National Academy of Medicine outlines strategies for high-need patients

On July 6, 2017, the National Academy of Medicine released a valuable report entitled, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health.” The report describes key characteristics of high-need patient populations, tools that can be adopted to identify evidence-based models of care for them, and strategies to promote successful implementation of such models in collaboration with a broad range of stakeholders at the federal, state, and community level. It stresses the importance of behavioral health issues, social determinants of health, and community-based supports for high-need patients who often struggle at home with functional limitations associated with aging, disabilities, and a wide range of long-term diseases examined in the report. [More]

CBO estimates that AHCA would severely increase the number of uninsured persons

On May 24, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released estimates on the impact of the proposed H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives on May 4, 2017. AHCA would partly repeal the Affordable Care Act (ACA). The CBO estimates that AHCA would severely increase the number of persons without health coverage, as compared to the ACA... [More]

States seek to intervene in House v. Price lawsuit

On May 18, 2017, 15 states and the District of Columbia filed a motion to intervene in House v. Price, a lawsuit threatening the availability of federal funds (about $9 billion in 2017) for cost-sharing reduction (CSR) payments to health insurers under the Affordable Care Act (ACA). The lawsuit pertains to whether or not CSR payments are subject to annual Congressional appropriations. It was initially filed in November 2014 in U.S. District Court, which ruled in favor of the U.S. House of Representatives in May 2016, but held its decision in abeyance pending appeal. It is now before the U.S. Circuit Court of Appeals in the District of Columbia. [More]

NGA calls for Congressional action on CHIP renewal

On May 11, 2017, the National Governors Association (NGA) released a letter to the Senate Finance Committee and the House Committee on Energy and Commerce calling for Congressional action to renew funding for the Children’s Health Insurance Program (CHIP) for five more years. The letter is signed by Virginia Governor Terry McAuliffe, NGA Chair, and Massachusetts Governor Charlie Baker, NGA Vice-Chair for Health and Human Services. [More]

GAO examines telehealth in federal programs

On April 14, 2017, the U.S. Government Accountability Office (GAO) released a report to Congress on coverage and payment rules for telehealth and remote patient monitoring under Medicare, state Medicaid programs, and health care programs operated by the Department of Defense (DOD) and the Department of Veterans’ Affairs (VA). The report examines rules across those agencies’ programs and outlines recent initiatives to improve care for high-risk patients. [More]

HHS encourages Governors to consider state innovation waivers

On March 13, 2017, the U.S. Secretary of Health and Human Services (HHS) released a letter to all governors outlining the parameters under which states can obtain waivers under section 1332 of the Affordable Care Act (ACA). HHS notes that state innovation waivers to implement high-risk pools and state-operated reinsurance programs may be an important opportunity to lower health insurance premiums for consumers, to improve health insurance market stability in the state, and to increase consumer choice. [More]

Amended ACA repeal legislation headed for critical vote in the U.S. House of Representatives

On March 20, 2017, the leadership in the U.S. House of Representatives released amendments to the proposed American Health Care Act (AHCA), which would repeal many provisions of the Affordable Care Act (ACA). The new amendments to AHCA would allow states to impose work-related activity requirements on specified categories of adult Medicaid recipients as a condition of eligibility. The work-related activity requirements would not apply to the aged, disabled, pregnant women, and certain other Medicaid eligibility groups; and would incorporate broad definitions of work-related activities and exemptions aligned with longstanding TANF requirements. An enhanced Medicaid administrative matching rate (a five percentage point increase on top of the usual 50 percent rate) would be available for Medicaid administrative expenditures necessary to implement the work-related activity requirements. [More]

Proposed ACA repeal legislation would increase persons without health coverage

On March 13, 2017, the Congressional Budget Office (CBO) released estimates on the impact of the proposed American Health Care Act (AHCA). The CBO indicates that AHCA would increase the number of persons without health coverage by 24 million persons in 2026: 52 million persons without coverage in 2026, as compared to 28 million persons in 2026 under the Affordable Care Act (ACA). [More]

Proposed ACA repeal legislation would impose new restrictions on state Medicaid programs

On March 6, 2017, the U.S. House of Representatives released its initial draft legislation to “repeal and replace” the Affordable Care Act (ACA). The initial draft legislation would impose significant new restrictions on state Medicaid programs. The legislation would impose annual per capita caps on federal financial participation (FFP) in state Medicaid expenditures beginning with the federal fiscal year (FFY) 2020 (October 1, 2019 – September 30, 2020). The Centers for Medicare and Medicaid Services (CMS) would impose separate per capita caps for six Medicaid eligibility categories: the aged, blind, disabled, children, Medicaid expansion adults, and non-expansion adults.
For FFY 2020, CMS would... [More]

CMS proposes rules to stabilize health insurance markets

On February 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued draft proposed regulations intended to stabilize the individual and small group health insurance markets under the Affordable Care Act (ACA). The proposed rules would shorten the open enrollment period for 2018, amend standards on special enrollment periods, increase pre-enrollment verification of eligibility on the HealthCare.gov website, allow health insurance issuers to apply consumers’ payments to past unpaid debts for coverage, increase allowable variations in the actuarial value (AV) calculations, offer more flexibility in substantiating provider network adequacy, and facilitate insurers’ compliance with essential community provider (ECP) standards. [More]