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]

Child Welfare team partners with Casey Family Programs

In response to a growing number of Native American tribes obtaining planning grants from the Administration for Children and Families (ACF), PCG’s Child Welfare/Youth Services team has partnered with Casey Family Programs in supporting approval to run their own child welfare system. The planning grant must be used to develop and implement a child welfare system unique to tribal issues and needs. [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]

Looking ahead: Key considerations for the future of health policy

There has been much discussion on the future of the Affordable Care Act (ACA) and health policy in general, since the election. While it is tempting to try to predict the future of health policy, in reality it is still too early to know how policy will change, via which vehicles, and according to what timeline. There are, however, some key themes to be mindful of as we approach inauguration day... [More]

Update on House v Burwell case

On December 5, 2016, the District of Columbia Circuit Court of Appeals accepted a Congressional request to postpone further proceedings in House v Burwell pending motions due February 21, 2017, turning the continued proceedings in this case over to the next administration and Congress.

In November 2014, the House of Representatives filed suit against the current administration claiming the cost-sharing reduction payments made to issuers for silver level Marketplace enrollees, with incomes of less than 250% of the Federal poverty level, are not lawful because Congress has not appropriated the funds. [More]

CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [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]

Brief - Child Welfare / Child Neglect

Highlights of a paper by Public Consulting Group and the Institute for Child Success. Click here for the white paper.

Neuroscience shows us that by redressing child neglect, child welfare agencies can not only reduce human suffering, but equip generations of children to become productive members of society. State policymakers can now build on scientific facts to raise the odds of success for youth born into challenging circumstances, break the inter-generational cycle of child neglect, and ease the burden on our systems of child welfare, education, and criminal justice. [More]

USDA examines dual participants in SNAP

A July 12th, Governing article shares findings of the U.S. Department of Agriculture’s (USDA) recent report examining a new data-sharing system’s ability to identify Supplemental Nutrition Assistance Program (SNAP) participants receiving benefits in more than one state. “Dual participants” cost the government millions in unintended costs and the data-sharing system, called the National Accuracy Clearinghouse, was successful in saving states money by identifying people who already get food stamps in another jurisdiction. [More]

Innovative approaches to Medicaid expansion within the Medicaid managed care delivery system

Much attention has been paid to innovative approaches to coverage of the Medicaid expansion population that leverage the private commercial insurance market for coverage through “premium assistance” programs. However, other states have turned to the Medicaid managed care delivery system as the vehicle for implementing innovative coverage designs for the newly eligible population. As outlined below, these states have received 1115 Medicaid Demonstration waivers to gain flexibility in the coverage offered to this population via managed care plans. [More]