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]

GAO releases report on CMS oversight of Medicaid expenditures

On February 6, 2017, the U.S. Government Accountability Office (GAO) issued a report on the Medicaid program entitled, “Program Oversight Hampered by Data Challenges, Underscoring the Need for Continued Improvement.” Six members of the U.S. Senate and the House of Representatives asked GAO to examine Medicaid data challenges based on estimates that there were about $36.3 billion in improper Medicaid payments in Federal fiscal year 2016. [More]

CMS finalizes rules on episode payment models

On January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published final rules on new Medicare episode payment models (EPMs) to be implemented on July 1, 2017. The EPMs are designed to encourage participating hospitals to devise strategies to improve discharge planning, adherence to treatment and medication regimens, and coordination among all providers and suppliers, in order to upgrade quality of care and to reduce overall Medicare spending. [More]

CMS announces expansions in value-based payment programs

On December 15, 2016, the Centers for Medicare and Medicaid Services (CMS) announced upcoming application opportunities to participate in its on-going Comprehensive Primary Care Plus (CPC+) and Next Generation Accountable Care Organization (ACO) demonstration programs. Both announcements outline a series of challenging steps scheduled for 2017 aimed at broadly expanding participation in these innovative programs by January 2018. The CPC+ program is designed to align Medicare, state Medicaid agencies, and commercial insurance payers to achieve more comprehensive, coordinated primary and preventive care, especially for patients with complex medical or behavioral health needs. Participating providers can qualify for incentive payments related to clinical quality/patient experience metrics as well as utilization/cost containment metrics. [More]

House passes 21st Century Cures bill

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

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]

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]