Administrative Action

Immediately upon entering office, President Trump signed an Executive Order on January 20th entitled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” stating his commitment to repealing the Affordable Care Act (ACA) and directing administration officials to avail themselves of existing authority to provide flexibility in administration of the ACA. While the Executive Order provided no new authority and made no policy changes itself, it did provide examples of flexibility that should be exercised. [More]

Where is “Prevention” in the ACA Replacement Debate?

The main goal of the Affordable Care Act (ACA) was to extend insurance coverage to millions of Americans left out of the health insurance markets, such as low-income parents ineligible for Medicaid or individuals unable to access employer-sponsored coverage. Rightfully, the terms of the ACA “Replacement” debate have been framed around alternative ways for meeting this goal, with most replacement plans distinguished and measured by the various mechanisms they propose to substitute for the insurance exchanges and Medicaid expansion measures used by the ACA to improve Americans’ access to health care. [More]

Value Based Purchasing Trends

While uncertainty swirls around Washington, D.C., one aspect of the healthcare marketplace is here to stay: value based purchasing (VBP). With the opportunity to reduce costs and payment variability, while improving the quality of care, commercial payers are continuing the adoption of disruptive payment arrangements. [More]

Inauguration Day – Get up to speed on Medicaid Block Grants

With Inauguration Day upon us, the discussion on the future of healthcare in the US and specifically the Affordable Care Act (ACA) will continue to be a major headline as the new administration focuses its efforts to ‘repeal and replace’ the ACA. While much of the attention has been on the plans of the Republican administration and Republican-led Congress to ‘repeal and replace’ the ACA, the discussion on the future of healthcare in the US has included the possibility for a major shift in the funding for the Medicaid program. [More]

SAMHSA Opioid Grant

SAMHSA, or the federal Substance Abuse and Mental Health Services Administration, is offering nearly $1 billion to states over a two-year period to earn much needed funds to help fight the opioid epidemic (https://www.samhsa.gov/sites/default/files/grants/pdf/ti-17-014.pdf). [More]

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]

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]