Tag: FFS

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. We spent time with Ret. Deputy Chief ...

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 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 ...

CMS announces CPC+ primary care model

On April 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the Comprehensive Primary Care Plus (CPC+) model.   The CPC+ model, which builds on the CPC model launched in October 2012, is designed to align Medicare, state Medicaid agencies, and commercial insurance payers to achieve comprehensive, coordinated primary care, especially for patients ...

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 ...

Behavioral Health’s Move Toward Value-Based Purchasing

“Alternative payment models are not an option for behavioral health providers,” Arizona Medicaid Director Tom Betlach said, “They are your growth strategy.” Betlach’s point was very clear and it resonated with the more than 5,500 attendees at NatCon, where Payment Reform – be it alternative payment methodologies (APMs) or value-based purchasing (VBP) models like Delivery ...