All posts by Thomas Entrikin

Mr. Entrikin has 45 years of experience with the Medicaid and Medicare programs. From 1981 to 1992, he was a Medicaid policy specialist with the US Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS), providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; health standards and certification requirements; and Medicaid waiver programs. Since coming to PCG in 1992, Mr. Entrikin has assisted in the design, development and implementation of revenue projects for school-based health services; hospital-based and municipal projects for pregnant women, infants, and children; state services offered through youth services, child welfare, mental health, substance abuse, developmental disabilities, and public health agencies; and reimbursement systems for hospitals, long term care facilities, and home and community-based services waiver programs. He has made presentations on home and community-based services waiver programs at national conferences sponsored by the Robert Wood Johnson Foundation as well as presentations on Medicare/Medicaid claiming and waiver options at the National Association of Reimbursement Officers and the National Association of State Human Services Finance Officers.

CDC issues new report on the growing opioid crisis

On March 6, 2018, the Centers for Disease Control and Prevention (CDC) released a report which shows that from July 2016 – September 2017, hospital emergency department visits for opioid overdoses rose about 30 percent in 52 reporting jurisdictions in 45 states. They rose 54 percent in large cities, and 70 percent in mid-western states. ...

President Signs Bipartisan Budget Act

On February 9, 2018, President Trump signed H.R. 1892, the Bipartisan Budget Act of 2018.  The new law reauthorizes federal funding for many health programs, modifies scheduled reductions in Medicaid disproportionate share hospital (DSH) allotments to states, tightens third party liability (TPL) billing requirements, and updates requirements affecting Medicare Advantage plans, accountable care organizations (ACOs), ...

Congress reauthorizes the Children’s Health Insurance Program

On January 22, 2018, Congress reauthorized funding for the Children’s Health Insurance Program (CHIP) through Federal fiscal year (FFY) 2023. The CHIP provisions are included as the Healthy Kids Act under H.R. 195, Division C.  Division B extends a short-term continuing resolution (CR), which was necessary to reverse a three-day federal government shut-down. Division D ...

CMS finalizes rules on episode payment models

On January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published final rules on new Medicare episode payment models (EPMs) to be implemented on July 1, 2017. The EPMs are designed to encourage participating hospitals to devise strategies to improve discharge planning, adherence to treatment and medication regimens, and coordination among all providers ...

CHIP funding crisis remains unresolved

Congressional authorization of Federal funds for CHIP expired on September 30, 2017.  Nine million children depend on this program.  States are now operating CHIP on carryover and redistribution payments from prior years.  CMS estimates that at least one state will exhaust such funding in this month.  Most states could exhaust such funding by March 2018. ...

White House releases report on opioid crisis

On November 1, 2017, the White House released a report drafted by the President’s Commission on Combatting Drug Addiction and the Opioid Crisis.  The report offers 56 recommendations for action by Congress, federal agencies, state governments, health care provider organizations, and health care payers. Those include: New training programs on screening patients for substance use ...

Senators introduce ACA repeal legislation

On September 13, 2017, U.S. Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson introduced legislation to scrap many provisions of the Affordable Care Act (ACA) while imposing funding caps on the traditional Medicaid program. The bill could become law under budget reconciliation rules that block a Senate filibuster. The bill could pass the ...

White House issues report on the opioid epidemic

On July 31, 2017, the White House posted the initial findings and recommendations of its Commission on Combatting Drug Abuse and the Opioid Crisis. The Commission cites evidence that: 142 Americans die from drug overdoses per day. Only 10 percent of the 21 million persons with a substance use disorder (SUD) are receiving appropriate treatment ...

National Academy of Medicine outlines strategies for high-need patients

On July 6, 2017, the National Academy of Medicine released a valuable report entitled, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health.”  The report describes key characteristics of high-need patient populations, tools that can be adopted to identify evidence-based models of care for them, and strategies to promote successful implementation of ...

CBO estimates that AHCA would severely increase the number of uninsured persons

On May 24, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released estimates on the impact of the proposed H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives on May 4, 2017.  AHCA would partly repeal the Affordable Care Act (ACA). ...