Alabama’s Regional Care Organization 1115 waiver approval

In May 2013, Act-2013-261, Ala. Code §§ 22-6-150 was passed, advancing the move from a fee-for-service (FFS) system to a managed care program. According to the Alabama Medicaid Advisory Board report issued in January 2013, based on 2011 data, 22 percent of Alabama’s population was Medicaid eligible for a portion of the year. Additionally, Alabama’s Medicaid program covered 53 percent of births, 47 percent of children, and two-thirds of nursing home residents. In 2009, Medicaid accounted for 16.3 percent of all health care expenditures in Alabama. In order to contain costs associated with the substantial Medicaid population, managed care in the form of regional care organizations (“RCOs”) were established with little guidance other than the Act 2013-261 itself. [More]

CMS announces the release of $22 Million in Health Insurance Enforcement and Consumer Protections grant funding

On June 15, 2016, the Centers for Medicare and Medicaid (CMS) announced the release of $22 million in grant funding for State planning and implementing of the health insurance market reform provisions of the Affordable Care Act (ACA). The grants are aimed at helping States ensure their laws, regulations and procedures are in line with Federal requirements and that the States are able to effectively monitor and enforce health insurance market reforms and consumer protections under the ACA. States must submit a letter of intent by July 6th. Grant applications are due August 15th at 3:00 pm. [More]

KFF estimates significant increases in Exchange premiums for 2017

On June 15, 2016, the Henry J. Kaiser Family Foundation (KFF) released a report entitled, “Analysis of 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces.” The report estimates that premiums on Federal and State-based Exchanges will rise in 2017 at about twice the rate of increase for 2016 and that insurer participation in Exchanges will decline. KFF compared final 2016 premiums versus proposed 2017 premiums for major cities in 13 states and the District of Columbia (the geographic areas for which KFF could access complete 2017 rate filings for all insurers planning to participate in Exchanges in 2017). Insurers’ proposed 2017 premiums will be subject to review by state insurance departments and may be adjusted following state review. [More]

Family First Act - A Closer Look

PCG Human Services has partnered with the Alliance for Strong Families and Communities to create a detailed summary of the Family First Prevention Services Act, which is under consideration by the US House and Senate. This bill would expand Title IV-E funding for certain services to children and families that aim to prevent a child’s placement into foster care. The bill also changes how Title IV-E reimburses states for costs associated with children who are placed in child caring institutions and reauthorizes several existing child welfare federal grants. [More]

New white paper examines implications of the Department of Labor’s Final Rule

The Fair Labor Standards Act of 1938 (FLSA) sets standards that affect workers in all industries, including federal benchmarks and protections for minimum wage, child labor, discrimination and overtime. The regulations that pertain to overtime were recently revised through the Department of Labor’s Final Rule that was published on May 23, 2016 (and effective December 1, 2016) [More]

CMS awards grants to promote children’s enrollment in Medicaid and CHIP

On June 13, 2016, the Centers for Medicare and Medicaid Services (CMS) announced $32 million in grant awards supporting innovative strategies to enroll and retain children in Medicaid and the Children’s Health Insurance Program (CHIP). Innovation awardees include 38 state, local, and provider-based organizations in 27 states, such as the Los Angeles Unified School District (involving multi-lingual outreach information at over 800 district sites), the Bexar County Hospital District in Texas, and the Refuah Health Center, Inc. in New York State. [More]

CMS announces steps to protect ACA risk pools

On June 8, 2016, the Centers for Medicare and Medicaid Services (CMS) announced new steps to protect the integrity of health insurance “risk pools.” The integrity of those pools directly affects the accuracy and stability of health insurance premiums under the Affordable Care Act (ACA). CMS has outlined new steps pertaining to: controlling the abuse of “short-term” health plans, improving the accuracy of risk adjustments, reducing abuse of Exchanges’ special enrollment periods, improving Exchanges’ data matches, and transitioning consumers to Medicare as they approach age 65. [More]

CMS finalizes changes to Medicare ACO rules

On June 6, 2016, the Centers for Medicare and Medicaid Services (CMS) issued final regulations on payment methods for accountable care organizations (ACOs) under the Medicare “shared savings” program (MSSP), which includes 434 ACOs serving 7.7 million Medicare beneficiaries in 49 states and the District of Columbia. Medicare Part A and Part B fiscal intermediaries and carriers pay ACOs on a fee-for-service (FFS) basis under the MSSP, but an ACO may qualify for a “shared savings” bonus if the ACO achieves CMS-specified Medicare savings targets while meeting CMS-specified quality of care performance metrics. Medicare ACOs achieved $411 million in Medicare savings in 2014; savings calculations for 2015 will be released this summer. [More]