Tag: Centers for Medicare & Medicaid Services

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, ...

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 – May 2019

Introduction This month, we are launching a new series of articles about alternative approaches to healthcare delivery—with a focus in this edition on approaches targeting social determinants of health, specifically nutrition, via health coverage. Stay tuned for an upcoming white paper that will include a review of Accountable Care models in a number of states, ...

Eat Your Veggies!

How do we increase the promotion of produce prescriptions in the never-ending quest to implement and integrate social determinants of health? As of 2010, diet has surpassed smoking as the leading cause of death for Americans—which translates to hundreds of billions of dollars being spent to combat diseases stemming from poor health and diet. Data ...

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: ...

Work Requirement Waiver Approvals Vacated in Kentucky and Arkansas

On March 27, 2019,  Judge James Boasberg of the United States District Court for the District of Columbia issued rulings on back-to-back cases addressing work requirement eligibility criteria included in Section 1115 waiver applications submitted by the states of Arkansas and Kentucky. Judge Boasberg again ruled against the implementation of a Medicaid work requirement in Kentucky, while ...

Health Policy News – February 2019

Introduction While 2019 started slowly under the Federal shutdown, its pace of action has significantly quickened. We bring you a range of health policy updates in this edition of Health Policy News. With the comment period closed for the annual Exchange guidance, states await final guidance for 2020 related to the certification and oversight of ...