Category: CMS Guidance

Health Policy News – November 2019

Introduction We hope many of you were able to join us for our second annual Fall Health Policy Webinar, which focused on innovative approaches to state Accountable Care Organization (ACO) Programs. If you were unable to attend (or would simply like to review Health Policy News’ report, tracking tool, and presentation materials), we have provided ...

Verma Announces Proposed Medicaid Fiscal Accountability Rule at National Association of Medicaid Directors (NAMD) Conference

On November 12th, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma kicked off the NAMD conference by announcing the CMS issuance of the proposed Medicaid Fiscal Accountability Rule (CMS-2392-P). In her opening remarks, Administrator Verma indicated that this proposed rule seeks to strengthen the Medicaid program through program integrity measures and equitable funding ...

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 ...

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 ...

Health Policy News – April 2019

Introduction In this month’s edition of Health Policy News, we delve into two of last month’s breaking Federal litigation updates: the decisions issued in cases regarding the Association Health Plan Final Rule and the use and operationalization of Medicaid work requirements. As both decisions reverse course on recent health policy developments, we analyze their likely ...

CMS Releases the Final 2020 Exchange Guidance

The Centers for Medicare & Medicaid Services (CMS) released final annual Exchange guidance for 2020 on April 18, 2019, via the Final Notice of Benefit and Payment Parameters for 2020 (NBPP) and the 2020 Letter to Issuers in the Federally-facilitated Exchanges (Letter) as well as ancillary guidance. CMS’s stated goals for this year’s guidance are: ...

Health Policy News – January 2019

 Introduction As readers are likely aware, the Centers for Medicare and Medicaid Services’ (CMS) long-awaited annual Exchange guidance was released on January 17, 2019, and, as in past years, PCG subject matter experts have prepared a summary of notable changes to assist states in parsing through this voluminous guidance. In addition to the summary, PCG ...

CMS Releases Its Long-Awaited Exchange Guidance for 2020

The Centers for Medicare & Medicaid Services (CMS) released first drafts of its long-awaited annual Exchange guidance on January 17, 2019 – the Proposed Notice of Benefit and Payment Parameters for 2020 (NBPP) and the 2020 Draft Letter to Issuers in the Federally-facilitated Exchanges (Letter) as well as ancillary guidance (the draft Actuarial Calculator and ...

CMS Proposes Changes to the Regulations Governing Medicaid and CHIP Managed Care

On November 14, 2018, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule making changes to the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care regulations. CMS had notified states in March 2017 that it was doing a thorough review of Medicaid and CHIP Managed Care regulations, which were last overhauled ...

Health Policy News November Edition

This month’s edition of Health Policy News highlights recent developments related to the Medicaid program. At the Federal level, we provide a summary of the recently published Proposed Rule on Medicaid and CHIP Managed Care, as well as an overview of a recent State Medicaid Director Letter regarding opportunities to increase access to behavioral health ...