HHS releases report on results of ACA’s third open enrollment period

On March 11, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) released a report detailing the Affordable Care Act’s (ACA) third open enrollment period numbers. From November 1, 2015 through February 1, 2016, 12,681,874 people enrolled in qualified health plans (QHPs) offered through Federally-facilitated Exchanges (FFEs) and State-based Exchanges (SBEs): 7,794,848 (61 percent) were re-enrollees and 4,887,026 (39 percent) new enrollees. The report shows that, FFEs accounted for the majority (76 percent) of all enrollees; about 68 percent of all enrollees selected “silver” level coverage (medium cost-sharing); and 83 percent qualified for advance premium tax credits (APTCs). [More]

Supreme Court issues decision on major health care case

States across the country have been nervously awaiting the Supreme Court ruling in Gobeille vs Liberty Mutual Insurance Company given its direct impact on state All-Payer Claims Databases (APCDs). That wait ended on March 1st and, with the decision known, states now have another piece of the puzzle to guide their next steps; however, the full impact on APCDs is yet to be seen. [More]

HHS finalizes ACA benefit and payment parameters for 2017

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) finalized its “Notice of Benefit and Payment Parameters” for 2017 in the March 8, 2016 Federal Register. As in prior years, this annual rules notice adjusts a wide range of policy, operational, and information technology requirements applicable to health insurance coverage obtained through Exchanges under the Affordable Care Act (ACA). [More]

Supreme Court declines review of “Origination Clause” challenge to ACA mandates

On February 29, the U.S. Supreme Court declined to review the Fifth Circuit Court of Appeals’ decision that a physician and his employer lacked standing to challenge the individual and employer mandates of the Affordable Care Act (ACA) under the Origination Clause of the U.S. Constitution. Hotze v. Burwell, No. 15-622, cert. denied (U.S. Feb. 29, 2016). [More]

CMS expands funding for health information technology

On February 29, 2016, the Centers for Medicare and Medicaid Services (CMS) released a bulletin expanding the availability of 90 percent Federal financial participation (FFP) on state Medicaid administrative expenditures to promote the adoption and meaningful use of electronic health records (EHRs). With this funding increase, CMS seeks to address the need for improved patient care coordination and care transitions across a wide range of services (e.g., acute, chronic, behavioral health, long term care, etc.), using system-wide health information exchange (HIE) technology solutions. [More]

CMS expands funding for services provided to Native Americans

On February 26, 2016, the Centers for Medicare and Medicaid Services (CMS) released a bulletin expanding the availability of 100 percent Federal financial participation (FFP) on state Medicaid expenditures for services received through Indian Health Service (IHS) facilities. The CMS bulletin states that 100 percent FFP will be available for IHS facility services as well as services authorized under written care coordination agreements between IHS facilities and non-IHS providers enrolled in Medicaid. [More]

Congress addresses impact of methamphetamine and opioid abuse on child welfare systems

Congress took action this week to highlight the significant impact parental abuse of methamphetamines and opioids is having on children across the country. On February 23, 2016, the Senate Finance Committee held a hearing, “Examining the Opioid Epidemic,” with presenters from the child welfare community, health care community, and law enforcement. In his introduction, Sen. Ron Wyden (D-OR) referred to the issue of opioid use as one of requiring a three-prong approach – more prevention, better treatment and tougher enforcement – for successful eradication. [More]

Current state of CMS quality rating programs

For Marketplace plans, quality is coming to the forefront as Quality Rating System (QRS) and Quality Improvement Strategy (QIS) requirements are rolled out for Qualified Health Plans (QHPs) starting in 2017. In short, pending the approval of proposed regulations, the following changes are coming for 2017:
• CMS will be publicly displaying QHP quality rating information on HealthCare.gov;
• QHP issuers will be allowed to include 2016 QRS and QHP Enrollee Survey results in marketing materials;
• QHP issuers must adhere to guidelines, including the QRS Technical Guidance and User Guide for the 2017 Coverage Year, established by Federal Department of Health and Human Services in consultation with health care quality experts and stakeholders.

Research centers examine national congregate care trends

Two research centers, Chapin Hall and the Chadwick Center, recently collaborated to examine nationwide patterns of congregated care placements (i.e., group homes, residential treatment facilities, psychiatric care institutions and emergency shelters). The research findings, which were published in a policy brief titled Using Evidence to Accelerate the Safe and Effective Reduction of Congregate Care for Youth Involved with Child Welfare, are quite timely since the Senate Finance Committee’s legislation addressing congregate care is still in-development. [More]

CMS and AHIP announce alignment in physician quality measures

On February 16, 2016, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) announced multi-payer alignment and simplification of core quality measures to be used in calculating quality-based payments for seven physicians’ services specialties. Multi-payer alignment is expected to reduce the reporting burden for providers and to accelerate the nationwide shift to value-based payment. [More]