives also fulfill requirements of the 21st Century Cures Act to ensure that the healthcare sector, researchers, patients, and their families understand how the Health Insurance Portability and Accountability Act (HIPAA) protects privacy and helps improve health and healthcare nationwide.

Read More


12/15/17 – CMS Strengthens Federal Support to California Residents Affected by Wildfires

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced that the agency has taken immediate steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires ravaging southern portions of the state. On Dec.11, 2017, Acting Health and Human Services Secretary Eric D. Hargan declared a public health emergency (PHE) in the state of California retroactive to Dec. 4, 2017. The PHE allows CMS to waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements if necessary to provide health services.

Read More


12/14/17 – Interdepartmental Serious Mental Illness Coordinating Committee Releases its First Report to Congress

People in the United States who experience serious mental illness and serious emotional disturbances need greater access to quality, affordable health care, according to a report released by the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).

Read More


12/14/17 – CMS Adds New Quality Information to the Physician Compare Website

The Centers for Medicare & Medicaid Services (CMS) has added new quality information to the Physician Compare website.

Read More


12/13/17 – Weekly Enrollment Snapshot: Week Six – Week 6, Dec 3 – Dec 9, 2017

In week six of Open Enrollment for 2018, 1,073,921 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Read More


12/13/17 – First Half of 2017 Average Effectuated Enrollment Report

Effectuated Enrollment Analysis

According to data as of September 15, 2017, an average of 10.1 million individuals had effectuated their coverage through June 2017, meaning that they selected a plan and paid their premium. This is approximately 300,000 fewer effectuated individuals compared to the effectuated report for the first half of 2016 and about 2.1 million below the number of plan selections at the end of 2017 open enrollment.

Read More

Click here to view a breakdown of the data by state


12/12/17 – Long-Term Care Hospital (LTCH) Compare Website – New Measures Added

This fact sheet contains information about the Long-Term Care Hospital (LTCH) Compare website that was refreshed with new quality measures added on December 12, 2017

Section 3004(a) of the Affordable Care Act established the LTCH Quality Reporting Program (QRP) and requires the Secretary of Health and Human Services to establish procedures for making quality data submitted by LTCHs available to the public. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) also requires public reporting of provider performance two years following the specified application date (the date data collection began). Historically, new items are added to the programs in the fall. This Compare refresh release contains data from over 400 LTCHs.

Read More


12/12/17 – Inpatient Rehabilitation Facility (IRF) Compare Website – New Measures Added

This fact sheet contains information about the Inpatient Rehabilitation Facility (IRF) compare website that was refreshed with new quality measures added on December 12, 2017

Section 3004(b) of the Affordable Care Act established the IRF Quality Reporting Program (QRP) and requires the Secretary of Health and Human Services to establish procedures for making quality data submitted by IRFs available to the public. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) also requires public reporting of provider performance two years following the specified application date (the date data collection began). Historically, new items are added to the programs in the fall. This Compare refresh contains data from over 1,100 IRFs.

Read More


12/11/17 – Medicare Care Choices Model (MCCM): The First Two Years

The Centers for Medicare & Medicaid Services (CMS) is conducting the Medicare Care Choices Model (MCCM) to provide beneficiaries, and their caregivers and providers, with greater flexibility when facing a life-limiting illness. MCCM provides Medicare beneficiaries who qualify for the Medicare hospice benefit, (and dually eligible beneficiaries who may qualify for the Medicaid hospice benefit in their state), the option to receive supportive care services typically furnished under the Medicare hospice benefit, while continuing to receive care from other Medicare providers for their terminal condition. Absent the model, Medicare beneficiaries who elect to receive hospice care cannot also receive curative treatment for their life-limiting condition.

Read More


12/06/17 – CMS Office of the Actuary Releases 2016 National Health Expenditures

In 2016, overall national health spending increased 4.3 percent following 5.8 percent growth in 2015, according to a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs. Following Affordable Care Act (ACA) coverage expansion and significant retail prescription drug spending growth in 2014 and 2015, health care spending growth decelerated in 2016. The report concludes that the 2016 expenditure slowdown was broadly based as growth for all major payers (private health insurance, Medicare, and Medicaid) and goods and service categories (hospitals, physician and clinical services, and retail prescription drugs) slowed in 2016.

Read More

Click here to view highlights of the report


11/30/17 – CMS Finalizes Changes to the Comprehensive Care for Joint Replacement Model, Cancels Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model

Today, the Centers for Medicare & Medicaid Services (CMS) finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients.

Read More

Click here to view a technical fact sheet


11/30/17 – FDA Announces Approval, CMS Proposes Coverage of First Breakthrough-Designated Test to Detect Extensive Number of Cancer Biomarkers

Agencies’ Parallel Review Process Makes Test for Efficient Identification of Multiple Targeted Therapy Options Available to Health Care Professionals, Patients and Eligible Beneficiaries Sooner

The U.S. Food and Drug Administration today approved the FoundationOne CDx (F1CDx), the first breakthrough-designated, next generation sequencing (NGS)-based in vitro diagnostic (IVD) test that can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor type. The Centers for Medicare & Medicaid Services (CMS) at the same time proposed coverage of the F1CDx. The test is the second IVD to be approved and covered after overlapping review by the FDA and CMS under the Parallel Review Program, which facilitates earlier access to innovative medical technologies for Medicare beneficiaries.

Read More


11/29/17 – Weekly Enrollment Snapshot: Week Four

In week four of Open Enrollment for 2018, 504,181 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Read More


11/29/17 – Updated Medicare Part D Opioid Drug Mapping Tool Unveiled

Interactive Tool Adds Extended-Release Opioid Prescribing Rates, County-Level Hot Spots

Today, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare opioid prescribing mapping tool. This tool is an interactive, web-based resource that visually presents geographic comparisons of Medicare Part D opioid prescribing rates. The tool includes the addition of extended-release opioid prescribing rates and county-level hot spots and outliers, which may identify areas that warrant attention.

Read More

Click here to view tool


11/28/17 – Market Saturation and Utilization Data Tool

The Centers for Medicare & Medicaid Services (CMS) has developed a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of the beneficiaries receiving that service in the area.

Read More

Click here to view tool


11/27/17 – DRAFT Bulletin: Proposed Timing of Submission of Rate Filing Justifications for the 2018 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2019

The Centers for Medicare & Medicaid Services (CMS) is releasing this draft bulletin for comment.  This bulletin proposes guidance for purposes of establishing the submission deadline under 45 CFR 154.220 for health insurance issuers to submit Rate Filing Justifications for single risk pool coverage in the individual and small group markets.
 

11/27/17 – Proposed Key Dates Calendar for 2018 – QHP Certification in the Federally-Facilitated Exchanges (FFEs), Rate Review and Risk Adjustment

Read More


11/27/17 – 2019 Draft Letter to Issuers in the Federally-Facilitated Exchanges

The Centers for Medicare & Medicaid Services (CMS) is releasing this 2019 Draft Letter to Issuers in the Federally-facilitated Exchanges (2019 Draft Letter). This Letter provides updates on operational and technical guidance for the 2019 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). Issuers should refer to these updates to help them successfully participate in any such Exchange in 2019. Unless otherwise specified, references to the FFEs include the FFSHOPs.

Read More


11/22/17 – Weekly Enrollment Snapshot: Week Three

In week three of Open Enrollment for 2018, 798,829 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.
 
 

11/22/17 – CMS Updates Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019

Expansion of Model to 25 Total States to Provide Medicare Beneficiaries with More Choices and Lower Costs – The Centers for Medicare & Medicaid Services (CMS) today announced several updates to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019 that encourages customized benefit designs and flexibilities that meet the health needs of beneficiaries in a total of 25 states.

Read More


11/17/17 – 2018 Medicare Parts A & B Premiums and Deductibles

On November 17, 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.
 
 

11/16/17 – CMS Releases Proposed Rule to Increase Choices and Lower Premiums for Medicare Advantage Enrollees

Medicare Beneficiaries Will See More Choices and Greater Affordability as a Result of Increased Flexibilities

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will result in lower premiums and increased plan choices for Medicare beneficiaries. During this year’s Medicare Advantage Open Enrollment, which started October 15th and runs until December 7th, seniors enrolling in Medicare Advantage have seen average monthly premiums drop by 6%, and CMS is proposing changes to continue to drive affordable options for Medicare beneficiaries that meet their unique health needs.

Read More

Click here to view the fact sheet


11/16/17 – CMS Proposes Policies to Lower the Cost of Prescription Drugs and Combat the Opioid Crisis

The Proposed Rule Eliminates Administrative Hurtles to Providing More Affordable Prescription Drugs and Will Allow Medicare to Combat Opioid Overprescribing and Abuse

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes a number of changes that, if finalized, will ensure that Part D Medicare enrollees have access to more affordable prescription drugs and more robust prescription drug coverage at the pharmacy they prefer. The rule also gives health plans a new tool to combat the opioid crisis.

Read More

Click here to view the fact sheet


11/15/17 – Weekly Enrollment Snapshot: Week Two

In week two of Open Enrollment for 2018, 876,788 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Read More


Verma Outlines Vision for Medicaid, Announces Historic Steps Taken to Improve the Program

New Policies Help Ensure States Can Focus More Resources, Time Achieving Positive Health Outcomes for Beneficiaries

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.

Read More

Click here to view a copy of Administrator Verma's remarks, as prepared for delivery

Click here to view the new updated Medicaid 1115 Demonstration Project page

Click here to view the Section 115 Demonstration Process Improvements Informational Bulletin

Click here to view the State Plan Amendment and 1915 Waiver Informational Bulletin

 


Episodic Alternative Payment Model for Radiation Therapy Services Announced

Section 3(b) of the Patient Access and Medicare Protection Act (PAMPA) (P.L. 114-115) directs the Secretary of Health and Human Services to submit a report to Congress on the development of an episodic alternative payment model (APM) for Medicare payment under title XVIII of the Social Security Act (the Act) for radiation therapy services furnished in non-facility settings.1 The Centers for Medicare & Medicaid Services (CMS) has prepared this report to respond to this requirement.

Read More


Medicare Diabetes Prevention Program (MDPP) Expanded Model Announced

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

Read More


CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2018

The Hospital Value-Based Purchasing (VBP) Program adjusts what Medicare pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of inpatient care they provide to patients. For fiscal year (FY) 2018, the law requires that the applicable percent reduction, which is the portion of Medicare payments available to fund the program’s value-based incentive payments, remain at 2 percent of the base operating Medicare Severity Diagnosis-Related Group (MS-DRG) payment amounts for all participating hospitals. We estimate that the total amount available for value-based incentive payments for FY 2018 discharges will be approximately $1.9 billion.

Read More


CMS Finalizes Policies that Reduce Provider Burden, Lower Drug Prices

2018 Quality Payment Program and Physician Fee Schedule Finalized

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for the 2018 Physician Fee Schedule and final rule with comment period for the Quality Payment Program (QPP). While part of CMS’s broader strategy to relieve regulatory burdens for providers, these rules also reflect the agency’s efforts to promote innovation in healthcare delivery aimed at lowering prices, increasing competition and strengthening the relationship between patients and their doctors.

Read More

Click here for the Physician Fee Schedule final rule

Click here for a fact sheet on the Physician Fee Schedule final rule

Click here for the Quality Payment Program final rule with comment period

Click here for a fact sheet on the Quality Payment Program final rule with comment period


CMS Announces Payment Changes for Medicare Home Health Agencies for 2018

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1672-F) that updates the calendar year (CY) 2018 Medicare payment rates and the wage index for home health agencies (HHAs) serving Medicare beneficiaries.

Read More


CMS Announces New Medicaid Policy to Combat the Opioid Crisis by Increasing Access to Treatment Options

Approves Demonstrations in Both New Jersey and Utah

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment. In addition, CMS is announcing the immediate approval of both New Jersey and Utah’s demonstration waivers under the new policy.

Read More

Click here to view a copy of the SMD # 17-003 Letter to state Medicaid directors


CMS Finalizes Policies that Lower Out-of-Pocket Drug Costs and Increase Access to High-Quality Care

2018 Medicaid Annual Payment Rules Finalized for Outpatient Hospital Departments, Ambulatory Surgical Centers, and Home Health Settings

Today, the Centers for Medicare & Medicaid Services (CMS) finalized two Medicare payment rules moving the agency in a new direction by putting patients first and ensuring that payments support access to high quality, affordable care. Among other things, the Hospital Outpatient payment rule will lower out-of-pocket drug costs for people with Medicare and empower patients with more choices. Both rules finalized today increase access to care. Importantly, the Hospital Outpatient rule takes steps to preserve access in rural communities.

Read More

Click here to view a fact sheet on the OPPS final rule with comment period

Click here to view a fact sheet on the Home Health final rule


CMS Issues Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System and Quality Reporting Programs Changes for 2018 (CMS-1678-FC)

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC), which includes updates to the 2018 rates and quality provisions, and other policy changes. CMS adopted a number of policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.

Read More


CMS Administrator Verma Announces New Meaningful Measures Initiative and Addresses Regulatory Reform; Promotes Innovation at LAN Summit

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation during a plenary session at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Virginia.

Read More

Click here to view fact sheet


HHS Office for Civil Rights Issues Guidance on How HIPAA Allows Information Sharing to Address the Opioid Crisis

Following President Trump’s call to action yesterday that led to the declaration of a nationwide public health emergency regarding the opioid crisis, the HHS Office for Civil Rights is releasing new guidance on when and how healthcare providers can share a patient’s health information with his or her family members, friends, and legal personal representatives when that patient may be in crisis and incapacitated, such as during an opioid overdose.

Read More


10/25/2017 – Federal Health Insurance Exchange 2018 Open Enrollment

The Federal Health Insurance Exchange Open Enrollment period runs from November 1, 2017, to December 15, 2017, with coverage starting on January 1, 2018. This year the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment. CMS continues to use consumer feedback to drive improvements. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2018 plans and prices before Open Enrollment begins.

Read More


10/19/2017 – CMS Strengthens Federal Support to California Residents Affected by Wildfires

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced that the agency has taken immediate steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires devastating the state. On Oct. 15, 2017, Acting Health and Human Services Secretary Eric D. Hargan declared a public health emergency (PHE) in the state of California retroactive to Oct. 8, 2017. The PHE allows CMS to waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements if necessary to provide health services.

Read More


10/17/2017 – Care for Dialysis Patients a Key Focus of Hurricane Maria Response Efforts in Puerto Rico

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today released additional details on the agency’s efforts in support of dialysis patients and providers in Puerto Rico. Care for these fragile patients is a top priority as are the agency’s actions to help all of those impacted by the storm. During the past few weeks, CMS has worked to ensure hospitals and other facilities can continue operations by waiving numerous Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements, and has helped individuals and doctors by creating special enrollment opportunities to access healthcare immediately and a hotline for physicians assisting with Hurricane Maria response efforts.

Read More


10/12/2017 – Statement from Centers for Medicare & Medicaid Services Administrator Seema Verma on Signing of Executive Order

“Today’s announcement represents an important step in providing Americans with more affordable health insurance coverage options by offering relief from Obamacare’s oppressive mandates and regulations that are driving up costs and driving down the quality of their healthcare. This Executive Order will promote affordable coverage options for Americans, whether they work for small businesses, large employers, or need to purchase coverage on their own. It will empower employers to offer more affordable health coverage and to provide their employees with the opportunity to exercise greater choice and control over their healthcare.”

 


10/11/2017 – Medicare Offers Improved Access to High-Quality Health Coverage Choices in 2018

Agency Releases Star Ratings for 2018 Health and Drug Plans in Advance of Medicare Open Enrollment

Today, the Centers for Medicare & Medicaid Services (CMS) released the Star Ratings for the 2018 Medicare health and drug plans. With the release of the Star Ratings, people with Medicare will have improved access to high-quality health choices for their Medicare coverage in 2018. This news comes on the heels of the recent release of the benefit and premium information for Medicare health and drug plans which shows that there will be more health coverage choices and decreased premiums in 2018.

Read More


10/10/2017 – 2018 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Hospitals

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for eligible hospitals that are not meaningful users of Certified Electronic Health Record (EHR) Technology. Eligible hospitals that do not successfully demonstrate meaningful use for an EHR reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year. The payment adjustments began on October 1, 2014 for eligible hospitals. Eligible hospitals that only participate in the Medicaid EHR Incentive Program and do not bill Medicare are not subject to these payment adjustments. Eligible hospitals that participate in both the Medicare and Medicaid EHR Incentive Programs will be subject to the payment adjustments unless they have successfully demonstrated meaningful use under one of these programs. Over 4,800 eligible hospitals may participate in the EHR Incentive Programs.

Read More


10/10/2017 – CMS Takes Steps to Help with Hurricane Nate Emergency Response

Agency Waivers Take Effect in Alabama, Florida, Louisiana and Mississippi

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced agency efforts underway to support Alabama, Florida, Louisiana and Mississippi in response to Hurricane Nate. On Oct. 8, 2017, Acting Health and Human Services Secretary Don Wright, M.D., M.P.H., declared a public health emergency in these four states. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to those affected by the hurricane. The actions include temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.

Read More


10/05/2017 – Medicare-Medicaid Accountable Care Organization (ACO) Model Updated: Request for Letters of Intent Withdrawn

After careful consideration, the Centers for Medicare & Medicaid Services (CMS) is withdrawing its Request for Letters of Intent to states to participate in the Center for Medicare and Medicaid Innovation’s Medicare-Medicaid ACO Model and will not be moving forward with implementation of the Model. CMS is withdrawing the Request for Letters of Intent because, although several states expressed early interest in the Model, CMS did not receive any letters of intent for the 2018 start date and received only one letter of intent for 2019.

Read More


10/02/2017 – CMS Offers Broad Support for Puerto Rico and the U.S Virgin Islands with Hurricane Maria Recovery

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today outlined broad agency efforts underway in support of Puerto Rico and the U.S. Virgin Islands in support of the Hurricane Maria recovery efforts. CMS has taken numerous actions to help those impacted by the storm and ensure hospitals and other facilities can continue operations and provide access to care. During the past few weeks, CMS has waived numerous Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements, created special enrollment opportunities for individuals to access healthcare immediately, and helped dialysis patients obtain critical life-saving services. CMS has also created a hotline for doctors assisting with hurricane Maria recovery efforts.

Read More


10/02/2017 – Data Show National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) established the National Partnership to Improve Dementia Care in Nursing Homes in 2012. The partnership utilized a multidimensional approach which included public reporting, partnerships and state-based coalitions, research, training for providers and surveyors, and revised surveyor guidance to empower and build upon the efforts of organizations across the country. The Partnership seeks to optimize the quality of care and quality of life for residents in America’s nursing homes by improving care for all residents, especially those with dementia. While the initial focus of the partnership was on reducing the use of antipsychotic medications, the larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices.

Read More


09/29/2017 – Medicare Offers More Health Coverage Choices and Decreased Premiums in 2018

Medicare Advantage Premiums Decrease, Choices Increase, while Enrollment Hits an All-Time High

Today, the Centers for Medicare & Medicaid Services (CMS) announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. As CMS releases the benefit and premium information for Medicare health and drug plans for the 2018 calendar year, the average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high. Earlier this year, CMS announced new policies that support increased benefit flexibilities allowing Medicare Advantage plans the ability to offer innovative plans that fit the needs of people with Medicare.

Read More

Click here to view a factsheet on Medicare Advantage and Part D in 2018


09/27/2017 – HHS Office of Minority Health Awards $5 Million to Help Communities Address the Opioid Crisis, Childhood Obesity and Serious Mental Illness

As part of the Administration’s efforts to address the opioid epidemic, childhood obesity and serious mental illness in communities throughout the country, the Office of Minority Health (OMH) at the U.S. Department of Health and Human Services (HHS) today announced just over $5 million in new cooperative agreement awards to 15 organizations. The awards were made through the OMH Empowered Communities for a Healthier Nation Initiative (Empowered Communities Initiative), which was created to help minority and disadvantaged populations in communities disproportionately affected by the opioid epidemic, childhood obesity and serious mental illness.

Read More


09/26/2017 – The Contract Year (CY) 2018 Medicare-Medicaid Plan (MMP) Explanation of Benefits (EOB) models (Drug-Only and Integrated)

Click here to view Drug-Only Model

Click here to view Integrated Model


09/26/2017 – HHS Brings Medical and Public Health Relief to US Territories Recovering from Hurricanes Maria, Irma

As part of the Trump Administration’s government-wide hurricane relief efforts in impacted U.S. territories, hundreds of medical personnel from the U.S. Department of Health and Human Services are on the ground in Puerto Rico and the U.S. Virgin Islands to help survivors of Hurricanes Maria and Irma. HHS personnel have set up a medical base of operations in hard-hit San Juan following Hurricane Maria, and have begun providing care to local residents since opening the facility on Monday.

Read More


09/22/2017 – Encounter Submission FAQs for Medicare-Medicaid Plans Participating in the Medicare-Medicaid Financial Alignment Initiative

Medicare-Medicaid Plans (MMPs) submit encounter data to CMS for all covered services. Data must be submitted on different files based on whether they are traditionally covered by Medicare vs. Medicaid (see Q1 below), and then further, by file type (see Q3 below). Please note that Prescription Drug Event data for Medicare Part D covered prescriptions must be submitted separately, per standard Medicare requirements for those data.

Read More


09/21/2017 – CMS Announces Efforts to Support Puerto Rico and the US Virgin Islands with Hurricane Maria Emergency Response

Agency Grants Waivers and Helps Patients Evacuated Access Safe Facilities for Care

The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced the efforts that are underway to support Puerto Rico and the U.S. Virgin Islands in the wake of Hurricane Maria. After Health and Human Services Secretary Tom Price, M.D., declared new public health emergencies in Puerto Rico and the U.S. Virgin Islands this week, CMS has waived or modified certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements to provide immediate relief to those affected by the hurricane. CMS also helped patients being evacuated get access to critical life-saving services.

Read More


09/20/2017 – 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through September 20, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

Read More


09/13/2017 – 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through September 13, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

Read More


09/13/2017 – CMS Announces Ongoing Efforts to Support Hurricane Irma Emergency Response

Agency Waives Provider Screening Requirements in U.S. Virgin Islands, Puerto Rico and Florida – The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma issued a letter granting 14 waivers to support Florida in response to Hurricane Irma. In the wake of the historic and unprecedented hurricane, Health and Human Services Secretary Tom Price, M.D., declared a public health emergency in Florida. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to those affected by the hurricane. The actions include temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.

Read More


09/07/2017 – CMS Waives Provider Screening Requirements in TX, LA During Hurricane Harvey Recovery Efforts

The Centers for Medicare & Medicaid Services (CMS) today approved suspending certain Medicare enrollment screening requirements for healthcare providers and suppliers that are assisting with Hurricane Harvey recovery efforts in areas impacted in Texas and Louisiana.

Read More


09/07/2017 – CMS Continues Helping Texas and Louisiana with Hurricane Harvey Recovery

Agency Helps Impacted Beneficiaries with Replacement of Medical Equipment and Supplies

Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma today announced new guidance to support people who are impacted by the loss of their durable medical equipment and supplies due to Hurricane Harvey. The ongoing response from CMS is focused on helping Medicare and Medicaid beneficiaries, providers, facilities and the general public with their immediate needs and ensuring access to healthcare services and resources are not interrupted throughout the recovery.

Read More

Click here to view the fact sheet


08/16/2017 - 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through August 16, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

Read More


08/16/2017 - CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients

Today, as part of our continuing commitment to greater data transparency, Centers for Medicare & Medicaid Services (CMS) unveiled the Hospice Compare website. The site displays information in a ready-to-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. CMS is working diligently to make healthcare quality information more transparent and understandable for consumers to empower them to take ownership of their health. By ensuring patients have the information they need to understand their options, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality.

Read More

Click here to view the fact sheet


08/15/2017 - CMS proposes changes to the Comprehensive Care for Joint Replacement Model, cancellation of the mandatory Episode Payment Models and Cardiac Rehabilitation Incentive payment model

Proposed rule to offer greater flexibility and choice for hospitals in orthopedic care for Medicare beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (Innovation Center) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

Read More

Click here to view the fact sheet


08/03/2017 - CMS Approves Florida Medicaid Demonstration Under New Era of State Flexibility

Today, the Centers for Medicare & Medicaid Services (CMS) approved a five-year extension of Florida’s Managed Medical Assistance (MMA) section 1115 demonstration that allows the state to operate a capitated Medicaid managed care program and a low-income pool (LIP) to provide continuing support for the safety net providers that furnish charity care to the uninsured.

Read More


08/02/2017 - 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through August 2, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

Read More


08/02/2017 - FY 2018 Medicare Payment and Policy Updates for Inpatient Psychiatric Facilities

On August 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a notice with comment period updating fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

Read More


08/02/2017 - Medicare Issues Projected Drug Premiums for 2018

This week, the Centers for Medicare & Medicaid Services (CMS) announced that the average basic premium for a Medicare Part D prescription drug plan in 2018 is projected to decline to an estimated $33.50 per month. This represents a decrease of approximately $1.20 below the actual average premium of $34.70 in 2017. 

Read More


08/02/2017 - CMS Finalizes 2018 Payment And Policy Updates For Medicare Hospital Admissions

Final rule supports transparency, flexibility, program simplification and innovation in the Medicare program

Today, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule, which updates 2018 Medicare payment and policies when patients are discharged from hospitals. The final rule relieves regulatory burdens for providers, supports the patient-doctor relationship in healthcare, and promotes transparency, flexibility, and innovation in the delivery of care for Medicare patients.

Read More

Click here to view the fact sheet


08/01/2017 - HHS Awards $3.2 Million for a Registry of Residents Affected by Lead Exposure in Flint, Michigan

The U.S. Department of Health and Human Services announced today that Michigan State University (MSU) will receive approximately $3.2 million to establish a registry of Flint residents who were exposed to lead-contaminated water from the Flint Water System during 2014-2015. The funds are the first installment of a 4-year, $14.4 million grant.

Read More


08/01/2017 - CMS Updates Medicare Payment Rates, Quality Reporting Requirements

Final rules include policies to be more responsive to patients’ needs

The Centers for Medicare & Medicaid Services (CMS) has issued three final rules outlining 2018 Medicare payment rates for skilled nursing facilities, hospice, and inpatient rehabilitation facilities. The final rules are effective for fiscal year (FY) 2018 and reflect a broader Administration strategy to streamline administrative requirements for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

Read More

Click here to view the fact sheet


07/31/2017 - Medicare Finalizes Fiscal Year 2018 Payment & Policy Changes For Skilled Nursing Facilities

On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1679-F] outlining Fiscal Year (FY) 2018 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). Policies in the final rule continue to build on CMS’ commitment to shift Medicare payments from volume to value, with continued implementation of the SNF Value-based Purchasing (VBP) program.

Read More


07/31/2017 - Final Fiscal Year 2018 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1671-F)

On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP).

Read More


07/28/2017 - Release of Core Quality Measures Collaborative Pediatric Core Measure Set

Today, Centers for Medicare and Medicaid Services (CMS) is announcing the release of a Pediatric measure set as part of the Core Quality Measures Collaborative (CQMC). This set of nine measures is intended for use at the provider level for individual or groups of clinicians and is intended to add focus to quality improvement efforts, reduce the burden of reporting of quality measures, and offer consumers actionable information for decision-making.

Read More


07/25/2017 - CMS Proposes 2018 and 2019 Payment Changes for Medicare Home Health Agencies

Proposed rule creates a more responsive home health payment system to meet patients’ needs

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment rates and the wage index for home health agencies (HHAs) serving Medicare beneficiaries in 2018 and proposes a redesign of the payment system in 2019. The Home Health Prospective Payment System (HH PPS) proposed rule is one of several proposed rules that would be effective for calendar year 2018 that reflect a broader strategy that CMS is pursuing to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

Read More

Click here to view the fact sheet


07/24/2017 - Market Saturation and Utilization Data Tool

The Centers for Medicare & Medicaid Services (CMS) has developed a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of the beneficiaries receiving that service in the area.

Read More


07/19/2017 - 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through July 19, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

Read More


07/16/2017 - Better Care Reconciliation Act Ensures That Low-Income Adults Receiving Medicaid Have Access To High Quality Affordable Coverage

CMS confirms that BCRA provides support for low-income Americans

The Senate’s healthcare proposal provides funding to ensure that low-income adults will have access to high quality, affordable coverage and care. The proposal provides significant new funding to states, including tax credits, a stability fund with over $180 billion that states can use to help low-income Americans purchase coverage, and $45 billion to address the opioid epidemic. This funding can be combined with states’ existing Medicaid funding to allow states to design a plan to help their low-income population purchase personal private coverage that offers more access to providers and better health outcomes.

Read More


07/15/2017 - HHS Secretary Tom Price and CMS Administrator Seema Verma Address the Summer 2017 National Governors Association Meeting "The Future of Health Care"

Today, Health and Human Services Secretary Tom Price, M.D., and Seema Verma, Administrator of the Centers for Medicare & Medicaid Services addressed the future of healthcare at a meeting with governors at the Summer 2017 National Governors Association Meeting in Providence, Rhode Island.

Read More


07/13/2017 - CMS Proposes 2018 Policy and Rate Changes for Hospital Outpatient, Ambulatory Surgical Center Payment Systems

Proposed rule and Request for Information promote improvements to quality, accessibility and affordability of care

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility and innovation in the delivery of care. 

Read More

Click here to view the fact sheet


07/13/2017 - CMS Proposes 2018 Payment And Policy Updates For The Physician Fee Schedule

Proposed rule & Request for Information provide flexibility, support strong patient-doctor relationships

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in calendar year (CY) 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care. 

Read More

Click here to view the fact sheet


07/13/2017 - Medicare Trustees Report Shows Trust Fund Solvent Through 2029

Independent Payment Advisory Board is not triggered

Today, the Medicare Trustees projected that the trust fund financing Medicare’s hospital insurance coverage will be depleted in 2029, one year later than projected in last year’s report. Lower spending in 2016, lower projected inpatient hospital utilization and slightly better projected hospital insurance deficit in 2017 than in 2016 were the contributing factors to the extended solvency projection. Further, because spending levels in Medicare did not exceed its targets, the Independent Payment Advisory Board (IPAB), set up by the Patient Protection and Affordable Care Act (ACA), was not triggered.

Read More

Click here to view the report


07/13/2017 - Proposed Policies for the Medicare Diabetes Prevention Program Expanded Model in the Calendar Year 2018 Physician Fee Schedule Proposed Rule

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) proposed rule that would make additional proposals to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018.  The MDPP expanded model was announced in early 2016, when it was determined that the Diabetes Prevention Program (DPP) model test through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards met the statutory criteria for expansion. Through expansion of this model test, more Medicare beneficiaries will be able to access evidence-based diabetes prevention services, potentially resulting in a lowered rate of progression to type 2 diabetes, improved health, and reduced costs.

Read More


07/10/2017 - Fewer Issuers Apply To Participate In Health Insurance Exchanges For 2018

Less choice for consumers as issuer health plan applications drop 38 percent from last year

The Centers for Medicare & Medicaid Services (CMS) today announced 141 individual market qualified health plan (QHP) issuers submitted initial applications to offer coverage using the Federally-facilitated Exchange eligibility and enrollment platform in 2018. At the initial filing deadline last year, 227 issuers submitted an application compared to 141 this year, a 38 percent drop in filings.

Read More


06/30/2017 - HHS Awards $15 Million To Help Families Affected By Lead Exposure In Flint, MI

The U.S. Department of Health and Human Services today announced approximately $15 million in funding for the Genesee County Healthy Start Program to provide health and social services for women, infants, and their families who have had, or are at risk for, lead exposure in Flint, Michigan and the surrounding community. The Genesee County Health Department oversees the county’s Healthy Start Program.

Read More


06/29/2017 - Changes to the Payment Error Rate Measurement and Medicaid Eligibility Quality Control Programs (CMS-6068-F)

Today, June 29, 2017 the Centers for Medicare & Medicaid Services (CMS) posted a final rule that will publish on July 5, 2017 to implement changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs to reflect changes to the way states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) required by law, as well as to implement other changes to the PERM and MEQC programs.

Read More


06/29/2017 - CMS Proposes 2018 Policy and Payment Rate Changes for End-Stage Renal Disease Facilities

Proposed rule builds patient-centered system of care to increase competition, quality and care - The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for calendar year 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

Read More

Click here to view the fact sheet


06/27/2017 - CMS Issues Updated County By County Analysis Of Current Projected Issuer Participation In Health Insurance Exchanges

Issuer participation in the Exchanges continues to decline - The Centers for Medicare & Medicaid Services (CMS) is releasing an updated county-level map of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through June 27, 2017. This updated map shows that coverage choices on the Exchanges continue to disappear week to week. Plan options are projected to be down from last year and, and in the last two weeks Americans in four additional counties are projected to have no coverage options available to them on the Exchanges.

Read More


06/20/2017 - CMS Proposes Quality Payment Program Updates To Increase Flexibility And Reduce Burdens

Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.

Read More


06/14/2017 - CMS Releases 1991-2014 Health Care Spending by State

Data details health care spending for residents by service and major payer - Today, the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014. The data shows that while most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates. The report also found that the most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage. Every state experienced slower growth in per capita personal health care spending from 2010-2013 than experienced during the period 2004-2009.

Read More


06/13/2017 - County by County Analysis of Current Projected Insurer Participation in Health Insurance Exchanges

The Centers for Medicare & Medicaid Services (CMS) is releasing a county-level map of 2018 projected Health Insurance Exchanges participation based on the known issuer participation public announcements through June 9, 2017. This map shows that insurance options on the Exchanges continue to disappear. Plan options are down from last year and, in some areas, Americans will have no coverage options on the Exchanges, based on the current data.

Read More


06/12/2017 - High Costs, Lack of Affordability Most Common Factors that Lead Consumers to Cancel Health Insurance Coverage

CMS issues two new reports on health insurance enrollment trends

Today, the Centers for Medicare & Medicaid Services (CMS) published two reports, the Effectuated Enrollment report and The Health Insurance Exchanges Trends report. These reports show that after selecting a plan on the Exchanges during open season which ended January 31, 2017, less than two months later nearly 2 million people had not paid their insurance premium to effectuate and maintain their health coverage. This number will be adjusted for individuals who effectuate their coverage in March 2017. Exit survey data also contained in the reports indicate that cost is the top reason cited for ending their coverage. Taken together, these reports provide a better understanding of why consumers are leaving the Exchanges.

Read More


06/08/2017 - The Centers for Medicare & Medicaid Services (CMS) seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (PPACA)

The Centers for Medicare & Medicaid Services (CMS) today issued a Request for Information (RFI) seeking recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets. Our goal through this process is to identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.

Read More


06/05/2017 - CMS Issues Proposed Revision Requirements for Long-Term Care Facilities’ Arbitration Agreements

The Centers for Medicare & Medicaid Services (CMS) issued proposed revisions to arbitration agreement requirements for long-term care facilities. These proposed revisions would help strengthen transparency in the arbitration process, reduce unnecessary provider burden and support residents’ rights to make informed decisions about important aspects of their health care.

Read More


05/31/2017 - HHS Announces Over $70 Million In Grants To Address The Opioid Crisis

Health and Human Services Secretary Tom Price, M.D., today announced the availability of over $70 million over multiple years to help communities and healthcare providers prevent opioid overdose deaths and provide treatment for opioid use disorder, of which $28 million will be dedicated for medication-assisted treatment (MAT).

Read More


05/31/2017 - HHS Announces The Move Health Data Forward Phase 3 Challenge Winners

Electronic solutions designed to help consumers share personal health data easily and securely

As part of its ongoing efforts to support the interoperable flow of health information, the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 3 – and final – winners of the Move Health Data Forward Challenge. The multi-phase challenge focused on the development of applications allowing individuals to share their personal health information safely and securely with their health care providers, family members or other caregivers.

Read More


05/30/2017 - New Medicare Cards Offer Greater Protection To More Than 57.7 Million Americans

New cards will no longer contain Social Security numbers, to combat fraud and illegal use

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

Read More


05/23/2017 - HHS REPORT: Average Health Insurance Premiums Doubled Since 2013

The Department of Health and Human Services (HHS) released a new analysis today that shows premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect. The analysis is based on data compiled by the previous Administration, and the report was produced by the Office of The Assistant Secretary for Planning and Evaluation (ASPE).

Read More

Click here to read the report

 


05/17/2017 - The Center For Medicare And Medicaid Services (CMS) Announces Streamlined Direct Enrollment Process For Consumers Seeking Exchange Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new streamlined and simplified direct enrollment process for consumers signing up for individual market coverage through Exchanges that use HealthCare.gov. Consumers applying for individual market coverage during the upcoming open enrollment period through direct enrollment partners will now be able to complete their application using one website. This reduces needless regulatory burden for businesses that provide direct enrollment services and offers consumers easier access to healthcare comparisons and shopping experiences for coverage offered through HealthCare.gov.

Read More


05/16/2017 - Centers for Medicare and Medicaid Services (CMS) Issues Section 1332 State Innovation Waiver Checklist

Checklist Aims to Help Stabilize State Health Insurance Markets for 2018

Today, the Centers for Medicare and Medicaid Services (CMS) released new information to help states seek waivers from requirements in the Affordable Care Act (ACA). The new tool is intended to help states complete waiver applications that allow them to establish high-risk pools/ state-operated reinsurance programs. Section 1332 waivers, generally can be used by states to opt-out of some mandated provisions under ACA.  CMS is helping to provide guidance to states who want to pursue solutions to help lower costs and increase coverage choices for Americans struggling with unaffordable premiums and reduced competition in the insurance market, brought on by the ACA. Individuals obtaining coverage in the ACA marketplace have faced double-digit premium increases and insurance issuer exits.

Read More


05/15/2017 - Centers for Medicare and Medicaid Services Offers New Health Coverage Enrollment Option for Small Business

Today, the Centers for Medicare & Medicaid Services (CMS) announced a plan to change the way that small businesses enroll in insurance coverage through the Federal exchanges, offering employers the help they need to find affordable insurance for their employees.  The Federally-Facilitated Small Business Health Options Program (FF-SHOP) program was mandated under the Affordable Care Act (ACA), but failed to sign-up significant numbers of small employers. Out of the nearly 30 million small businesses in the country, less than 8,000, just .1 percent of small businesses currently participate in the FF-SHOPs in 33 states, which cover less than 40,000 individuals nationwide. SHOP programs are now defunct and do not provide needed insurance coverage for small businesses.

Read More


05/09/2017 - CMS Announces Extension for States under Medicaid Home and Community-Based Settings Criteria

Agency reinforces partnership with states in administering Medicaid Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced a three-year extension for state Medicaid programs to meet the Home and Community Based Services (HCBS) settings requirements for settings operating before March 17, 2014. This extension is in response to states’ request for more time to demonstrate compliance with the regulatory requirements and ensure compliance activities are collaborative, transparent, and timely.

Read More


04/24/2017 - $2.5 Million Settlement Shows That Not Understanding HIPAA Requirements Creates Risk

The U.S. Department of Health and Human Services, Office for Civil Rights (OCR), has announced a Health Insurance Portability and Accountability Act of 1996 (HIPAA) settlement based on the impermissible disclosure of unsecured electronic protected health information (ePHI). CardioNet has agreed to settle potential noncompliance with the HIPAA Privacy and Security Rules by paying $2.5 million and implementing a corrective action plan. This settlement is the first involving a wireless health services provider, as CardioNet provides remote mobile monitoring of and rapid response to patients at risk for cardiac arrhythmias.

Read More


04/17/2017 - Rural Community Hospital Demonstration

Updated April 2017

The Centers for Medicare & Medicaid Services (CMS) is conducting the Rural Community Hospital Demonstration Program, which was originally authorized for a 5-year period by section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), and extended for another 5-year period by sections 3123 and 10313 of the Patient Protection and Affordable Care Act (Affordable Care Act). Section 15003 of the 21st Century Cures Act, enacted December 13, 2016, again amended section 410A of the MMA to require another 5-year extension period for the demonstration.

Read More


04/14/2017 – CMS Proposes 2018 Payment and Policy Updates for Medicare Hospital Admissions, and Releases a Request for Information

Proposed Rule Seeks Transparency, Flexibility, Program Simplification and Innovation to Transform the Medicare Program

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare payment and policies when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.

Read More

Click here to view the fact sheet


04/13/2017 – CMS Issues Final Rule to Increase Choices and Encourage Stability in Health Insurance Market for 2018

The Centers for Medicare & Medicaid Services (CMS) today issued the final Market Stabilization rule, to help lower premiums and stabilize individual and small group markets and increase choices for Americans.  Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits. The CMS rule is designed to provide some relief for patients and issuers now.

Read More

Click here to view the final rule


04/13/2017 – CMS Releases Quality Data Showing Racial, Ethnic and Gender Differences in Medicare Advantage Health Care during National Minority Health Month

In recognition of National Minority Health Month, the Centers for Medicare & Medicaid Services, Office of Minority Health (CMS OMH) released a pair of reports detailing the quality of care received by people enrolled in Medicare Advantage (MA). One report compares quality of care for women and men while the other report looks at racial and ethnic differences in health care experiences and clinical care, among women and men. Each April, in recognition of National Minority Health Month, CMS plans to make additional reports available online on the CMS OMH website. 

Read More


04/13/2017 – Bulletin: Revised Timing of Submission Posting of Rate Filing Justifications for the 2017 Filing Year for ingle Risk Pool Coverage; Revised Timing of Submission for Qualified Health Plan Certification Application

On December 16, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final Unified Rate Review Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage1, as well as the final 2018 Letter to Issuers. On February 17, 2017, CMS released a draft bulletin for comment on the proposed revised uniform timeline for submission and public release of information about rate filings for single risk pool coverage, consistent with 45 CFR Part 154. CMS separately released an Addendum to the final 2018 Letter to Issuers, which revised the timeline for the submission of Qualified Health Plan (QHP) applications for certification in the Federally-facilitated Exchanges for Plan Year 2018.

Read More


04/13/2017 – Key Dates for Calendar Year 2017: Qualified Health Plan Certification in the Federally-facilitated Exchanges; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors

Revised April 2017

The dates in Table 1 below generally supersede Table 1.1 Timeline for Qualified Health Plan (QHP) Certification in the Federally Facilitated Exchanges (FFM) on pages 7 and 8 from the 2018 Letter to Issuers released on December 16, 2016. The Centers for Medicare & Medicaid Services (CMS) released an Addendum to the 2018 Letter to Issuers to reflect the revised Plan Year 2018 QHP certification timeline consistent with Table 1 below. Table 2 reflects the revisions to the Unified Rate Review timeline, as reflected in the April 13, 2017 Bulletin: Revised Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage. Table 3 includes the dates for Risk Adjustment and Reinsurance and has been updated to include key dates for Risk Corridors for the 2016 Benefit Year.
 
 

 


04/06/2017 – CMS’ Accountable Health Communities Model Selects 32 Participants to Serve as Local ‘Hubs’ Linking Clinical and Community Services

Last year, the Centers for Medicare & Medicaid Services (CMS) released a Funding Opportunity Announcement (FOA) for applications for the Center for Medicare and Medicaid Innovation’s (Innovation Center) Accountable Health Communities (AHC) model. Over a five-year period, CMS will implement and test the three-track AHC model to support local communities in addressing the health-related social needs of Medicare and Medicaid beneficiaries by bridging the gap between clinical and community service providers. Social needs include housing instability, food insecurity, utility needs, interpersonal violence and transportation.

Read More


04/03/2017 - CMS Finalizes 2018 Payment And Policy Updates For Medicare Health And Drug Plans, And Releases A Request For Information

Rate Announcement supports benefit flexibility, efficiency, and innovation in Medicare Advantage and Part D

The Centers for Medicare & Medicaid Services (CMS) today released final updates to the Medicare Advantage and Part D Prescription Drug Programs for 2018. Through these changes, CMS seeks to support benefit flexibility and efficiency that allows Medicare enrollees to choose the care that best fits their health needs.  “Medicare is committed to strengthening Medicare Advantage and the Prescription Drug Program by supporting flexibility and efficiency,” said CMS Administrator Seema Verma, MPH. “These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs.”

Read More

Click here to view the fact sheet

Click here to view the 2018 Rate Announcement and Call Letter


03/21/2017 - Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative

This brief provides an overview of care coordination activities and early findings on successes and challenges of providing care coordination services for capitated model demonstrations in nine states (CA, IL, MA, MI, NY, OH, SC, and VA) implemented between October 2013 and February 2015. The brief focuses on major elements of the care coordination process, including care coordination entities and individual care coordinators, health risk assessments, individualized care plans, interdisciplinary care teams, and care coordination data systems.

Read More


03/21/2017 - Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative

This brief, made possible with funding from the CMS Office of Minority Health as part of the evaluation of the Financial Alignment Initiative, describes the experiences of beneficiaries who are users of long-term services and supports (LTSS) and/or behavioral health services. Focus groups were conducted between May 2015 and April 2016 and included enrollees of demonstrations in six states (CA, IL, MA, OH, VA, and WA). The brief contains findings on common themes identified by focus groups, including the experiences of racial, ethnic, and linguistic minorities. While participants’ satisfaction with the demonstrations varied, the evaluators found that experiences were generally similar across racial and ethnic groups. 

Read More


03/21/2017 - Special Populations Enrolled in Demonstrations under the Financial Alignment Initiative

This brief, made possible with funding from the CMS Office of Minority Health, examines findings from surveys and focus groups conducted in Massachusetts and Washington from mid to late 2015 and early 2016. It describes the experiences of beneficiaries who are users of LTSS and/or behavioral health services, with a focus on the experience of racial, ethnic, and linguistic minorities. In both Massachusetts and Washington, beneficiary satisfaction did not appear to vary along racial or ethnic lines.  

Read More


03/15/2017 - Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management

Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) and the Federal Office of Rural Health Policy at the Health Resources and Service Administration (HRSA) introduced Connected Care, an educational initiative to raise awareness of the benefits of chronic care management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to provide health care professionals with support to implement CCM programs. Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease.

Read More


Community Provider News

9/4/18 – Kaiser Health News – Creating Rituals to Honor the Dead at Long-Term-Care Facilities

By Judith Graham

One by one, their names were recited as family members clutched one another’s hands and silently wept.

Read More


05/09/18 – CHCS – ThedaCare: Leveraging Community Paramedics to Bridge Persistent Gaps in Care

Brian Randall is a paramedic in northeastern Wisconsin, but when he goes out on a call he does not careen down the street in an ambulance, sirens blaring and lights flashing. Instead, Randall, who meets with people with complex medical and social needs in their homes, drives a Suburban and is more likely to be carrying a weighted lap blanket or blood pressure cuff than a stretcher. He is one of two community paramedics from Gold Cross Ambulance Service who work in partnership with ThedaCare, a large nonprofit health care system in Wisconsin, to bridge existing gaps in chronic disease management for patients struggling to manage their health.

Read More


04/26/18 – CHCS – Providing Home- and Community-Based Nutrition Services to Low-Income Older Adults: Promising Health Plan Practices

By Stephanie Gibbs

State Medicaid agencies and Medicaid health plans increasingly recognize the importance of social support services, including nutritious food, as part of a holistic approach to addressing the needs of low-income older adults and enabling them to live independently. Medicaid health plans are especially well-positioned to identify nutrition-related needs for this population and address them through partnerships with community-based organizations.

Read More


04/03/18 – Kaiser Family Foundation – Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2008 Through 2016

By Charlene Harrington, Helen Carrillo, Rachel Garfield, MaryBeth Musumeci, and Ellen Squires

Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. Medicaid plays a major role in financing nursing facility care in the United States, and policy proposals to limit federal financing for Medicaid may lead to cuts in eligibility or scope of coverage for long-term care services. In addition, regulations effective November 2016 aimed to address longstanding challenges in quality and safety in nursing facilities. As the demand for long term care continues to increase and policy proposals and regulations unfold, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers.

Read More

Click here to view supplemental tables


02/14/18 – McKnight’s – Skilled Nursing Providers Would Lose Out Under Trump’s Revised Payment System

By Kimberly Marselas

A plan to lump together payments to all post-acute providers would be a budget cut dressed up as reform, providers said after reviewing the Department of Health and Human Services budget proposal.

Read More


12/19/17 – NAHC - NAHC Opposes Cuts to Medicare Home Health Payment Rates and Spending

Congress is considering severe cuts to Medicare home health payment rates and spending that could total $4-$6 billion over the next ten years. What’s more, lawmakers are considering phasing out the rural add-on over the next three to five years.

Read More


12/4/17 – NAHC – The Time for Private Duty Home Care Accreditation is Now

It is an exciting time in private duty home care services, with expanding business opportunities yielding the possibility of rapid growth. However, growth in the industry has led to calls for more oversight and regulation and more and more states are considering legislation to make accreditation for private duty home care agencies mandatory.

Read More

 


11/27/17 – McKnight’s – Tomorrow’s the Day: Providers Prepare for Phase 2 Deadline

By Emily Mongan

Despite efforts from provider groups and lawmakers to delay Phase 2 of the Centers for Medicare & Medicaid Services' Requirements of Participation, the new survey process is expected to take effect Tuesday.

Read More


11/16/17 – McKnight’s – Changes to Medicare Telehealth Coverage May Benefit LTC

By Emily Wein

While arguably late to the telehealth game, long term care and post-acute care providers are now key players in telehealth as its benefits become more and more apparent for their patients and business models. Recent changes in federal law may provide some additional support and momentum for the continued and increased use of telehealth within this industry.

Read More


09/14/2017 – McKnight’s – New Bill Seeks to Bolster LTC Workforce with Grants, Awards Program

By Emily Mongan

Legislation introduced in the House last week will aim to shore up the nation's long-term care workforce with increased investment in training and a focus on caregivers in rural areas.

Read More

Click here to view the bill


08/16/2017 – The Commonwealth Fund - An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems

By Joshua M. Sharfstein, Sule Gerovich, Elizabeth Moriarty, and David C. Chin

Many communities in the United States experience high rates of premature illness and death. In 2015, the nation’s life expectancy dropped for the first time since 1993.  Expanding access to primary care, behavioral health services, and other social services can improve health outcomes and moderate rising costs. However, finding sustainable sources of funding for clinical transformation has been challenging. One major reason is that the safety-net health care systems still depend on fee-for-service reimbursement for hospital services. When health systems can stay afloat only by keeping inpatient beds filled, major investments in prevention can sink the ship.

Read More


08/08/2017 – The Commonwealth Fund - Patients Are Not Given Quality-of-Care Data About Skilled Nursing Facilities When Discharged from Hospitals

Most hospital patients who require care from a nursing facility following their discharge receive no information about the quality of available facilities, according to interviews with patients and medical staff. With hospitals now held partly responsible for their patients’ care after discharge, Medicare will likely need to amend or clarify its rules to encourage hospitals to recommend higher-quality facilities to their patients.

Read More

Click here to view the report


07/13/2017 – The United States Department of Justice - National Health Care Fraud Takedown Results in Charges Against Over 412 Individuals Responsible for $1.3 Billion in Fraud Losses

Largest Health Care Fraud Enforcement Action in Department of Justice History

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists. 

Read More


07/13/2017 – All Gov - Assistant Secretary for Aging: Who Is Lance Robertson?

On June 19, 2017, President Donald Trump nominated Lance A. Robertson of Oklahoma to be the next chief of the Administration for Community Living, an office in the Department of Health and Human Services that is responsible for home and community-based services and programs related to aging. Since 2007, Robertson has been director of Aging Services at the Oklahoma Department of Human Services. If confirmed by the Senate, Robertson would succeed Kathy Greenlee, who had served since 2009.

Read More


07/11/2017 – Kaiser Family Foundation - Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2015

By Charlene Harrington, Helen Carrillo, and Rachel Garfield

Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. Medicaid plays a major role in financing nursing facility care in the United States, and recent policy proposals to limit federal financing for Medicaid may lead to cuts in eligibility or scope of coverage for long-term care services. In addition, new regulations, effective November 2016, aim to address longstanding challenges in quality and safety in nursing facilities. As the demand for long term care continues to increase and new policy proposals and regulations unfold, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers.

Read More

Click here to view the supplemental tables


06/14/2017 – AARP Public Policy Institute – Long-Term Services and Supports State Scorecard 2017 Edition

By Susan C. Reinhard, Jean Accius, Ari Houser, Kathleen Ujvari, Julia Alexis, and Wendy Fox-Grage

The Long-Term Services and Supports (LTSS) State Scorecard—a compilation of state data and analysis—finds that progress toward better support for our rapidly increasing populations that are aging and living with disabilities is slow and uneven, with great variation among states. Still, states made significant improvements in supporting family caregivers, providing more home- and community-based services, and reducing burdensome care transitions from one care setting or provider to another.

Read More


06/07/2017 – The Commonwealth Fund - An Overview of Home-Based Primary Care: Learning from the Field

By Sarah Klein, Martha Hostetter, Douglas McCarthy

In the United States, some 2 million older adults are so sick, frail, or functionally limited they are effectively homebound; another 5 million have difficulty leaving home without help.1 Many suffer from multiple chronic health conditions such as heart failure, emphysema, and stroke, which may be compounded by psychiatric or cognitive disorders, including depression or dementia.2 These figures don’t include the millions of younger Americans suffering from catastrophic or disabling conditions like quadriplegia or ALS.3 “These are the people you don’t see in grocery stores and restaurants. Because they also don’t get to the doctor, they often end up in the emergency department and the hospital in crisis,” says Terri Hobbs, executive director of Housecall Providers, a Portland, Oregon–based nonprofit that brings primary, palliative, and hospice services to people at home.

Read More


05/12/2017 – CHCS - Self-Direction of Home- and Community-Based Services: A Training Curriculum for Case Managers

Self-direction of home- and community-based services (HCBS) allows individuals to determine what mix of personal care services and supports works best for them within the parameters of their person-centered service plan. Many states implementing Medicaid managed long-term services and supports or other managed integrated care programs that provide HCBS are offering individuals the opportunity to self-direct their HCBS. Health plan case managers play a key role in implementing self-direction.

Read More


05/10/2017 – Kaiser Family Foundation - Data Note: A Large Majority of Physicians Participate in Medicaid

By Julia Paradise

About 70% of all office-based physicians accept new Medicaid patients, including two-thirds of primary care physicians and close to three-quarters (72%) of specialists. The percentage of physicians accepting new Medicaid patients varies by state, ranging from 39% in New Jersey to 97% in Nebraska (Figure 1). Overall, about 85% of physicians accept new privately insured patients, but this rate also varies by state, ranging from 57% in the District of Columbia to 95% in Illinois. In one-quarter of states (14), more than 85% of physicians accept new Medicaid patients, including 10 states where at least 90% do. Physician participation in Medicaid is generally highest in the most rural states.

Read More


04/06/2017 – Alzheimer’s Association - Toolkit for Medicare Coverage of Care Planning

Cognitive decline — including Alzheimer's disease and other dementias — can be difficult and time consuming to discuss with patients. Although in-depth care planning is beneficial for all, this type of service has not been covered under Medicare — until now.  The new G0505 Medicare code provides reimbursement for a clinical visit that results in a comprehensive care plan, allowing you to deliver services that can contribute to a higher quality of life for your patients. Clinicians who can be reimbursed under the code include: physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives.

Read More

Click here to view the complete toolkit


04/05/2017 – McKnight’s - More Targeted Medicare Claims Reviews Coming, Former Agency Examiner Says

By Emily Mongan

An evolving Medicare integrity program and improved data analytics will put providers on the receiving end of more targeted claims reviews, one industry expert warned on Tuesday.  That increased scrutiny means providers would be wise to beef up their documentation and ensure they're responding to additional development requests with timely, sufficient document packets, according to Jaclyn Warshauer, PT, national clinical director for Aegis Therapies. She spoke Tuesday during the American College of Health Care Administrators' annual convocation in St. Louis.

Read More


03/21/2017 – Administration for Community Living - DRAFT Principles for a Person-Centered Approach to Serious or Advanced Illness

By Edwin Walker and Bob Williams

At ACL, we believe that every person should be able to make choices and to control their own decisions, regardless of their age, disability, or illness.  ACL, in consultation with stakeholders from the aging and disability communities, has drafted a set of principles to guide our work in this area, and to enhance existing programs and services related to serious or advanced illness for older adults and people with disabilities.  Now we need your feedback. We know there are a wide variety of deeply held perspectives on these issues, and we are committed to better understanding them.  We are seeking input from the people we serve—older adults, people with dementia, people with all types of disabilities, and the families and caregivers who often support them.  We also hope to hear from our partners in the aging and disability networks.  Please send your comments, by May 12, 2017, to AdvancedIllness@acl.hhs.gov. We will carefully consider all input as we finalize the principles, which we will share via ACL.gov when complete.    

Read More


Other Releases

10/30/18 – CHCS– Inclusion and Exclusion Criteria for Complex Care Programs: Survey of Approaches

Around the country, innovative health care organizations are developing programs to better coordinate care for people with complex medical, behavioral health, and social needs. As a first step, organizations need to consistently and efficiently identify individuals in their patient population who can benefit from enhanced care coordination and also determine when to “graduate” patients out of their programs. The Center for Health Care Strategies surveyed organizations involved in its Transforming Complex Care and Complex Care Innovation Lab initiatives to find out how they are identifying individuals for their respective complex care programs. Although this field is still emerging, the criteria used by these innovators can help inform other programs seeking to develop or refine eligibility criteria for complex care management programs.
 
 

 


10/30/18 - ACL - Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Health Care Utilization

By James Mabli, Arkadipta Ghosh, Bob Schmitz, Marisa Shenk, Erin Panzarella, Barbara Carlson, and Mark Flick

The 2018 evaluation of the Older Americans Act (OAA) Nutrition Services Program (NSP) Outcomes Report Part II describes the effect of the OAA Title III-C NSP on participants’ Medicare-funded health care utilization. Part I of this report, available on the ACL website, provided statistical evidence that the OAA Title III-C nutrition programs are fulfilling the statutory purpose: reducing hunger and food insecurity, promoting socialization and promoting health and well-being through providing a nutritious meal. 
 

10/26/18 – ASPE – 2019 Health Plan Choice and Premiums in Healthcare.gov States

This brief presents information on qualified health plans (QHPs) available in states that rely on the HealthCare.gov eligibility and enrollment platform (HealthCare.gov states), including estimates for issuer participation, consumer options, average premiums, and subsidies in the upcoming open enrollment period (OEP), and trends since the first OEP. National estimates and summary tables are presented in each section of the text. State-specific estimates are in the Appendix. Unless otherwise specified, all estimates reflect all states using the HealthCare.gov platform for each given year.

Read More


10/25/18 – ASPE – Comparison of U.S. and International Prices for Top Medicare Part B Drugs by Total Expenditures

The prices charged by drug manufacturers to wholesalers and distributors (commonly referred to as ex-manufacturers prices) in the United States are 1.8 times higher than in other countries for the top drugs by total expenditures separately paid under Medicare Part B. U.S. prices were higher for most of the drugs included in the analysis, and U.S. prices were more likely to be the highest prices paid among the countries in our study.

Read More


10/22/18 – The Commonwealth Fund - The Potential Implications of Work Requirements for the Insurance Coverage of Medicaid Beneficiaries: The Case of Kentucky

By Sara R. Collins, Sherry A. Glied and Adlan Jackson

With encouragement from the Trump administration, 14 states have received approval for or are pursuing work requirements for nondisabled Medicaid beneficiaries. The requirements have sparked controversy, including two legal challenges.

Read More


10/17/18 – The Commonwealth Fund – Health Care in America

The Experience of People with Serious Illness

By Eric C. Schneider, Melinda Abrams, Arnav Shah, Corrine Lewis, and Tanya Shah

Most Americans expect the health care system will deliver effective treatment and support them through trying times when they get sick. But in reality, health care in America sometimes hurts even as it helps. Appointments can be difficult to get. Clinics and emergency rooms are often overcrowded. Doctors’ recommendations can be confusing and difficult to follow. And when the bills arrive, the costs can be unexpected and devastating. More than 40 million adults in the United States experienced serious illness in the past three years. More than 41 million provided unpaid care to elderly adults during the past year.

Read More


10/16/18 – Kaiser Family Foundation - What Are the Latest Trends in Medicaid?

Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019 at a Forum with the National Association of Medicaid Director

At 9:30 a.m. ET on Thursday, Oct. 25, KFF (the Kaiser Family Foundation) will release its 18th annual 50-state Medicaid budget survey for state fiscal years 2018 and 2019. KFF and the National Association of Medicaid Directors (NAMD) will hold a joint briefing to discuss trends in enrollment and spending and highlight key policy developments at a time when the majority of states are focused on quality and outcomes while some are pursing policies that could restrict Medicaid coverage.
 
 

10/16/18 – Kaiser Family Foundation - People on Medicare Will Be Able to Choose Among 24 Medicare Advantage Plans and 27 Medicare Part D Drug Plans, on Average, During the Open Enrollment Period for 2019, New Analyses Find

With Medicare Advantage playing an increasingly larger role in Medicare, the average person on Medicare will be able to choose among 24 plans during the annual Medicare open enrollment period that began Oct. 15, finds a new analysis from KFF (the Kaiser Family Foundation).

Read More


10/15/18 – Kaiser Health News - Medicare Advantage Riding High As New Insurers Flock To Sell To Seniors

By Paul Galewitz

Health care experts widely expected the Affordable Care Act to hobble Medicare Advantage, the government-funded private health plans that millions of seniors have chosen as an alternative to original Medicare.

Read More


10/15/18 – MedPAC - MedPAC comment on CMS's proposed rule on Medicare Shared Savings Program ACOs

Read More


10/2/18 – Kaiser Health News - Drugmakers Play The Patent Game To Lock In Prices, Block Competitors

By Sarah Jane Tribble

David Herzberg was alarmed when he heard that Richard Sackler, former chairman of opioid giant Purdue Pharma, was listed as an inventor on a new patent for an opioid addiction treatment. 
 
 

10/2/18 – CHCS -  Achieving Value in Medicaid Home- and Community-Based Care: Considerations for Managed Long-Term Services and Supports Programs

By Michelle Herman Soper, Debra Lipson, Maria Dominiak, and James Lloyd

States are increasingly adopting value-based payment (VBP) models to tie payment to outcomes including quality of care, health status, and costs for their Medicaid programs. Although most Medicaid VBP models are for primary and acute care services, states are beginning to explore VBP for long-term services and supports (LTSS).

Read More


10/2/18 – CHCS -  Rewarding Healthy Behaviors and Addressing Day-to-Day Needs: AccessHealth Spartanburg’s Gift-In-Kind Closet

Recognizing an unmet need for toiletries and household products among clients, AccessHealth Spartanburg (AHS) stocks a closet where eligible clients can “shop” for items. Clients can shop when they first enroll and at targeted intervals, plus they can earn coupons to shop for items by attending appointments, meeting with case managers, and/or achieving health-related milestones. This builds trusting relationships between clients and staff and meets basic client needs. AHS is a participant in the Transforming Complex Care initiative, a national multi-site demonstration made possible through support from the Robert Wood Johnson Foundation.

Read More


10/1/18 – Kaiser Health News – Feds Settle Huge Whistleblower Suit Over Medicare Advantage Fraud

By Fred Schulte

One of the nation’s largest dialysis providers will pay $270 million to settle a whistleblower’s allegation that it helped Medicare Advantage insurance plans cheat the government for several years.

Read More


10/1/18 – ICRC - Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

Read More


10/1/18 – CHCS - Serving Adults with Serious Mental Illness in the Program of All-Inclusive Care for the Elderly: Promising Practices

By Logan Kelly and Nancy Archibald

Program of All-Inclusive Care for the Elderly (PACE) organizations now serve a greater number of older adults with serious mental illness (SMI) than ever before, and increasingly include behavioral health providers in their care teams to meet the complex needs of this population. This brief highlights promising practices for assessment, care planning, and care coordination for older adults with SMI drawn from PACE programs, Medicare Advantage Special Needs Plans, and Medicaid plans. These approaches may be helpful for PACE programs seeking to improve or expand the delivery of behavioral health services for older adults with SMI.
 

9/28/18 – Kaiser Family Foundation – The U.S. Government Engagement in Global Health: A Primer

Attention to global health by governments, policymakers, media, business leaders, and other institutions has increased markedly in recent decades, with a particular focus on health challenges facing low- and middle-income countries. This has led to growing funding, the establishment of new institutions and global goals, and a burgeoning community of stakeholders.

Read More


9/28/18 – Kaiser Family Foundation – Medicaid Waiver Tracker: Which States Have Approved and Pending Section 1115 Medicaid Waivers?

Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS).

Read More


9/21/18 – MedPAC comment on CMS's proposed rule on hospital outpatient and ambulatory surgical center payment systems for CY 2019 

Read More


9/17/18 – Kaiser Health News – New Medicare Advantage Tool to Lower Drug Prices Puts Crimp in Patients’ Choices

By Susan Jaffe

Starting next year, Medicare Advantage plans will be able to add restrictions on expensive, injectable drugs administered by doctors to treat cancer, rheumatoid arthritis, macular degeneration and other serious diseases.

Read More


9/13/18 – Kaiser Family Foundation - An Early Look at State Data for Medicaid Work Requirements in Arkansas

By Robin Rudowitz and MaryBeth Musumeci

Arkansas is one of four states for which CMS has approved a Section 1115 waiver to condition Medicaid eligibility on meeting work and reporting requirements and the first state to implement this type of waiver. CMS approved Arkansas’ waiver on March 5, 2018, and the new requirements took effect for the initial group of beneficiaries on June 1, 2018. The requirements are being phased in for enrollees ages 30 to 49 from June through September, 2018, and for those ages 19 to 29 in 2019. Unless exempt, enrollees must engage in 80 hours of work or other qualifying activities each month and must report their work or exemption status using an online portal. Individuals need to report work activities or exemptions by the 5th of the following month. The Arkansas Department of Human Services released data related to the new requirements in June, July and August. This brief looks at the data for August 2018 released on September 12, 2018.

Read More


8/31/18 – MedPAC Comment on CMS’s Proposed Rule on the ESRD PPS Update for CY 2019 and DMEPOS Competitive Bidding Program

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments to Correct Existing Regulations Related to the CBP for Certain DMEPOS” in the Federal Register, vol. 83, no. 139, p. 34304–34415 (July 19, 2018). This proposed rule includes provisions that update the end-stage renal disease (ESRD) prospective payment system (PPS) for 2019, updates the payment rate for individuals with acute kidney injury (AKI) when furnished in dialysis facilities, addresses the ESRD Quality Incentive Program (QIP), and revises the DMEPOS CBP. We appreciate your staff’s ongoing efforts to administer and improve payment systems for physician and other services, particularly considering the competing demands on the agency. 

Read More


8/23/18 – HealthIT – Request for Information for Input on EHR Reporting Program

ONC issued a request for information (RFI) for public stakeholders to share their views on the components of the EHR Reporting Program and to provide feedback that will inform the development of EHR Reporting Program criteria and processes.

Read More


8/21/18 – ASPE - Data Point – Prescription Pharmaceutical Price Changes since the Release of the President’s Drug Price Blueprint

Executive Summary - Using manufacturer-reported prescription pharmaceutical prices, we observe that the number of price increases has been reduced considerably since the release of the President’s Drug Pricing Blueprint, compared to the same time period in the year prior.
 

8/21/18 – Kaiser Family Foundation - Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead

By Juliette Cubansk

As of 2019, Medicare beneficiaries enrolled in Part D prescription drug plans will no longer be exposed to a coverage gap, sometimes called the “donut hole”, when they fill their brand-name medications. The coverage gap was included in the initial design of the Part D drug benefit in the Medicare Modernization Act of 2003 in order to reduce the total 10-year cost of the benefit. Subsequent legislative changes are phasing out the coverage gap by modifying the share of total costs paid in the gap by Part D enrollees and plans and requiring drug manufacturers to provide a discount on the price of brand-name drugs in the gap. This data note presents trends on the Part D coverage gap and discusses recent and proposed changes affecting out-of-pocket costs for Part D enrollees who reach the coverage gap.
 
 
 

8/08/18 – ASPE – An Overview of Long-Term Services and Supports and Medicaid: Final Report

By NGA T. Thach, BS and Joshua M. Wiener, PHD

ABSTRACT - This report examines the role of long-term services and supports (LTSS) in Medicaid. It also examines how sociodemographic changes are likely to affect the demand for LTSS in the future, and as a result, Medicaid use and expenditures. The report shows: the demand for LTSS is likely to increase dramatically; LTSS is a major part of the Medicaid program, accounting for about a third of total expenditures, and Medicaid is the dominant payer of LTSS.

Read More


8/7/18 - Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

Read More


8/7/18 – Kaiser Health News – Once Its Greatest Foes, Doctors Are Embracing Single-Payer

By Shefali Luthra

When the American Medical Association — one of the nation’s most powerful health care groups — met in Chicago this June, its medical student caucus seized an opportunity for change.

Read More

 


8/7/18 – Kaiser Family Foundation - Does Employment Lead to Improved Health? New Research Review Finds Mixed Evidence with Caveats that Could Impact Applicability to Medicaid Work Requirements

With nearly a dozen states seeking or implementing waivers to add work requirements for some Medicaid beneficiaries, a central question is whether such policies promote health and therefore promote the goals of the Medicaid program.

Read More

Click here to view the report

 


7/31/18 – CHCS – Faces of Medicaid Data Series: Examining Children’s Behavioral Health Service Use and Expenditures, 2005 - 2011

Medicaid is a significant source of funding for behavioral health care for children and youth in the United States. However, there are few national analyses examining behavioral health care being used by children in Medicaid.

Read More

Click here to view Toolkit Overview

 


7/24/18 – CHCS – The Perspective Role of Charity Care Programs in a Changing Health Care Landscape

By Matthew Ralls, Lauren Moran and Stephen A. Somers

In the post Affordable Care Act environment, charity care programs remain an important feature of the safety-net landscape in many communities, typically offering or organizing free- and reduced-cost care to individuals. Federal policy changes, such as decreased funding for navigation services, raise questions about the role charity care programs see themselves playing in the immediate future. Through support from Kaiser Permanente Community Health, the Center for Health Care Strategies recently conducted an informal survey of charity care programs across the country to explore how these programs see their role in the changing health care environment. Among the themes identified, charity care programs: (1) connect diverse populations to a wide range of human services beyond health care; (2) predict an increase demand for services through 2020; and (3) plan to rely on existing funding sources, but have concerns about funding commitments.

Read More


7/23/18 – Kaiser Family Foundation – What do Different Data Sources Tell Us About Medicaid and Work?

A central question in the ongoing debate about imposing work requirements in Medicaid is what current work patterns are among Medicaid adults and how many so-called “able bodied” adults are not already working. Answers to these questions rely on various data sources, and characteristics of the underlying data and analytic decisions may lead to different conclusions. This data note examines what different data sources and analytic decisions tell us about Medicaid and work.

Read More

Click here to view the data note


7/20/18 – MedPAC – June 2018 Data Book: Health Care Spending and the Medicare Program

The MedPAC Data Book provides information on national health care and Medicare spending as well as Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiary and other payer liability. It also examines provider settings—such as hospitals and post-acute care—and presents data on Medicare spending, beneficiaries’ access to care in the setting (measured by the number of beneficiaries using the service, number of providers, volume of services, length of stay, or through direct surveys), and the sector’s Medicare profit margins, if applicable. In addition, it covers the Medicare Advantage program and prescription drug coverage for Medicare beneficiaries, including Part D. 

Read More


7/19/18 – The Commonwealth Fund – Has Medicare’s Bundled Payments Initiative Lowered Costs?

To help keep costs down, improve quality of care, and increase health care providers’ accountability, Medicare has been experimenting with something called bundled payments. In one model hospitals are responsible for the patient’s entire “episode of care” — the care bundle — instead of Medicare paying piecemeal for each individual service or office visit. An episode may be defined as a surgery, for example, or treatment of a chronic medical condition. If the cost of care is lower than an historical benchmark, hospitals share in the savings; if the cost is higher, hospitals are responsible for a portion of the overage.

Read More


07/11/18 – Kaiser Family Foundation - Medigap Enrollment and Consumer Protections Vary Across States

By Cristina Boccuti, Gretchen Jacobson, Kendal Orgera, and Tricia Neuman

One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period.

Read More


07/11/18 – CHCS – Opportunities to Enhance Community-Based Medication Management Strategies for People with Complex Health and Social Need

By Caitlin Thomas-Henkel, Stefanie Turner and Bianca Freda

For many Americans, taking prescription medications is part of everyday life. Nearly 75 percent of the population takes at least one medication daily, and 29 percent take five or more. Despite these numbers, there is scant guidance available to help people navigate complicated drug regimens. The problem is exacerbated for individuals with multiple chronic conditions, who are often prescribed numerous drugs by various providers to be taken on different schedules — with no single entity that is coordinating all of their medications. 
 
 

 


06/21/18 – CHCS – Community Management of Medication Complexity National Multi-Site Demonstration Launched

The Center for Health Care Strategies (CHCS) today launches the Community Management of Medication Complexity Innovation Lab, a multi-site demonstration that will identify and test community-based strategies to improve medication safety for people with complex health and social needs. This national initiative, made possible with support from the Gordon and Betty Moore Foundation and led by CHCS, will work with five competitively selected organizations to expand and enhance existing community-based medication management programs.

Read More


06/20/18 – Kaiser Health News – ‘Holy Cow’ Moment Changes How Montana’s State Health Plan Does Business

By Julie Appleby

Marilyn Bartlett, the director administrator of Montana’s Health Care and Benefits Division, recalls thinking “holy cow” when she got an urgent directive from state legislators in late 2014: “You have to get these costs under control, or else.”

Read More


06/20/18 – Kaiser Family Foundation – What’s in the Administration’s 5-Part Plan for Medicare Part D and What Would it Mean for Beneficiaries and Program Savings?

By Juliette Cubanski

Today more than 43 million older adults and people with disabilities have prescription drug coverage under Medicare Part D. Part D helps people with Medicare afford their medications by subsidizing the purchase of drug coverage from private stand-alone prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PDs), and offering additional financial help to people with low-incomes. Although premiums for Part D plans have been stable in recent years, cost-sharing requirements for drugs covered by plans have increased over time. While there have been changes to the benefit since it took effect in 2006 to enhance financial protections—in particular, phasing out the coverage gap—Part D coverage does not fully protect beneficiaries from high drug costs because the benefit does not have an annual cap on out-of-pocket spending. Enrollees who do not receive low-income subsidies are required to pay 5 percent of their total drug costs above the catastrophic coverage threshold.

Read More


06/15/18 – MedPAC - Report to the Congress: Medicare and the Health Care Delivery System · June 2018

The Commission’s June 2018 report examines a variety of Medicare payment system issues. In the 10 chapters of this report, we consider: the effects of the Hospital Readmissions Reduction Program; using payment to ensure appropriate access to and use of hospital emergency department services; rebalancing Medicare’s physician fee schedule toward ambulatory evaluation and management services; paying for sequential stays in a unified prospective payment system for post-acute care; encouraging Medicare beneficiaries to use higher quality post-acute care providers; issues in Medicare’s medical device payment  policies; applying the Commission’s principles for measuring quality to population-based measures and hospital quality incentives; recent performance of and long-term issues confronting Medicare accountable care organizations; managed care plans for dual-eligible beneficiaries; and Medicare coverage policy and use of low-value care.

Read More

Click here to view press release


06/05/18 – Kaiser Health News - Medicare Financial Outlook Worsens

By Phil Galewitz

Medicare’s financial condition has taken a turn for the worse because of predicted higher hospital spending and lower tax revenues that fund the program, the federal government reported Tuesday.

Read More


05/21/18 – Kaiser Family Fund - New Brief Examines Potential Effects of Public Charge Changes on Health Coverage for Citizen Children

The Trump Administration is pursuing changes that, for the first time, would allow the federal government to take into account the use of federal health, nutrition, and other non-cash public programs, including Medicaid and the Children’s Health Insurance Program (CHIP), when making a determination about whether someone is likely to be a “public charge.” Under these changes, use of these programs by an individual or a family member, including a citizen child, could result in an individual being denied lawful permanent resident status or entry into the U.S.

Read More


05/15/18 – MedPAC - MedPAC releases March 2018 report on Medicare Payment Policy

Today, the Medicare Payment Advisory Commission (MedPAC) releases its March 2018 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage (MA) and the prescription drug benefit, Part D. MedPAC also recommends changing the way Medicare pays for clinician services in FFS by moving beyond the Merit-based Incentive Payment System (MIPS), recommends changes to MA and Part D to improve the equity and efficiency of those programs, and responds to a Congressional mandate on telehealth in Medicare. In the Bipartisan Budget Act of 2018, Congress enacted several policies that are similar to recommendations contained in this report.

Read More

Click here to view the fact sheet


05/11/18 – ASPE - Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Evaluation of Outcomes of Selected Health Home Programs, Annual Report – Year Five

by Brenda C. Spillman and Eva H. Allen

Medicaid health homes, authorized by Section 1945 of the Social Security Act, allows states to coordinate care and integrate services for Medicaid beneficiaries with multiple chronic physical, mental, or behavioral health conditions. The health home model is similar to the patient-centered medical home model, but targets high cost, high need populations and focuses on providing integrated physical, mental, and behavioral health care services, including links to nonclinical services and supports in the community. The Urban Institute, under the contract from ASPE, has conducted a five-year evaluation of the Medicaid health home option to assess the program implementation and its impacts on utilization and costs. The expectation is that improved access to integrated and coordinated primary and behavioral health care will reduce unnecessary use of costly facility-based care and result in lower spending. This fifth-year and final report presents findings from quantitative analysis of health home outcomes with respect to use of emergency room, inpatient hospital, and other facility-based care and Medicaid spending. The report also includes a brief description of the health home model and background on state programs included in the evaluation, as well as a summary of qualitative findings from previous reports.

Read More


05/09/18 – ICRC - Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization 

Read More


05/09/18 – The Commonwealth Fund – 2018 Scorecard on State Health System Performance

By David C. Radley, Douglas McCarthy, and Susan L. Hayes

A state-by-state report measuring access to care, quality of care, health outcomes, and health disparities across the United States.

Read More


05/09/18 – Kaiser Family Foundation - Why are Healthcare Prices So High, and What can be Done about Them?

Nearly a fifth of the United States’ economy goes to healthcare spending – a far larger share than in any other large, wealthy country in the world. Research suggests that price, rather than the volume of services, is the main driver of this disparity, and price is also a primary factor in pushing up the nation’s health spending over time.
 
 
 

05/09/18 – CHCS – AccessHealth Spartanburg: Wrap-Around Community Support for South Carolina’s Most Vulnerable Patients

In Spartanburg County, in the northern part of South Carolina, roughly 18 percent of non-elderly adults are uninsured, including a significant portion who experience multiple hardships such as poverty, chronic illness, mental health needs, poor access to primary care, and other barriers to health. Roughly one-third of Spartanburg’s most medically and socially complex patients are also caught in a coverage gap — they have too much income to be eligible for the state’s Medicaid program, but are too poor to qualify for federal health insurance subsidies available under the Affordable Care Act. When these individuals do seek care they are often in crisis, resulting in multiple and costly visits to the emergency department (ED) and frequent hospitalizations.

Read More


04/26/18 – The Commonwealth Fund - What Commissioner Gottlieb’s FDA Is Doing to Lower Prescription Drug Prices and Steps Congress Can Take to Help

By Henry Waxman, Bill Corr, Kristi Martin, and Sophia Duong

Issue: Prescription drug prices have been climbing, creating significant barriers for patients. Since becoming U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb announced an action plan and several policy changes to increase generic drug competition and transparency to address high prescription drug prices.
 
Goal: This issue brief aims to explain the FDA’s plan of action and assess its implementation to date. It also aims to assess whether FDA actions, if implemented, address the known problems leading to high drug pricing.
 
Methods: We analyzed the FDA’s announced plans and actions as of March 31, 2018, and compared them to a comprehensive list of potential actions that could improve price competition among drug manufacturers included in our report, Getting to the Root of High Prescription Drug Prices: Drivers and Potential Solutions.
 

05/08/18 – Kaiser Health News – 4 Takeaways From Trump’s Plan To Rescind CHIP Funding

By Phil Galewitz

President Donald Trump wants to employ a rarely used budget maneuver called “rescission” to eliminate $15 billion in federal spending, including $7 billion from the popular Children’s Health Insurance Program (CHIP).

Read More


04/26/18 – Kaiser Health News – Hospitals Lure Diabetes Patients with Self-Care Courses, But Costs Can Weigh Heavily

By Julie Appleby

When a routine physical revealed mildly elevated blood-sugar levels, Michael Phillips was strongly encouraged to sign up for a diabetes self-management class.

Read More


04/26/18 – ICRC – New and Departing Dual Eligible Special Needs Plans (D-SNPs) in Calendar Year 2018, by State 

Read More


04/25/18 – Kaiser Health News – Peak Health Plan Premiums Give Rise to Activism – And Unconventional Solutions

By Rachel Bluth

When Garnett and Dave Mellen sent their 19-year-old daughter, Gita, off to college an hour away at Virginia Commonwealth University last fall, they didn’t expect to follow her.

Read More


04/23/18 – Kaiser Family Foundation – Understanding Short-Term Limited Duration Health Insurance

By Karen Pollitz, Michelle Long, Ashley Semanskee, and Rabah Kamal

Short-term, limited duration (STLD) health insurance has long been offered to individuals through the non-group market and through associations.  The product was designed for people who experience a temporary gap in health coverage.1  Unlike other products that are considered “limited benefit” or “excepted benefit” policies – such as cancer-only policies or hospital indemnity policies that pay a fixed dollar benefit per inpatient stay – short-term policies are generally considered to be “major medical” coverage; however, short-term policies are distinguished from other comprehensive major medical policies because they only provide coverage for a limited term, typically less than 365 days.  Short-term policies are also characterized by other significant limitations, including the types of services covered, often with a dollar maximum.

Read More


04/06/18 – The Commonwealth Fund – 1115 Medicaid Waivers: From Care Delivery Innovations to Work Requirements

After months of debate, the Medicaid program emerged from efforts to repeal and replace the Affordable Care Act (ACA) without major legislative changes. Now, however, the Trump administration is encouraging states to apply for waivers that place new conditions on Medicaid eligibility as well as additional costs on beneficiaries in the form of premiums and copayments at the point of service.

Read More


04/05/18 – Kaiser Family Foundation – Analysis: Cost of Treating Opioid Addiction Rose Rapidly for Large Employers as the Number of Prescriptions Has Declined

By Cynthia Cox, Matthew Rae and Bradley Sawyer

A new Kaiser Family Foundation analysis finds that while the use of prescription opioids among people with employer-based health coverage has declined to its lowest levels in over a decade, the cost of treating addiction and overdoses has increased sharply.

Read More

Click here to view the analysis


03/29/18 – Kaiser Health News – Scrutinizing Medicare Coverage for Physical, Occupational and Speech Therapy

By Judith Graham

For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare.

Read More


03/29/18 – The Commonwealth Fund – State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market

By Kevin Lucia, Justin Giovannelli, Sabrina Corlette, JoAnn Volk, Dania Palanker, Maanasa Kona, and Emily Curran

Issue: Certain forms of individual health coverage are not required to comply with the consumer protections of the Affordable Care Act (ACA). These “alternative coverage arrangements” — including transitional policies, short-term plans, health care sharing ministries, and association health plans — tend to have lower upfront costs and offer far fewer benefits than ACA-compliant insurance. While appealing to some healthy individuals, they are often unattractive, or unavailable, to people in less-than-perfect health. By leveraging their regulatory advantages to enroll healthy individuals, these alternatives to marketplace coverage may contribute to a smaller, sicker, and less stable ACA-compliant market. The Trump administration recently has acted to reduce federal barriers to these arrangements.
 
Goal: To understand how states regulate coverage arrangements that do not comply with the ACA’s individual health insurance market reforms.
 
Methods: Analysis of the applicable laws, regulations, and guidance of the 50 states and the District of Columbia.
 
Findings and Conclusions: No state’s regulatory framework fully protects the individual market from adverse selection by the alternative coverage arrangements studied. However, states have the authority to ensure a level playing field among coverage options to promote market stability.
 
 

03/28/18 – Kaiser Family Foundation – Where are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults

This fact sheet provides Medicaid and CHIP eligibility levels for children, pregnant women, parents, and other non-disabled adults as of January 2018, based on annual state survey data.1 The data highlight the central role Medicaid and CHIP play in covering low-income children and pregnant women and show Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA). See Tables 1-3 for state-specific data.

Read More


03/22/18 – The Commonwealth Fund – Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case – A Practical Guide to Support Health Plan and Provider Investments in Social Services

The impact of social determinants of health (SDOH) as drivers of medical utilization, cost, and health outcomes is both widely researched and acknowledged. This growing body of evidence attributes as much as 40 percent of health outcomes to SDOH such as housing, education, poverty, and nutrition and that as much as a third of the deaths in the United States can be accounted for by social factors. The influence of SDOH is particularly pronounced in vulnerable high-need, high-cost (HNHC) populations with single to multiple functional limitations.

Read More


03/15/18 – MedPAC – Report to the Congress March 2018

The Medicare Payment Advisory Commission (MedPAC) is required by law annually to review Medicare payment policies and make recommendations to the Congress. In the March 2018 report, MedPAC makes payment policy recommendations for nine provider sectors in fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage (MA) and Medicare’s prescription drug benefit (Part D). MedPAC also recommends changing the way Medicare pays for clinician services in FFS by moving beyond the Merit-based Incentive Payment System (MIPS), recommends changes to MA and Part D to improve the equity and efficiency of those programs, and responds to a Congressional mandate on telehealth in Medicare. In the Bipartisan Budget Act of
2018, Congress enacted several policies that are similar to recommendations contained in this report.
 
 
 

03/14/18 – Kaiser Health News – Lifting Therapy Caps Proves a Load Off Medicare Patients’ Shoulders

By Susan Jaffe

Physical therapy helps Leon Beers, 73, get out of bed in the morning and maneuver around his home using his walker. Other treatment strengthens his throat muscles so that he can communicate and swallow food, said his sister Karen Morse. But in mid-January, his home health care agency told Morse it could no longer provide these services because he had used all his therapy benefits allowed under Medicare for the year.

Read More


03/13/18 – Kaiser Health News – Patients Overpay for Prescriptions 23% of the Time, Analysis Shows

By Sydney Lupkin

As a health economist, Karen Van Nuys had heard that it’s sometimes cheaper to pay cash at the pharmacy counter than to put down your insurance card and pay a copay.

Read More


03/13/18 – The Commonwealth Fund – Health Care Spending in the United States and Other High-Income Countries

By Irene Papanicolas, Liana R. Woskie and Ashish Jha

A study of why the United States spends so much more on health care than in other high-income countries concludes that higher prices — particularly for doctors and pharmaceuticals — and higher administration expenses are predominantly to blame. U.S. policy must focus on reducing these costs in order to close its spending gap with other countries.

Read More


03/01/18 – McKnights – Congressional Opioid Efforts Targeting Medicare, Limits on New Prescriptions

By Kimberly Marselas

A bipartisan group of senators introduced legislation Tuesday that would set a three-day initial prescribing limit on opioids for acute pain and increase recovery services and availability for addicts.

Read More


03/01/18 – Kaiser Family Foundation – The Financial Burden of Health Care Spending: Larger for Medicare Households than for Non-Medicare Households

By Juliette Cubanski, Kendal Orgera, Anthony Damico, and Tricia Neuman

Medicare offers health and financial protection to nearly 60 million adults ages 65 and over and younger people with disabilities. However, the high cost of premiums, cost-sharing requirements, and gaps in the Medicare benefit package, combined with relatively low incomes among the Medicare population, can result in beneficiaries devoting a substantial share of their total household spending to health care costs.
 

03/01/18 – CHCS – The History, Evolution, and Future of Medicaid Accountable Care Organizations

By Rachael Matulis and Jim Lloyd

Accountable care organizations (ACOs) have become increasingly prevalent in the United States. These organizations shift more accountability for health outcomes to providers and many have shown positive results for achieving the “Triple Aim” of better health, improved patient experience, and lowered costs for Medicare, Medicaid, and commercial populations.

Read More

Click here to view state activity map

Click here to view the fact sheet


 

02/28/18 – ICRC – Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization 

Read More


02/26/18 – The Commonwealth Fund – Income Disparities in the Prevalence, Severity, and Costs of Co-Occurring Chronic and Behavioral Health Conditions

By Peter J. Cunningham, Tiffany L. Green and Robert T. Braun

People with depression, substance abuse problems, or other behavioral health issues also often have chronic medical conditions like obesity, hypertension, or diabetes. This “co-occurring” of conditions is far more likely to befall people with low incomes than those with higher incomes. When people have both behavioral and chronic health conditions, those with low incomes spend more on their care than people with higher incomes. This disparity may reflect greater severity of disease as well as poorer access to care.

Read More


02/23/18 – MedPAC – MedPAC Comment on CMS’s Advance Notice of Medicare Advantage Payment Policy for 2019

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS’s) December 27, 2017 “Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS–HCC Risk Adjustment Model” and the February 1, 2018 “Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 Draft Call Letter” (collectively, the Advance Notice). We appreciate your staff’s work on the notice, particularly considering the statutory requirements for changes to the risk adjustment model.
 
 

02/14/18 – Kaiser Family Foundation – Analysis: Insurance Riders to Cover Abortion Services Not Available to Women in States that Restrict Abortion Coverage

In 10 states, insurance plans are currently banned from including abortion as a covered service in state-regulated private plans — all individually purchased policies and fully-insured group plans. Most of these laws do not include exceptions for rape, incest, or health endangerment. In nine of these states, insurers may sell health insurance riders for abortion coverage, but the availability of such riders has been unknown.

Read More

Click here to view analysis


02/13/18 – Kaiser Family Foundation – Proposed Changes to “Public Charge” Policies for Immigrants: Implications for Health Coverage

A draft version of a proposed rule by the Trump Administration would make changes to “public charge” policies that govern how use of public benefits may affect individuals’ immigration status. This fact sheet provides an overview of the proposed changes and their implications for health and health coverage.

Read More


01/31/18 – Kaiser Health News – Expert Advice for the Corporate Titans Taking on Health Care

By KHN Staff

An announcement Tuesday by three of the nation’s corporate titans — Amazon, Berkshire Hathaway and JPMorgan Chase & Co. — that they are joining forces to address the high costs of employee health care has stirred the health policy pot. It immediately sent shock waves through the health sector of the stock market and reinvigorated talk about health care technology, value and quality.

Read More


01/31/18 – ICRC – Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization – January 2018  

Read More


01/31/18 – CHCS – Partnerships for Health: Lessons for Bridging Community-Based Organizations and Health Care Organizations

By Bianca Freda, Deborah Kozick and Anna Spencer

Given the impact that social factors have on health status and expenditures, and the shift toward value-based payment models that reward providers based on outcomes, health care organizations (HCO) and community based organizations (CBO) across the country are increasingly working together to address patients’ social needs. In Massachusetts, the state Medicaid agency, MassHealth, through its Medicaid 1115 demonstration waiver, is investing in accountable care organizations (ACOs) and community partners to integrate physical health, behavioral health, and long-term services and supports. The state is also funding certain approved “flexible services” that address health-related social needs that are not otherwise covered as MassHealth benefits. To inform these efforts, it is important to examine the strategic, operational, and financial approaches that drive the success of HCO and CBO partnerships. This brief draws on insights gleaned from the Robert Wood Johnson Foundation’s (RWJF) Partnership for Healthy Outcomes project and the Blue Cross Blue Shield of Massachusetts Foundation (BCBSMA Foundation) June 2017 conference, which convened several HCO-CBO partnerships to share promising partnership models. It outlines characteristics of successful HCO-CBO partnerships and provides recommendations to guide the development of successful collaborations between health care and social service organizations.
 

01/31/18 – The Commonwealth Fund – Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools 

By Deborah Bachrach, Jocelyn Guyer, Sarah Meier, John Meerschaert, and Shelly Brandel

Issue: It is widely recognized that social factors, such as unstable housing and lack of healthy food, have a substantial impact on health outcomes and spending, particularly with respect to lower-income populations. For Medicaid, now dominated by managed care, this raises the question of how states can establish managed care rates to sustain investments in social supports.
 
Goal: To explore practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues.
 
Methods: Literature review, interviews with stakeholders, and analysis of federal regulations.
 
Findings and Conclusions: We identify the following options: 1) classify certain social services as covered benefits under the state’s Medicaid plan; 2) explore the additional flexibility afforded states through Section 1115 waivers; 3) use value-based payments to support provider investment in social interventions; 4) use incentives and withholds to encourage plan investment in social interventions; 5) integrate efforts to address social issues into quality improvement activities; and 6) reward plans through higher rates for effective investments in social interventions. More needs to be done, however, to assist interested states in using these options and identifying pathways to braid Medicaid dollars with other social services funding.
 

01/02/18 – Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization  

Read More


12/22/17 – The United States Department of Justice – Kmart Corporation to Pay U.S. $32.3 Million to Resolve False Claims Act Allegations for Overbilling Federal Health Programs for Generic Prescription Drugs

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation (SHC), has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, the health program for uniformed service members and their families, the Justice Department announced today.

Read More


12/21/17 – The Commonwealth Fund – Do Medicare Advantage Plans Minimize Costs? Investigating the Relationship Between Benchmarks, Costs, and Rebates

By Stephen Zuckerman, Laura Skopec and Stuart Guterman

Issue: Medicare Advantage (MA), the program that allows people to receive their Medicare benefits through private health plans, uses a benchmark-and-bidding system to induce plans to provide benefits at lower costs. However, prior research suggests medical costs, profits, and other plan costs are not as low under this system as they might otherwise be.
 
Goal: To examine how well the current system encourages MA plans to bid their lowest cost by examining the relationship between costs and bonuses (rebates) and the benchmarks Medicare uses in determining plan payments.
 
Methods: Regression analysis using 2015 data for HMO and local PPO plans.
 
Findings: Costs and rebates are higher for MA plans in areas with higher benchmarks, and plan costs vary less than benchmarks do. A one-dollar increase in benchmarks is associated with 32-cent-higher plan costs and a 52-cent-higher rebate, even when controlling for market and plan factors that can affect costs. This suggests the current benchmark-and-bidding system allows plans to bid higher than local input prices and other market conditions would seem to warrant.
 
Conclusion: To incentivize MA plans to maximize efficiency and minimize costs, Medicare could change the way benchmarks are set or used.
 

12/07/17 – ICRC – Spotlight: Additional Detail on Selected CMS Proposed Changes for Medicare Advantage and the Prescription Drug Benefit Program

This Spotlight is a follow-up to the November 22 ICRC e-alert on the Centers for Medicare & Medicaid Services (CMS)’ proposed policy changes and updates for Medicare Advantage (MA) and the Part D prescription drug benefit. In this Spotlight, ICRC presents a more detailed description of some of the proposed changes that may be of special interest to states planning or operating integrated programs for dually eligible Medicare-Medicaid enrollees under the capitated model of the Financial Alignment Initiative and through contracts with Dual Eligible Special Needs Plans (D-SNPs).

Read More


12/6/17 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, November 2016 to November 2017

Read More

 

12/6/17 – ICRC – Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization 

Read More


12/5/17 – CHCS – Medicaid ACOs: State Activity Map

State-based Medicaid accountable care organizations (ACOs) are becoming increasingly prevalent across the country, with more and more states pursuing ACOs as a way to improve health outcomes and control costs through greater provider accountability. This interactive map offers an ongoing update of Medicaid ACO activities by state, including governance structure, scope of services, and payment model.

Read More


12/4/17 – The Commonwealth Fund – The Big Five Health Insurers’ Membership and Revenue Trends: Implications for Public Policy

By Cathy Schoen and Sara R. Collins

The five largest U.S. commercial health insurers collectively cover more than two-fifths of the insured population. Over the past decade, these companies’ bottom lines have become increasingly linked to Medicare and Medicaid, with the two programs accounting for 59 percent of revenues in 2016. Access to coverage could be improved if insurers that participate in Medicaid or Medicare were required to also participate in the marketplaces in the same geographic area.

Read More

Click here to view the press release

Click here to view the appendix


11/21/17 – Kaiser Health News - Massachusetts Grabs Spotlight By Proposing New Twist on Medicaid Drug Coverage

By Shefali Luthra

In the absence of new federal policies to tame break-the-bank drug prices, Massachusetts’ state Medicaid program hopes to road-test an idea both radical and market-driven. It wants the power to negotiate discounts for the drugs it purchases and to exclude drugs with limited treatment value.

Read More


11/21/17 – CMCS – Nationwide Adult Medicaid CAHPS – Analytic Brief – November 2017

Health Care Experiences of Adults with Disabilities Enrolled in Medicaid Only: Findings from a 2014-2015 Nationwide Survey of Medicaid Beneficiaries

Persons who qualify for Medicaid on the basis of a disability are a diverse population group, consisting of individuals with a wide range of physical impairments, functional limitations, and intellectual and mental health disabilities. In 2015, Medicaid provided coverage for 10.2 million non-elderly individuals on the basis of a disability. Most of those individuals were adults ages 18 and older residing in a community setting. Medicaid beneficiaries with a disability may be enrolled in Medicaid alone or be dually enrolled in Medicaid and Medicare. This brief focuses on adult Medicaid beneficiaries who are not dually enrolled and qualified for Medicaid on the basis of a disability.
 
 
 

11/15/17 – The Commonwealth Fund – Older Americans Were Sicker and Faced More Financial Barriers to Health Care Than Counterparts in Other Countries

2017 Commonwealth Fund International Health Policy Survey of Older Adults

By Robin Osborn, Michelle M. Doty, Donald Moulds, Dana O. Sarnak, and Arnav Shah

An international survey of older adults finds that seniors in the United States are sicker than their counterparts in 10 other high-income countries and face greater financial barriers to health care, despite the universal coverage that Medicare provides. Across all the countries, few elderly adults discuss mental health concerns with their primary care providers. Moreover, nearly a quarter are considered “high need” — meaning they have three or more chronic conditions or require help with basic tasks of daily living.

Read More

Click here to view the press release


ICRC – Value-Based Payment in Nursing Facilities: Options and Lessons for States and Managed Care Plans

By Jenna Libersky, Julie Stone, Leah Smith, James Verdier, and Debra Lipson

To improve the value of care provided in nursing facilities, payers are experimenting with value-based payment (VBP) approaches that link financial rewards to measures of quality. Drawing on findings from interviews with state officials and plan representatives, this brief describes the VBP approaches that select states and managed care plans currently use, presents perceived effects of VBP, and shares lessons on the design and administration of VBP programs. States interested in VBP may look to the examples in the brief to design their own VBP programs or encourage plans to do so.

Read More


10/26/2017 – Avalere – Impact Evaluation: Medicare Advantage Transition from RAPS to EDS

By Christie Teigland

In February 2017, Avalere, an Inovalon company, analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
 
 

10/25/2017 – Kaiser Family Foundation – Data Note: Public’s Views of a National Health Plan

By Ashley Kirzinger, Liz Hamel, Bianca DiJulio, Cailey Munana, and Mollyann Brodie

The October Kaiser Health Tracking Survey continues our efforts to track attitudes towards a national health plan, sometimes referred to as a “single-payer plan” or “Medicare-for-all,” in which all Americans would get health insurance from a single government plan. About half of the public (53 percent) favor having a national health plan, while 44 percent oppose such a plan. Support for such a proposal is largely driven by Democrats with three-fourths (73 percent) favoring such a plan, of which nearly half (46 percent) say they “strongly favor” it. On the other hand, seven in ten (71 percent) Republicans oppose such a plan, including more than half (55 percent) of Republicans who say they “strongly oppose” it. Independents are more divided with a slightly larger share favoring a national health plan than opposing it (55 percent vs. 43 percent).

Read More

Click here to view Topline & Methodology


10/23/2017 – CHCS – Virginia Commonwealth University Health System: Beyond the Walls and Into Communities

Using Outreach Workers to Extend Complex Care into High-Opportunity Neighborhoods – In late September 2016, Briana Ricks, an outreach worker employed by Virginia Commonwealth University Health System’s (VCU Health) Complex Care Clinic (CCC) in Richmond, met with a new patient who had been admitted to the hospital for the fifth time that month. Struggling with diabetes, chronic obstructive pulmonary disease (COPD), hypertension, and a history of substance use, the woman was being hospitalized frequently due to fluid build-up in her lungs.

Read More


10/19/2017 – AHIP – Health Plans Launch New STOP Initiative to Help Battle Opioid Crisis in America

By Cathryn Donaldson

Health plans nationwide are working closely with state and federal leaders, as well as with physicians and other providers on multiple strategies to address the opioid crisis. To build on these efforts, America’s Health Insurance Plans (AHIP) has launched its Safe, Transparent Opioid Prescribing (STOP) Initiative. The STOP Initiative is designed to support widespread adoption of clinical guidelines for pain care and opioid prescribing.
 
 

10/18/2017 – The Commonwealth Fund – How Well Does Insurance Coverage Protect Consumers from Health Care Costs?

Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016

By Sara R. Collins, Munira Z. Gunja and Michelle M. Doty

Issue: The United States has made historic progress on insurance coverage since the Affordable Care Act became law in 2010, with 20 million fewer people uninsured. However, we must also measure progress by assessing how well people who have insurance from all coverage sources are protected from high health care costs.
Goals: To estimate the number and share of U.S. insured adults who are “underinsured” or have out-of-pocket costs and deductibles that are high relative to their incomes.
 
Method: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2003–2016.
 
Findings: As of late 2016, 28 percent of U.S. adults ages 19 to 64 who were insured all year were underinsured — or an estimated 41 million people. This is more than double the rate in 2003 when the measure was first introduced in the survey, and is up significantly from 23 percent, or 31 million people, in 2014. Rates climbed across most coverage sources, and, among privately insured, were highest among people with individual market coverage, most of whom have plans through the marketplaces. Half (52%) of underinsured adults reported problems with medical bills or debt and more than two of five (45%) reported not getting needed care because of cost.
 
 
 
 

10/12/2017 – CHCS – Bridging Community-Based Human Services and Health Care Case Study Series

Given the importance of social factors in influencing health and wellbeing, health care organizations and community-based organizations (CBOs) across the country are increasingly interested in working together in new ways to address social needs that may be contributing to poor health outcomes and unnecessary costs. As these cross-sector relationships emerge, there is much to learn about these innovative partnership models as well as the strategic, cultural, operational, and financial approaches that drive their success.

Read More

 
 
 
 

10/05/2017 – Avalere- CMS Proposal for New Medicare Payment System Could Lead to Late Payment Variability for Specialists

New Analysis from Avalere Finds that Payments to Certain Physician Specialists Could Increase or Decrease by as Much as 16% for Their 2018 Performance Under the Merit-Based Incentive Payment Program (MIPS)

By John Feore and Richard Kane

The adjustments could take effect if the Centers for Medicare & Medicaid Services (CMS) finalizes a proposal to change how payments to clinicians are calculated under MIPS. For most types of physicians, these payment adjustments would only range between +/- 5%, as provided for under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
 
 

09/28/2017 – Kaiser Health News – Why Glaring Quality Gaps Among Nursing Homes are Likely to Grow if Medicaid is Cut

By Jordan Rau

Nursing homes that rely the most on Medicaid tend to provide the worst care for their residents — not just the people covered by the program but also those who pay privately or have Medicare coverage.

Read More


09/27/2017 – NAHC – Two Wins in One Day! Senate Passes CHRONIC Care Act and RAISE Family Caregivers Act

Home care and hospice won a double victory yesterday, September 26, when the United States Senate passed the CHRONIC Care Act and the RAISE Family Caregivers Act. Both pieces of legislation are important to the home care and hospice community and the millions of Americans who depend on it. NAHC worked hard to ensure passage of the legislation in the Senate and we will be working hard to get the legislation moved forward in the House of Representatives.

Read More


09/27/2017 – CHCS – Financing Project ECHO: Options for State Medicaid Programs

By Greg Howe, Allison Hamblin, and Lauren Moran, Center for Health Care Strategies

Project ECHO®, a unique model for expanding access to specialty health care services, can bolster state Medicaid program efforts to improve care in underserved areas. With a handful of states using Medicaid funds to support Project ECHO, more states are interested in pursuing ECHO models to enhance services for at-risk populations. This brief outlines an array of financing options, including approaches currently in use as well as new options, and highlights how four states — California, Colorado, New Mexico, and Oregon — leveraged Medicaid support for ECHO. It outlines design considerations for specific delivery system environments as well as broad considerations for long-term sustainability of Project ECHO approaches. This brief is a product of the Project ECHO Medicaid Learning Collaborative made possible with support from the Leona M. and Harry B. Helmsley Charitable Trust and the GE Foundation.

Read More

Click here to view the Medicare Financing Models for Project ECHO

Click here to view fact sheet


09/26/2017 – NAHC – NAHC Files Comments with CMS on Home Health Prospective Payment System Rate Update and More

The National Association for Home Care & Hospice (NAHC) filed comments on Tuesday, September 25, 2017, with the Centers for Medicare & Medicaid Services (CMS) on the CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements.

Read More

 


09/26/2017 – The Commonwealth Fund – Intensive Outpatient Care Program: A Care Model for the Medically Complex Piloted by Employers

By Kristof Stremikis, Clare Connors, and Emma Hoo

Improving care for high-need, high-cost patients has long been a priority for both public and private sector purchasers of health care. In 2009, the Pacific Business Group on Health (PBGH) partnered with Boeing to implement a care management initiative that Boeing had successfully piloted with about 700 of its employees, retirees, and dependents. Called the Intensive Outpatient Care Program (IOCP),1 the initiative aims to improve outcomes for medically complex patients and prevent unnecessary hospital use by providing care coordination, self-management support, and effective ambulatory care. The overall goal of IOCP is to keep participants at home and in their communities by providing intensive, person-centered outpatient care.

Read More


09/22/2017 – MedPAC – MedPAC Comment on CMS’s Proposed Rule on the CY 2018 Home Health Prospective Payment System

The Medicare Payment Advisory Commission (MedPAC) appreciates the opportunity to submit comments on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements,” Federal Register, Vol. 82, No. 144, p. 35270 (July 28, 2017). We appreciate your staff’s efforts to administer and improve the Medicare payment system for home health agencies (HHAs), particularly given the competing demands on the agency.

Read More


09/19/2017 – The Commonwealth Fund – Extending the Children’s Health Insurance Program: High Stakes for Families and States

By Sara Rosenbaum, Rachel Gunsalus, Sara Rothenberg and Sara Schmucker

Congress must decide whether to extend federal funding authority for the Children’s Health Insurance Program (CHIP), which ends September 30, 2017. CHIP operates much like Medicaid, providing federal matching payments for state program expenses, although CHIP’s funding rate is higher than the federal rate paid for traditional Medicaid and was further enhanced under the Affordable Care Act. States can use their CHIP funds to expand Medicaid, operate separate CHIP programs, or combine the two approaches. Today CHIP covers 8.4 million children and provides maternity coverage for approximately 370,000 women.

Read More


09/18/2017 – Avalere – Exchange Reinsurance Stabilization Package Could Reduce 2018 Premiums by 17%

Market Stabilization Efforts Could Also Lead to Higher Enrollment in Exchanges

By Chris Sloan and Elizabeth Carpenter

Funding a $15 billion reinsurance stabilization package, in combination with a delay of the Affordable Care Act’s (ACA’s) health insurance tax (HIT) through the end of 2018 and guaranteeing funding of cost-sharing reductions (CSRs), could reduce average yearly premiums by $1,363 (a 17% reduction), according to new research from Avalere. Uncertainty in the individual market, rising premiums, and declining issuer participation have created the need for federal and state policy makers to address these issues to stabilize the marketplace.

Read More


09/11/2017 – The Commonwealth Fund – The HITECH Era and the Path Forward

By David Blumenthal, Vindell Washington, Karen DeSalvo, and Farzad Mostashari

In 2004, President George W. Bush established the Office of the National Coordinator for Health Information Technology (ONC) to help bring the health care sector into the digital age. Then, in 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act to spur greater action on digitizing health and moving away from the waste and errors associated with a paper-based health system.

Read More


09/06/2017 – Kaiser Family Foundation - Current Status of State Planning for the Future of CHIP

Federal funding for the Children’s Health Insurance Program (CHIP), which covered 8.9 million children in FY 2016, is set to expire on September 30, 2017. This fact sheet provides an overview of current state plans for CHIP amid continuing uncertainty about future federal funding for the program and discusses how states and children would be affected if Congress does not extend funding by the September 30, 2017 deadline. With this deadline nearing, states will need to begin making decisions soon about actions they will take if Congress does not extend funding. States provide CHIP through a separate CHIP program, a CHIP-funded Medicaid expansion, or a combination of both approaches. States with CHIP-funded Medicaid expansions would be required to maintain this coverage under the Affordable Care Act (ACA) maintenance of effort requirement, and state costs would increase since states would receive the lower federal Medicaid match rate. States with separate CHIP coverage would not be required to maintain this coverage if federal funding ends.

Read More


09/06/2017 – The Commonwealth Fund - Insurer Market Power Lowers Prices in Numerous Concentrated Provider Markets

By Richard M. Scheffler and Daniel R. Arnold

Health care providers and insurers have each increased their market power by consolidating in recent years. Researchers found that this consolidation has implications for negotiations between providers and insurers. Specifically, they found that in markets where both providers and insurers are highly concentrated, insurers have bargaining power to reduce prices for hospital admissions and visits to certain physician specialists. While insurers are able to bargain for reduced prices, there is little evidence that these savings will be passed on to consumers through lower premiums.

Read More


08/31/2017 – CHCS – Design Considerations for Nursing Facility Quality Improvement Initiatives in Medicaid Managed Long-Term Services and Supports Programs

By Ann Mary Philip and Stephanie Gibbs

Nursing facilities are an essential part of most Medicaid managed long-term services and supports (MLTSS) programs. Improving the quality of care provided by nursing facilities is a goal for states, managed care organizations, nursing facility providers, and facility residents and their families.
 
This brief, developed with support from the Robert Wood Johnson Foundation, examines four key considerations for states developing nursing facility quality improvement initiatives: (1) using existing data sources when possible to reduce provider burden; (2) enlisting the help of internal or external quality measurement experts; (3) seeking stakeholder engagement and support; and (4) understanding how the initiative may influence beneficiary protections and access to care.
 

08/03/2017 – Kaiser Family Foundation - Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries

As of July 2017, nearly 400,000 beneficiaries who are dually eligible for Medicare and Medicaid were enrolled and receiving services from health plans in 10 states with capitated financial alignment demonstrations. These demonstrations, jointly managed by the Centers for Medicare and Medicaid Services (CMS) and the participating states, seek to maintain or decrease costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with disabilities. This fact sheet provides a snapshot of enrollment in the demonstrations by state, as of July 2017.

Read More


08/02/2017 – The Kaiser Family Foundation - Many More Counties Lack Medicare Advantage Plans Today than are at Risk for Lacking an ACA Marketplace Insurer in 2018

A new analysis from the Kaiser Family Foundation finds that 147 counties lack Medicare Advantage plans – many more than the 19 counties expected to lack an Affordable Care Act (ACA) marketplace insurer next year. Yet Medicare Advantage, the private plans that cover a third of all Medicare beneficiaries, is often described as an example of a robust insurance market, while some policymakers say the “bare” counties under the ACA are evidence that the law is failing.

Read More

Click here to view the issue brief


07/20/2017 – Forbes - UnitedHealth Group Predicts 50% Of Seniors Will Choose Medicare Advantage

By Bruce Japsen

Medicare Advantage plans could quickly become the choice of one in two seniors as millions flock to privately administered health benefits for the government’s health insurance for elderly Americans, the nation’s largest health insurer is predicting.

Read More


07/20/2017 – McKnight’s - Observers Skeptical Of House Republicans' Call To Cut $2 Trillion In Medicaid, Medicare

By Emily Mongan

A budget plan released Tuesday by House Republicans would cut close to $2 trillion from federal healthcare programs — but it's unlikely to get very far in the legislative process, observers say.  The House's Fiscal Year 2018 budget blueprint, dubbed “Building a Better America,” would reportedly achieve a $6.5 trillion deficit reduction over the next decade.

Read More

Click here to view the FY 2018 budget blueprint


07/19/2017 – Avalere - New Medicare Incentives Encourage Accountable Care Organizations To Assume Greater Risk

By Josh Seidman, John Feore, and Biruk Bekele

New research from Avalere finds that accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) would have earned an additional net payments of $886 million in 2015 if they had assumed greater financial risk under the program and had qualified for the 5 percent bonus payment now available under the Quality Payment Program (QPP).

Read More


07/18/2017 – Kaiser Family Foundation - The Facts on Medicare Spending and Financing

By Juliette Cubanski and Tricia Neuman

Medicare, the federal health insurance program for 57 million people ages 65 and over and younger people with permanent disabilities, helps to pay for hospital and physician visits, prescription drugs, and other acute and post-acute care services. In 2016, spending on Medicare accounted for 15 percent of the federal budget (Figure 1). Medicare plays a major role in the health care system, accounting for 20 percent of total national health spending in 2015, 29 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services.1 This issue brief includes the most recent historical and projected Medicare spending data published in the 2017 annual report of the Boards of Medicare Trustees from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary (OACT) and the 2017 Medicare baseline and projections from the Congressional Budget Office (CBO).
 
 

07/17/2017 – McKnight’s - CMS Proposes Medicare Coverage For Outpatient Joint Replacements, Changes To SNF 3-Day Stay Rule

By Emily Mongan

The Centers for Medicare & Medicaid Services released two proposals last week that may change where beneficiaries receive joint replacements, and how accountable care organizations deal with the agency's three-day stay rule waiver.

Read More


07/14/2017 – The Commonwealth Fund - New 11-Country Study: U.S. Health Care System Has Widest Gap Between People With Higher And Lower Incomes

New International Ranking Underscores the Importance of Health Insurance Coverage and Strong Primary Care

Your level of income defines the health care you receive far more in the United States than in other wealthy nations, according to the Commonwealth Fund’s new 11-country report. The study, the only to include survey data to measure and compare patient and physician experiences across wealthy nations, ranks the U.S. last overall, and on providing equally accessible and high-quality health care, regardless of a person’s income. For example, in the United Kingdom, 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting needed health care—a three percentage point gap between those with higher and lower incomes. In the U.S., 44 percent of lower income and 26 percent of higher income people reported financial barriers to care. Remarkably, a high-income person in the U.S. was more likely to report financial barriers than a low-income person in the U.K.
 
 
 
 
 

07/10/2016 – CHCS - Working Together Toward Better Health Outcomes

By Elise Miller, Trishna Nath, and Laura Line

With rising costs, persistent health inequities, and gaps in care access, there is a heightened focus across sectors on new approaches to achieve better health outcomes. Policy and industry practices are shifting to prioritize value over volume. New payment and delivery models, and value-based contracting are aiming to reduce costs while improving patient care and community health. In addition, a broadening recognition of the critical role of the social determinants of health is forging increasingly common ground for providers of healthcare and human services.

Read More


07/10/2017 – The Commonwealth Fund -Getting to the Root of High Prescription Drug Prices

By Henry Waxman, Bill Corr, Kristi Martin, and Sophia Duong

Historic increases in prescription drug prices and spending are contributing to unsustainable health care costs in the United States. While rising prescription drug utilization is clearly a product of population growth, an aging population, and greater use of drugs in health care among all age groups, about one-third of the rise in prescription spending from 2010 to 2014 was a result of either price increases for drugs or a shift in prescribing toward higher-price products. Caught in the middle are patients. Faced with rising drug costs, too many must choose between taking life-saving drugs or paying the rent. And many Americans are concerned about how they will afford their medications in the future.

Read More

Click here to view the report


06/15/2017 – MedPAC - Medicare Payment Advisory Commission Releases Report On Medicare And The Health Care Delivery System

Today the Medicare Payment Advisory Commission (MedPAC) releases its June 2017 Report to the Congress: Medicare and the Health Care Delivery System. As part of its mandate from the Congress, each June MedPAC reports on issues affecting the Medicare program as well as broader changes in health care delivery and the market for health care services.

Read More

Click here to read the fact sheet

Click here to read the full report


06/13/2017 – Kaiser Family Foundation - Testimony: Promoting Integrated and Coordinated Care for Medicare Beneficiaries

By Gretchen A. Jacobson, Ph.D.

Gretchen Jacobson, Associate Director of the Foundation’s Program on Medicare Policy, testified on June 7, 2017 before the U.S. House Committee on Ways and Means, Subcommittee on Health as part of the Committee’s hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries. Her testimony focused on the challenges and opportunities presented by three approaches for integrating and coordinating care for high-cost, high-need Medicare beneficiaries, many of whom are dually eligible for Medicare and Medicaid. These approaches included Medicare Advantage Special Needs Plans (SNPs), the Program of All-Inclusive Care for the Elderly (PACE), and value-based insurance design (VBID) for beneficiaries who choose to enroll in Medicare Advantage plans.

Read More


06/08/2017 – Kaiser Family Foundation - Medicaid’s Role for Seniors

There are 47.5 million Americans age 65 and older, making up 15% of the population, as of 2015.  Many have complex physical and behavioral health care needs, such as heart disease, diabetes, and dementia.  Seniors often require services that are not covered by Medicare, such as long-term care.  There include assistance with self-care, such as bathing and dressing, and household activities, such as preparing meals and housekeeping.  

Read More


06/06/2017 – Kaiser Family Foundation - Medicare Advantage 2017 Spotlight: Enrollment Market Update

By Gretchen Jacobson, Anthony Damico, Tricia Neuman, and Marsha Gold

Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade.  The trend in enrollment growth is continuing in 2017, and has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA).  This Data Spotlight reviews national and state-level Medicare Advantage enrollment trends as of March 2017 and examines variations in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, and quality ratings.

Read More 


05/31/2017 – McKnight’s - Senators Push To Preserve Funding For Medicare Assistance Program

By Emily Mongan

Lawmakers called on Congress last week to continue funding a program that helps beneficiaries navigate Medicare, following the administration's fiscal year 2018 budget proposing to cut it entirely.  The State Health Insurance Assistance Program, which provides counselors to Medicare beneficiaries to help with enrollment, choosing plans and appealing coverage denials, found itself on the chopping block for the second time in a year under last week's budget plan.

Read More

Click here to read the letter


05/31/2017 – The Commonwealth Fund - International Profiles of Health Care Systems

Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States

By Elias Mossialos, Ana Djordjevic, Robin Osborn, and Dana Sarnak

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.

Read More


05/18/2017 – MedPAC – Testimony: Report to the Congress: Medicare Payment Policy (Ways and Means)

By law, the Medicare Payment Advisory Commission reports to the Congress each March on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). In this year’s report, we consider the context of the Medicare program in terms of the effects of its spending on the federal budget and its share of national gross domestic product (GDP).

Read More


05/12/2017 – The Commonwealth Fund - Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status

By Cathy Schoen, Karen Davis, and Amber Willink

For more than 50 years, Medicare has been a stable, trusted source of health insurance that provides basic access and financial protection for elderly and disabled beneficiaries for acute hospital and medical care services. The program has directly contributed to sharp declines in mortality and longer life expectancy for those age 65 and older. It also has succeeded in holding spending per beneficiary nearly flat over the past five years, below private insurance increases.

Read More

Click here to view the Appendices

Click here to view the chartpack


05/09/2017 – Avalere - Medicare Advantage Patients Less Likely to Use Post-Acute Care

By Fred Bentley and Erica Breese

Specifically, 77 percent of MA patients are sent directly home (without home health) following a hospital stay compared to 63 percent of FFS patients (Figure 1). While there are many factors that could influence the variation in post-acute care use, Avalere’s findings point to potential differences in how MA plans manage their beneficiaries’ care.

Read More


05/02/2017 – Kaiser Family Foundation - Brief Examines Per Enrollee Medicaid Spending for Seniors and People with Disabilities, Which Varies Greatly By State

Medicaid coverage of acute and long-term care for more than 6 million low-income seniors and 10 million nonelderly people with disabilities accounts for nearly two-thirds of overall Medicaid spending, although such enrollees represent less than a quarter of people on Medicaid.  Much of Medicaid’s spending on seniors and people with disabilities also depends on state decisions about whom to cover and which services to pay for, which is a big reason why Medicaid spending per enrollee for these populations varies greatly from state to state.

Read More

Click here to view the Issue Brief


04/21/2017 – Kaiser Family Foundation - Income and Assets of Medicare Beneficiaries, 2016-2035

By Gretchen Jacobson, Shannon Griffin, Tricia Neuman, and Karen Smith

Many Medicare beneficiaries, including seniors and younger adults with disabilities, live on fixed incomes supplemented by the savings they accumulated during their working years.  Their income and accumulation of savings is tied to many life experiences, including their education, health status, marital status, number of work years, household income, periods of unemployment, investments, years of homeownership, access to employer retirement benefits, inheritance, other financial supports, and various economic factors.  As a result, the income and assets of Medicare beneficiaries vary greatly. 

Read More


04/19/2017 – GAO – Medicaid Program Integrity: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States

Medicaid remains a high-risk program, partly due to concerns about improper payments. CMS oversees and supports states, in part, by reviewing their program integrity activities, hiring contractors to audit providers, and providing training. In recent years, CMS made changes to its Medicaid program integrity efforts, including a shift to collaborative audits.

Read More


03/20/2017 – MACPAC - March 2017 Report to Congress on Medicaid and CHIP

In the March 2017 Report to Congress on Medicaid and CHIP, MACPAC addresses three functions central to the roles of Medicaid and the State Children’s Health Insurance Program (CHIP) as the source of coverage for almost 90 million people:
providing health insurance for children,
making payments to safety-net hospitals, and
monitoring access to care under managed care and fee for service (FFS).
 
 

03/15/2017 – MedPAC - Medicare Payment Advisory Commission Releases Report On Medicare Payment Policy

The Medicare Payment Advisory Commission (MedPAC) releases its March 2017 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in fee-for-service (FFS) Medicare and provides a review of Medicare Advantage (MA) and the prescription drug benefit, Part D.

Read More

Click here to view the fact sheet

Click here to view the complete report


 

Community Resource Center
Get the latest and breaking news sent directly to your mailbox

Have a question for Resource Link?