Health Policy News March 2016

March was another big month in Federal health policy – with the Centers for Medicare and Medicaid Services (CMS) issuing final guidance on the 2017 certification standards for Qualified Health Plans (QHPs) on February 29, 2016 and a major Supreme Court case decided on March 1, 2016.  As such, in the March issue of Health Policy News, we focus on piecing together the latest developments.

We have provided a summary of the final 2017 Benefit and Payment Parameter regulations (“regulations”) and the final 2017 Letter to Issuers in the Federally-Facilitated Marketplaces (“Letter”). By highlighting major developments from prior years and flagging changes from the proposed guidance, we hope the summary serves as an easy-to-read guide for states as they begin another cycle of QHP review.

Early this month, the Supreme Court issued their decision on Gobeille vs Liberty Mutual Insurance Company. Nine states currently operate an All-Payer Claims Database (APCDs) with mandatory reporting requirements, and with many more examining the feasibility of an APCD, this case sets important precedent.

Finally, this month’s Health Policy News also includes a special feature highlighting Behavioral Health issues facing state policymakers and providers alike. In the behavioral health articles to follow, PCG Health members share a few insights learned at the National Council for Behavioral Health’s (the National Council) annual conference, “NatCon,” (#NatCon16) earlier this month. For more information on any of the behavioral health pieces, or to learn more about PCG’s behavioral health services, please contact James Waldinger (, Associate Manager in PCG Health.

As always, you can also contact us at for more information on any of these pieces.

Supreme Court Issues Decision on Major Health Care Case

Given its direct impact on state APCDs, states across the country have been nervously awaiting the Supreme Court ruling in Gobeille vs Liberty Mutual Insurance Company.  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. Click here to read more.

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Behavioral Health’s Move Toward Value-Based Purchasing

“Alternative payment models are not an option for behavioral health providers,” Arizona Medicaid Director Tom Betlach said, “They are your growth strategy.” Betlach’s point was very clear and it resonated with the more than 5,500 attendees at the NCBH conference, where Payment Reform – be it alternative payment methodologies (APMs) or value-based purchasing (VBP) models like Delivery System Reform Incentive Payment (DSRIP) initiatives – was a key theme. In line with this, New York State’s DSRIP efforts were highlighted repeatedly throughout the conference (PCG has played an instrumental role in spearheading New York’s initiative). Click here to read more.

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The Science of Addiction

Research presented by Dr. Nora Volkow, Director of the National Institute on Drug Abuse, at NatCon used brain imaging to dramatically illustrate how addiction changes brain function. Dr. Volkow’s research demonstrates, for example, that the frontal cortex – or reward center – of the brain weakens as a result of alcohol and illicit drug use. Because the tissue no longer functions in the same way, addiction must be considered a disease of the brain, just as heart disease is a disease of the heart. Click here to read more.

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CCBHC Is the Start of Something Good!

CCBHCs! That’s Certified Community Behavioral Health Centers, for those not familiar with the billion dollar investment that the Substance Abuse and Mental Health Services Administration (SAMHSA) will soon make to state behavioral health systems. In 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. Click here to read more.

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