UPDATED: Centers for Medicare and Medicaid Services releases Long-Awaited Block Grant Guidance

2/7/2020 Update: Click here for a detailed analysis of the Healthy Adult Opportunity (HAO) guidance (SMDL 20-001) from PCG’s Health Policy News subject matter experts. The Centers for Medicare and Medicaid Services (CMS) released its long-awaited guidance promoting block grant waivers – being referred to as the Healthy Adult Opportunity (HAO) – yesterday. As expected, under guidance, in exchange for funding limited to an ...

Chronic Care Alternative for Marketplace Enrollees: State Complex Care Plan

Over the past four years, thirteen states have received approval to implement State Innovation Waivers (renamed “State Relief and Empowerment Waivers” by CMS in October 2018) under the authority of Section 1332 of the Affordable Care Act. Twelve of those states (all except Hawaii) leveraged Section 1332 to implement reinsurance programs aimed at reducing premiums. ...

California’s Innovative Approach to Address Rising Pharmaceutical Costs

Addressing rising prescription drug costs has been a top priority for California Governor Gavin Newsom’s administration. Health Policy News reported early in his term about the Governor’s Executive Order that authorized the state’s Department of Health Care Services to negotiate prescription drug prices for the state’s Medicaid program. Governor Newsom’s efforts continued into 2020 with ...

Public Comment Period on Draft Transparency in Coverage Rule Extended Until January 29th

The draft Transparency in Coverage rule was developed by the Departments of Treasury, Labor and Health and Human Services (hereinafter “the Departments’) and published on November 27, 2019.  This rule was developed in response to the President’s Executive Order on Improving Price and Quality Transparency. The proposed rule applies to group plans and health insurance ...

2020 Prediction: Continued Focus on Ensuring Access to Healthcare, Prescription Drugs, and Healthy Food to Combat Diet-Related Illness

Over the past year, Health Policy News readers were drawn to topics that were top of mind for many policymakers, as well as articles that detailed innovative solutions to complex problems like controlling health costs and expanding access to healthcare. As 2019 comes to a close, this piece revisits these popular topics, providing updates on ...

2020 Prediction: More State Waivers and Activity Related to Major Health Policy Litigation and Federal Regulations

Many major health policy developments in 2019 were related to state waivers, major health policy litigation, and federal health insurance regulations, with activity on these issues expected to continue into 2020. One of these developments—this week’s new ruling in the Texas vs United States case challenging the validity of the Affordable Care Act (ACA)—is certain ...

Verma Announces Proposed Medicaid Fiscal Accountability Rule at National Association of Medicaid Directors (NAMD) Conference

On November 12th, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma kicked off the NAMD conference by announcing the CMS issuance of the proposed Medicaid Fiscal Accountability Rule (CMS-2392-P). In her opening remarks, Administrator Verma indicated that this proposed rule seeks to strengthen the Medicaid program through program integrity measures and equitable funding ...

States Seek to Expand Substance Abuse Treatment Services via Telehealth

Passed in October 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act and its provisions seek to tackle the opioid misuse crisis by encouraging recovery, supporting affected caregivers and families, and encouraging innovation to create long-term solutions. As Health Policy News previously reported, a particularly interesting ...

National Association of Medicaid Program Integrity (NAMPI) 2019 Annual Conference

PCG staff members joined over 500 attendees at the 35th Annual NAMPI Conference in August. As always, the conference was an excellent way for program integrity (PI) leaders to network with one another while sharing best practices, lessons learned and innovative ideas within the Medicaid arena. The NAMPI conference covered a range of topics, from ...

Innovative Approaches to Accountable Care

In 2018, it was estimated that 10 percent of the population was receiving care under an Accountable Care Organization (ACO) approach to health care delivery. Recent enrollment data from 2019 indicated that ACO enrollment is composed of 55% commercial ACO models, 7% Medicaid and 38% Medicare, which indicates a diverse approach to ACO integration across ...

Browse Categories