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.

Proposed ACA repeal legislation would increase persons without health coverage

On March 13, 2017, the Congressional Budget Office (CBO) released estimates on the impact of the proposed American Health Care Act (AHCA). The CBO indicates that AHCA would increase the number of persons without health coverage by 24 million persons in 2026: 52 million persons without coverage in 2026, as compared to 28 million persons ...

House passes 21st Century Cures bill

On November 30, 2016, the U.S. House of Representatives passed an amended “21st Century Cures” bill by a 392-26 vote.  The bill covers a diverse range of topics, such as: medical research, development of drugs and medical devices, interoperability of electronic health record systems, and mental health/substance use disorder (MH/SUD) programs. MH/SUD provisions in the ...

CMS finalizes rules on new Medicare payment methodologies for clinicians

On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) issued final rules to implement a new Quality Payment Program which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).  The new program is authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  That landmark ...

CMS releases report on Affordable Care Act (ACA) health insurers’ payment trends

The Centers for Medicare and Medicaid Services (CMS) released a report on August 11, 2016, entitled, “Changes in ACA Individual Market Costs from 2014 to 2015: Near-Zero Growth Suggests an Improving Risk Pool.” The report states that per member per month (PMPM) paid claims for health insurers in the individual market under the Affordable Care ...

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 ...

CMS finalizes mental health parity rules

On March 30, 2016, the Centers for Medicare and Medicaid Services (CMS) published final rules on mental health/substance use disorder parity requirements applicable to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP).   The final Medicaid/CHIP rules are based on the Mental Health Parity and Addiction ...

CMS and AHIP announce alignment in physician quality measures

On February 16, 2016, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) announced multi-payer alignment and simplification of core quality measures to be used in calculating quality-based payments for seven physicians’ services specialties.  Multi-payer alignment is expected to reduce the reporting burden for providers and to accelerate the nationwide ...