Health Policy News – February 2020


On January 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters (NBPP) and the draft Letter to Issuers in the Federally-facilitated Exchanges, as well as accompanying guidance and timelines. The March 2nd deadline for comment on the proposed policy changes included in the annual guidance is fast approaching. To assist states in considering whether to submit comments, Health Policy News prepared a fact sheet about the guidance and outlined potential areas of interest for states in our first article this month.

Our last couple of editions highlighted proposed Medicaid policy changes, including efforts by CMS to increase fiscal accountability and transparency as well as promote the Health Adult Opportunity (HAO). This month, we compiled a comprehensive round-up of recently released Medicaid guidance—including updates on the HAO guidance; state input on the recent federal Medicaid Fiscal Accountability Rule; a new Preadmissions Screening and Resident Review (PASRR) rule; and the latest decision in the Arkansas Medicaid work requirement case.

Lastly, we are excited to tackle a new topic in this edition: Emergency Medical Services (EMS). In our final article this month, we share policy insights and lessons learned from PCG’s EMS cost reporting and operational reorganization work. Stay tuned for more on EMS in forthcoming editions, including the opportunity to engage with our subject matter experts about this topic!

Comments on the 2021 Proposed Payment Notice and Draft Letter to Issuers in the FFM Due March 2nd

As in past years, Health Policy News prepared an overview of CMS’s annual Marketplace guidance—with a focus on key changes applicable to the Qualified Health Plan certification process to assist states considering whether, and on what topics, to submit comments. To view our fact sheet outlining these key changes, the CMS proposed timeline for 2021, and other areas we highlight for potential comment by states, click here.

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Medicaid Updates: Regulations, Guidance and Litigation

The last several weeks saw a number of Medicaid policy-related developments. We compiled key takeaways from each of them into a round-up post.

The majority of developments covered this month pertain to recent CMS releases. In an update to our breaking news alert from last month’s edition, we posted a fact sheet detailing CMS’s Medicaid block grant (or HAO) guidance. Additionally, CMS is currently wading through nearly 4,000 comments regarding its proposed Medicaid Fiscal Accountability Rule. While CMS contends that the rule would help to strengthen the Medicaid program by ensuring federal dollars are being spent to support patient care, Governors from across the political spectrum, as well as Medicaid providers, are raising alarms about the rule’s ramifications for Medicaid maintenance of effort. And just last week, CMS issued yet another Medicaid rule—this one seeking to modernize standards for the Preadmissions Screening and Resident Review (PASRR) Program.

Finally, earlier this month the D.C. Appeals Court issued its ruling on the Arkansas Medicaid work requirement, joining the District Court in finding that CMS’s approval of the waiver violated federal standards. All eyes now turn to CMS as it decides how to proceed.

For more information on all of these developments, click here.

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An Interview with Retired Deputy Fire Chief Ken Riddle, PCG’s Emergency Medical Services Subject Matter Expert

Health Policy News often features Medicaid-related policy topics; this month, we are featuring the first in a series of pieces that touch on Medicare policy—specifically, Emergency Medical Services (EMS). PCG is fortunate to have retired Las Vegas Deputy Fire Chief Ken Riddle leading our work in this area.

This month, we spent time with Ret. Deputy Chief Riddle discussing his current work for PCG, as well as how recent policy changes present EMS providers—from large-scale, city-based operations to tiny, rural providers—an opportunity to revisit the efficiency and cost-effectiveness of current service delivery models. To read more about ways states can ensure they meet EMS reporting requirements, click here.

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