Category: All Posts
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 ...
Health Policy News – October 2019
Introduction This month, we are featuring a new report by the Health Policy News Team: “Innovative Approaches to Accountable Care”. This report aims to assist those states that are thinking about integrating alternative care delivery methods into their Medicaid program or commercial insurance marketplace. To accompany this report, HPN will host an overview of the ...
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 ...
HCBS Conference Recap: Topics, Trends, and Takeaways from PCG
In August, PCG attended and presented at a successful and informative National Home and Community-Based Services (HCBS) Conference in Baltimore, MD. This annual event is a unique opportunity for federal, state, and local policymakers to meet up with the people who administer, manage, and deliver HCBS programs across the country. This year, the conference hosted ...
Health Policy News – September 2019
Introduction Since publishing our summer edition, the Health Policy News team has attended various conferences. We were thrilled to see many subscribers in person at the National Conference of State Legislatures Legislative Summit, as well as the National Academy of State Health Policy annual conference. In this edition, we share our insights (and relevant fact ...
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 ...