CMS Issues New Regulations to Enhance Program Integrity

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), published a final rule in the September 10, 2019 Federal Register to implement program integrity enhancements to the provider enrollment process under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  The CMS rule will be effective November 4, ...

Tennessee Releases Its Block Grant Plan

This month, Tennessee continued its pursuit of a Medicaid block grant, unveiling its draft Medicaid waiver amendment application on September 17th. Underpinning Tennessee’s months-long exploration of this model is the current federal administration’s interest in supporting these types of proposals—with implementation guidance expected to be released, but still under review, by the Office of Management ...

Critical Incident Management Solutions in Medicaid Long-Term Care

Medicaid agencies must assure the health and safety of their Home & Community-Based Services (HCBS) waiver program recipients by managing the reporting, investigation, and prevention of incidents.  Failure to do so poses a host of risks around compliance, fraud, and the safety of Medicaid recipients. States’ Medicaid agencies have administrative authority of their Medicaid Waiver ...

Recent Trends with OIG and CMS Related to Reporting Costs Associated with Waivers on the CMS-64

Claiming administrative costs to Medicaid waivers has become a targeted area of review by the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS). A number of state Medicaid agencies in various regions are facing potential disallowances or deferral of Medicaid administrative claims for failing to properly claim administrative costs to ...

Dishing from the 32nd National Academy of State Health Policy Annual Conference (#NASHPCONF19)

The Health Policy News team continued our summer conference travels and spent time in Chicago from August 21st-23rd at the 32nd Annual #NASHPCONF19. While we heard from many of our clients and listened to them speak about projects with which we are presently assisting, we also met many newcomers who were attending for the first ...

Legislation aimed at Health Care Costs Advances in Congress

Unlike many topics under discussion in Congress this year, the issue of health care costs is a priority across party lines. With bills pending in both the U.S. House of Representatives and U.S. Senate, and a recent executive order issued on the topic, we have broken down the details on the latest cost control developments ...

The House Passes Legislation Aimed at Preserving the Affordable Care Act

Notable among the bills passed by the U.S. House of Representatives in recent months are two bills aimed at shoring up the Affordable Care Act (ACA). Below, we explore the content of both bills—though it is worth noting that neither bill has been, nor is expected to be, taken up by the Senate. H.R. 987 ...

Hearings Begin on “Medicare for All” Legislation

On June 12, 2019, the U.S. House of Representatives’ Ways and Means Committee conducted its initial hearings on H.R. 1384, the Medicare for All Act of 2019. Introduced by U.S. Representative Pramila Jayapal (D-WA) in February, H.R. 1384 would: Provide health coverage for all U.S. residents. Authorize automatic enrollment upon birth or establishment of U.S. ...

How Can Communities Support Fresh Produce Programs for Their Citizens?

As we reported in May, funding for a first-of-its-kind Produce Prescription (“Produce RX”) pilot program was included in the 2018 Farm Bill. Produce RX programs seek to connect physicians and patients with vendors that accept prescriptions for fruits and vegetables. The federal government is currently evaluating proposals from organizations hoping to use this funding to launch ...

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