CHIP funding crisis remains unresolved

Congressional authorization of federal funds for the Children’s Health Insurance Program (CHIP), which Nine million children depend on, expired on September 30, 2017. States are now operating CHIP on carryover and redistribution payments from prior years. The Centers for Medicare and Medicaid Services (CMS) estimates that at least one state will exhaust such funding in November 2017 and most will by March 2018. [More]

American Hospital Association files lawsuit against the Department of Health and Human Services

On November 13, 2017, the American Hospital Association (AHS) and associated entities filed a lawsuit in the U.S. District Court for the District of Columbia challenging certain provisions of a final rule issued on November 1, 2017 by the Department of Health and Human Services (DHHS), which would reduce by nearly 30% Medicare outpatient reimbursements to certain public and not-for-profit hospitals and clinics for prescription drugs purchased on a discounted basis under section 340B of the Public Health Service (PHS) Act. [More]

CBO releases report on bipartisan ACA stabilization plan

On October 25, 2017, the Congressional Budget Office (CBO) released a report on the Bipartisan Health Care Stabilization Act of 2017, which is now under consideration within the Senate Committee on Health, Education, Labor, and Pensions. The new legislation would offer additional flexibility under the state innovation waiver process, appropriate funding for cost-sharing reductions (CSRs), require some insurers to pay rebates on premiums for 2018, allow more individuals to purchase high-deductible plans, and require Federal support for outreach and enrollment activities. [More]

Senators introduce ACA repeal legislation

On September 13, 2017, U.S. Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson introduced legislation to scrap many provisions of the Affordable Care Act (ACA) while imposing funding caps on the traditional Medicaid program. The bill could become law under budget reconciliation rules that block a Senate filibuster. The bill could pass the Senate and House on a majority vote before September 30, 2017.

The non-partisan Congressional Budget Office (CBO) says that it can’t comprehensively analyze the bill’s potentially adverse impact on health insurance premiums and coverage until next month. Congress will be acting this month based on a preliminary CBO analysis expected to show long-term federal budget savings. [More]

Governors outline market stabilization strategy

On August 30, 2017, a bipartisan coalition of Governors issued a letter to Congress on steps needed to restore stability and affordability in coverage to 22 million Americans served through individual health insurance markets under the Affordable Care Act (ACA). The Governors’ letter sets the stage for testimony before a US Senate committee on September 7, 2017, by Massachusetts Governor Charlie Baker, Montana Governor Steve Bullock, Tennessee Governor Bill Haslam, Utah Governor Gary Herbert, and Colorado Governor John Hickenlooper. [More]

Upgrading Training in Child Welfare Agencies – Five Steps to Creating a Learning Organization

After the hiring process, training is the most important aspect in the development of a good case manager. Training is understood to be an important first step by management of administration in understanding the philosophy of child welfare and child protection, the policies and practices of the agency, and the functions necessary to become an effective and efficient case manager.
There are many moving parts to consider when implementing a successful training program. Child protection, child welfare, the clients, the agency’s operation, the laws, technology, paperwork, and stakeholders are not just complicated individually, but collectively such considerations can be overwhelming.
After the hiring process, training is the most important aspect in the development of a good case manager. Training is understood to be an important first step by management of administration in understanding the philosophy of child welfare and child protection, the policies and practices of the agency, and the functions necessary to become an effective and efficient case manager.
There are many moving parts to consider when implementing a successful training program. Child protection, child welfare, the clients, the agency’s operation, the laws, technology, paperwork, and stakeholders are not just complicated individually, but collectively such considerations can be overwhelming. [More]

CMS proposes reductions in Medicaid allotments to states for hospitals’ uncompensated care

On July 28, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement $43 billion in reductions in federal Medicaid allotments to state Medicaid agencies for payment adjustments to hospitals serving a disproportionate share of low-income persons. The reductions in such allotments under the proposed rule will apply to federal fiscal years 2018-2025. Reductions nationwide will start at $2 billion in FY 2018 and will reach $8 billion per year in FY 2024 and FY 2025. [More]

U.S. District Court in Connecticut certifies nationwide class of Medicare beneficiaries in challenge to “observation status”

On July 31, 2017, the U.S. District Court for the District of Connecticut certified a nationwide class of Medicare beneficiaries who desire to challenge their placement on “observation status” during their hospital stays. Alexander v. Price, No. 3:11-cv-1703 (D. Conn. July 31,2017).

The plaintiffs in this long-running action argue that the decision to categorize Medicare beneficiaries as outpatients on observation status rather than inpatients should be subject to administrative review. Currently, Medicare does not allow beneficiaries to appeal this determination. [More]

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]