Highlights from the annual NAMD conference

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

Massachusetts wins CMS renewal of demonstration waivers

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

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

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

NEJM article analyzes ACA coverage increases

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

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

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

HHS estimates 22 percent increase in 2017 ACA premiums

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

Foster Care and Medicaid

Under the Affordable Care Act (ACA), youth who were in foster care and receiving Medicaid on their 18th birthday are categorically eligible for Medicaid until their 26th birthday, regardless of their income. The provision in the law aligned with the extended coverage of young adults whose parents have private health insurance. On October 18, 2016, Columbia University’s School of Public Health released a policy brief reporting that an estimated 180,000 young people who have aged out of foster care are eligible for extended health care coverage. [More]

California health care provider to pay more than $2 million to settle HIPAA violation

Recent media reports have stated that St. Joseph Health in Irvine California has agreed to pay $2.1 million to settle allegations that its 14 hospitals and other health care operations left personally identifiable records of 31,800 people exposed on a newly-installed computer server. As reported, this marks the 12th Health Insurance Portability and Accountability Act (HIPAA) violation settlement this year, a record number. [More]

PCG facilitates public meetings with Chilliwack school district

PCG’s Education Consulting team led public meetings with members of the Chilliwack school district in British Columbia to discuss a potential change to the district’s grade configuration. According to an October 26th article in the Chilliwack Progress, this week’s meetings were an opportunity for members of the community to voice concerns, ask questions and learn more about the reconfiguration in general, as well as its potential impact on students. [More]

CMS finalizes rules on new Medicare payment methodologies for clinicians

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