Tag: Medicaid

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 ...

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 ...

Legislation aimed at Health Care Costs Advances in Congress

Unlike many topics under discussion in Congress this year, the issue of health care costs is a priority across party lines. With bills pending in both the U.S. House of Representatives and U.S. Senate, and a recent executive order issued on the topic, we have broken down the details on the latest cost control developments ...

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 ...