Category: All Posts

Bridging the electronic health information highway and promoting interoperability for Medicaid providers

The Centers for Medicare and Medicaid Services (CMS) recently expanded the scope of the Health Information for Economic and Clinical Health Act (HITECH) 90/10 funding available to encourage the adoption and promote the use of electronic health record (EHR) technology and health information exchange (HIE). This new funding source provides Medicaid agencies with the ability ...

Consumer assistance for open enrollment 2017

This year, for the first time since the health insurance marketplace began, states will not have the support of consumer assistance funding from the Centers for Medicare and Medicaid Services (CMS) to educate the public about marketplace plan offerings. Without federal funding, many states are scrambling to find ways to assist consumers in the upcoming ...

CMS releases report on Affordable Care Act (ACA) health insurers’ payment trends

The Centers for Medicare and Medicaid Services (CMS) released a report on August 11, 2016, entitled, “Changes in ACA Individual Market Costs from 2014 to 2015: Near-Zero Growth Suggests an Improving Risk Pool.” The report states that per member per month (PMPM) paid claims for health insurers in the individual market under the Affordable Care ...

Health Policy News June 2016

The Centers for Medicare and Medicaid Services (CMS) announced a new grant opportunity for states last week.  State insurance regulators across the country are eligible to apply for funding to support planning and implementation of health insurance market reform provisions of the Affordable Care Act (ACA). The first article in this edition of Health Policy ...

Alabama’s Regional Care Organization 1115 waiver approval

In May 2013, Act-2013-261, Ala. Code §§ 22-6-150 was passed, advancing the move from a fee-for-service (FFS) system to a managed care program. According to the Alabama Medicaid Advisory Board report issued in January 2013, based on 2011 data, 22 percent of Alabama’s population was Medicaid eligible for a portion of the year.  Additionally, Alabama’s ...

Innovative approaches to Medicaid expansion within the Medicaid managed care delivery system

Much attention has been paid to innovative approaches to coverage of the Medicaid expansion population that leverage the private commercial insurance market for coverage through “premium assistance” programs.  However, other states have turned to the Medicaid managed care delivery system as the vehicle for implementing innovative coverage designs for the newly eligible population.  As outlined ...

CMS announces the release of $22 Million in Health Insurance Enforcement and Consumer Protections grant funding

On June 15, 2016, the Centers for Medicare and Medicaid (CMS) announced the release of $22 million in grant funding for State planning and implementing of the health insurance market reform provisions of the Affordable Care Act (ACA). The grants are aimed at helping States ensure their laws, regulations and procedures are in line with ...

Health Policy News April 2016

Last summer, the Centers for Medicare and Medicaid Services (CMS) proposed a comprehensive overhaul of the regulations governing Medicaid and Children’s Health Insurance Program (CHIP) Managed Care. With the final version released earlier this week, the next two issues of Health Policy News will focus on Medicaid Managed Care. This month, we recap the proposed ...

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 ...

Supreme Court issues decision on major health care case

Members of PCG Health’s Health Innovation Policy Information Technology (HIPIT) center of excellence have been keeping an eye on Gobeille vs Liberty Mutual Insurance Company given its direct impact on All-Payer Claims Databases (APCD), which many PCG state clients rely on to gather data necessary to analyze data on health care services and impact rising ...