Policy Updates

PA Delays New Long-Term Care Program

The Pennsylvania Department of Human Services will delay for six months the introduction of its Community HealthChoices program in southeastern Pennsylvania. The program’s implementation in the five-county Philadelphia area, scheduled to begin on July 1, 2018, has been pushed back to January 1, 2019. Preparations are currently under way to launch Community HealthChoices in 14 southwestern Pennsylvania counties on January 1, 2018. Community HealthChoices is a new state program of managed long-term services and supports for Pennsylvanians over the age of 55 who are eligible for both Medicare and Medicaid. Learn more about the program’s delay in southeastern Pennsylvania in [...]

iqtsupport2017-11-09T06:00:33-05:00November 9, 2017|Pennsylvania Medicaid|

CMS Shares Vision for Medicaid

Medicaid is about to undergo major changes, CMS administrator Seema Verma outlined in a news release yesterday and in a speech to state Medicaid directors. According to the news release, those changes include: re-establishing a state-federal partnership that Verma believes has become too much federal and not enough state giving states greater freedom to innovate offering new guidelines for how states can align their individual programs with federal Medicaid objectives new guidance on section 1115 waivers longer section 1115 waivers with simpler review processes CMS willingness to consider proposals to impose work requirements on Medicaid beneficiaries Medicaid and CHIP “scorecards” [...]

iqtsupport2017-11-08T13:00:50-05:00November 8, 2017|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

CMS Offers States New Medicaid Path for Opioid Treatment

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance to states advising them on how they can use section 1115 Medicaid waivers to improve access to treatment for Medicaid recipients struggling with opioid abuse problems. According to the 14-page guidance letter from CMS to state Medicaid directors, CMS is now offering a more flexible, streamlined approach to accelerate states’ ability to respond to the national opioid crisis while enhancing states’ monitoring and reporting of the impact of any changes imsplemented through these demonstrations. As the opioid crisis continues to raise alarm and highlight the need for better [...]

iqtsupport2017-11-08T06:00:52-05:00November 8, 2017|Centers for Medicare & Medicaid Services, Medicaid|

MedPAC Meets

The agency that advises Congress on Medicare payment issues met in Washington, D.C. last week. At that meeting, members of the Medicare Payment Advisory Commission discussed a number of Medicare payment issues, including: refining an alternative to the merit-based incentive payment system (MIPS) improving incentives in the emergency debarment payment system rebalancing the physician fee schedule towards primary care increasing the equity of payments within each post-acute-care setting principles for evaluating the expansion of Medicare’s coverage of telehealth services Find the issue briefs and presentations used during the meeting to guide these discussions here, on MedPAC’s web site.

iqtsupport2017-11-07T06:00:47-05:00November 7, 2017|MedPAC|

Alternative Payment Model Spending Grows

In 2016, 29 percent of all health care payments were made through alternative payment models, continuing the movement toward paying for value rather than for volume. That 29 percent in 2016 was up from 23 percent in 2015. APMs include shared savings and shared risk programs, bundled payments, and population-based payments. Fee-for-service and other “legacy” payments accounted for 43 percent of health care payments in 2016 and pay for performance or care coordination fees accounted for another 28 percent of payments. These numbers come from a report from the Health Care Payment Learning and Action Network. Learn more about the [...]

iqtsupport2017-11-03T06:00:35-04:00November 3, 2017|Uncategorized|

CMS Announces Drive to Reduce Paperwork

The Centers for Medicare & Medicaid Services is launching a new “Meaningful Measures” initiative that will seek to reduce the regulatory burden on health care providers. According to a CMS news release, Meaningful Measures …will involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes. The agency aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes.. In a speech at the Health Care Payment Learning and Action Network, CMS administrator Seema Verma explained that this project will include moving the Center for Medicare and Medicaid Innovation [...]

iqtsupport2017-11-02T06:00:16-04:00November 2, 2017|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services|

CMS Nursing Home Program Cuts Hospital Admissions

An experimental Medicare program has helped nursing homes reduce the frequency with which their residents are admitted to hospitals. The Centers for Medicare & Medicaid Services’ Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents has reduced avoidable hospitalizations among nursing facility residents 17 percent in the program’s three years. 143 nursing homes in seven states participated in the program, which employed third-party vendors, known as enhanced care and coordination providers, to provide education to nursing facility staff. Hospitals, too, can benefit from the program because it may help reduce avoidable hospital readmissions for which they are penalized financially by [...]

iqtsupport2017-11-01T06:00:28-04:00November 1, 2017|Centers for Medicare & Medicaid Services, Medicare post-acute care|

New Rules Facilitate Integration of Physical, Behavioral Care

New federal regulations are facilitating better integration of physical and behavioral health services for the Medicaid population. Two developments, in particular, are advancing this integration: the 2016 Medicare managed care rule and a 2016 rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Together, these rules encourage providers to perform comprehensive assessments of their patients, increase flexibility for providers in how they use Medicaid payments, and pave the way for improvements in the use of information technology that foster better integration of physical and behavioral medical care. A new issue brief from the Commonwealth Fund presents in [...]

iqtsupport2017-10-31T06:00:27-04:00October 31, 2017|Medicaid managed care, Medicaid regulations|

AMA: Health Insurance Concentration in Urban Areas Threatens Competition

Too much market share by insurers in urban areas can inhibit competition, and according to the American Medical Association, there is too little competition among insurers in too many urban markets today. According to a new AMA study, 69 percent of 389 metropolitan statistical area-level markets are “highly concentrated” in 89 percent of MSAs, at least one insurer issues at least 30 percent of commercial health insurance policies in 43 percent of urban MSAs, a single insurer owns at least 50 percent of the market In a statement accompanying release of the report, an AMA spokesperson explained that After years [...]

iqtsupport2017-10-30T06:00:28-04:00October 30, 2017|Uncategorized|

Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey. The survey also found that: More than half of the uninsured are insured through their employer. Nearly one in four insured through their employer are underinsured. More than one in four Medicaid recipients were underinsured. Half of the underinsured report problems paying their medical bills. Individuals with higher deductibles are more likely to report problems paying their medical bills. More than 45 percent of the underinsured report skipping care they need because of cost. Low-income people and those with chronic [...]

iqtsupport2017-10-27T10:56:29-04:00October 27, 2017|Uncategorized|