New York’s Delivery System Reform Incentive Payment (DSRIP) program: Transitioning to payments based on performance measures

On April 14, 2014, the Centers for Medicaid and Medicare Services (CMS) approved New York state’s groundbreaking DSRIP program through their Medicaid 1115 waiver amendment, allowing the state’s Department of Health (DOH) to reinvest $8 billion of federal savings generated by Medicaid Redesign Team (MRT) reforms. NY’s DSRIP incentive payments promote community-level collaborations in the ...

Insights from the annual National Academy of State Health Policy Conference #NASHPCONF16

From October 17th to 19th, members of PCG’s Health Policy team attended the annual National Academy of State Health Policy (NASHP) Conference in Pittsburg, PA. The theme for this year’s event was “Where Ideas and Action Converge,” with particular focus on Delivery System Reform Incentive Payment (DSRIP) waivers, Medicaid expansion and payment and delivery system ...

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 ...

Health Policy News September 2016

Today’s special edition of Health Policy News focuses on the Proposed Notice of Benefit and Payment Parameters (NBPP) for 2018 issued by the Centers for Medicare & Medicaid Services (CMS) on August 29th. PCG subject matter experts are hosting a webinar about the proposed regulations tomorrow, Thursday, September 15th at 3:00pm EST. See below for information ...

Health Policy News August 2016

As states across the country prepare for another year of open enrollment for the health insurance marketplace, they must assess the past three years of operation while adjusting to the changes brought on by evolving federal regulations. This issue of Health Policy News touches upon efforts being made at both the state and federal level ...

Bridging the electronic health information highway and promoting interoperability for Medicaid providers

The Centers for Medicare and Medicaid Services (CMS) recently expanded the scope of the Health Information for Economic and Clinical Health Act (HITECH) 90/10 funding available to encourage the adoption and promote the use of electronic health record (EHR) technology and health information exchange (HIE). This new funding source provides Medicaid agencies with the ability ...

Consumer assistance for open enrollment 2017

This year, for the first time since the health insurance marketplace began, states will not have the support of consumer assistance funding from the Centers for Medicare and Medicaid Services (CMS) to educate the public about marketplace plan offerings. Without federal funding, many states are scrambling to find ways to assist consumers in the upcoming ...

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 ...

Health Policy News June 2016

The Centers for Medicare and Medicaid Services (CMS) announced a new grant opportunity for states last week.  State insurance regulators across the country are eligible to apply for funding to support planning and implementation of health insurance market reform provisions of the Affordable Care Act (ACA). The first article in this edition of Health Policy ...

Alabama’s Regional Care Organization 1115 waiver approval

In May 2013, Act-2013-261, Ala. Code §§ 22-6-150 was passed, advancing the move from a fee-for-service (FFS) system to a managed care program. According to the Alabama Medicaid Advisory Board report issued in January 2013, based on 2011 data, 22 percent of Alabama’s population was Medicaid eligible for a portion of the year.  Additionally, Alabama’s ...

Browse Categories