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]

Louisiana implements Medicaid expansion

On June 1, 2016, Louisiana became the 31st state to implement Medicaid expansion under the Affordable Care Act (ACA). Louisiana has obtained federal approval to use pre-existing data from its Supplemental Nutrition Assistance Program (SNAP) to adjudicate Medicaid eligibility in real time, both at initial Medicaid enrollment and upon re-enrollment; it is the first State to have won such approval via a Medicaid plan amendment rather than time-limited federal waivers. [More]

HHS finalizes ACA non-discrimination rules

On May 18, 2016, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), finalized rules in the Federal Register on non-discrimination under federally-funded health care programs and activities. The final rules implement section 1557 of the Affordable Care Act (ACA), which broadly prohibits discrimination based on race, color, national origin, sex, age, or disability, in order to advance health care equity and reduce health care disparities. The final rules reflect OCR’s evaluation of 24,875 public comments on proposed rules that were published on September 8, 2015. [More]

PCG provides program validation for innovative pay-for-success program aimed at reducing recidivism

In 2012, the Commonwealth of Massachusetts launched a pay-for-success program aimed at reducing recidivism among juvenile and adult offenders while improving the lives of hundreds of high-risk young men, saving taxpayer dollars, and strengthening communities. Referred to as the Massachusetts Juvenile Justice Pay for Success Project, this program was the third large-scale implementation of a pay-for-success model according to a Harvard Business School (HBS) case study entitled, “Massachusetts Pay for Success Contracts: Reducing Juvenile and Young Adult Recidivism.” [More]

Supreme Court returns ACA contraceptive cases to lower courts in hope of compromise resolution

In an opinion issued on May 16, 2016, the U.S. Supreme Court remanded to the lower courts challenges by a number of nonprofit religious organizations to the contraceptive coverage requirement contained in the Affordable Care Act (ACA).

Without expressing any “view on the merits of the case,” the Supreme Court vacated and sent back the cases to the Courts of Appeal indicating the possibility of the parties reaching a compromise, based upon supplemental briefs that were ordered to be submitted. The action was viewed as an attempt to avoid a 4-4 split decision by the Supreme Court, which would result in different outcomes in different states. [More]