PCG’s long-time partner recognized on the Senate floor

PCG is a proud long-time partner of Commonwealth Care Alliance (CCA), a managed care organization in Massachusetts specializing in the management of dually eligible populations. CCA’s client-centered focus has won accolades in state and nationally. PCG has provided claims processing and other related services to CCA for more than 10 years. [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]

House Committees move forward on ACA repeal

The House took a major step in advancing action on the Affordable Care Act (ACA) with the filing of the American Health Care Act. The bill, which was filed in the House of Representatives on March 6, 2017, is a compilation of budget reconciliation packages from the House Ways & Means Committee and the House Energy & Commerce Committee, in follow-up to the budget resolution adopted in January. [More]

Transitional health plans to continue through 2018

In November of 2013, the Centers for Medicare & Medicaid Services (CMS) introduced the concept of “grandmothered plans,” coverage in place prior to 2014 that would have been prohibited as of 2014 as a result of changes under the Affordable Care Act (ACA). CMS issued guidance permitting those plans to be renewed for existing policyholders if permitted by states. Specifically, such plans are not considered to be out of compliance with ACA provisions related to... [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]

Five Steps to Ensuring Reasonableness in Cost-Based Reimbursement Programs

As the debate over national health policy continues, many state health administrators are looking for ways to do more with less. A key step towards maximizing the impact of state and federal healthcare dollars is ensuring reasonable spending on existing programs. There are endless factors which impact the cost of healthcare such as geographic location, patient demographics, intensity of services and availability of resources. Consequently, reasonable cost is difficult to pinpoint. [More]

Planning for Zika should start now— and not just at your Department of Public Health

Winter may not be ending until March 20—but it is never too early for state officials from many agencies, not just public health specialists, to start planning for this coming summer’s likely spike in Zika infections. As of this writing, 47 women in the U.S. have given birth to babies with neurological defects caused by the Zika virus, according to the latest data from a U.S. Centers for Disease Control (CDC) registry. That’s approximately 6 percent of all pregnant women infected with Zika who have given birth, and the numbers look certain to rise as more and more women infected by Zika last August and September come to the full term of their pregnancies. [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]

Alleviating Emergency Medical Services’ Fiscal Challenges”

State budgets are under significant pressure and Emergency Medical Service (EMS) providers are facing declining reimbursement in response to serving as the public health care safety net. Many fiscal challenges exist for over-burdened departments and the prospects for addressing these inequities are dim. Healthcare systems and EMS ambulance transport providers are struggling to find alternative funding sources because of the decreasing reimbursement dollars from private and public insurance. This overall sentiment is evidenced by an article posted on the EMSWorld Website, which highlights the challenges faced by the EMS provider community. [More]