CMS releases final Market Stabilization Rule

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final Patient Protection and Affordable Care Act; Market Stabilization Rule. The final rule is aimed at stabilizing the individual and small group markets by tightening enrollment standards and providing increased flexibility related to standards for Qualified Health Plans (QHPs), as outlined in detail below. The final rule also seeks to provide greater deference to state regulation of health insurance. [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]

U.S. Supreme Court rejects West Virginia’s challenge to Obama administration’s decision not to enforce certain provisions of the Affordable Care Act (ACA)

On Monday, April 17, 2017, the U.S. Supreme Court declined to take up West Virginia’s challenge to the decision by the Obama administration not to enforce certain mandates of the ACA following the cancellation of millions of plans by insurance companies in 2013. (West Virginia, Ex Rel. Morrisey v. Dept. of H & HS, 16-721, 4/17/17). [More]

The Importance of Forecasting Market Demand

As States continue to face constrained budgets, it is incumbent upon agency leadership to fine-tune their short- and long-term budgeting processes. PCG has found that forecasting market demand is a way state leaders to accurately allocate scarce government resources. Market forecasting makes a strong case for fiscal support because it relies heavily on a data driven decision making. It also offers state leaders a strategy that is non-partisan, and a level of transparency that appeals to both constituents and legislators. Ultimately, forecasting market demand ensures that the commitment of public funds will benefit the broader community. [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]

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]