Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

CMS

CMS Proposes 9-Month Extension of Short-Term Health Plans

February 21, 2018 - CMS is proposing that consumers should be allowed to stay on short-term health plans, including association health plans, for twelve months at a time, despite the fact that these plans are generally non-compliant with the Affordable Care Act.   The proposed rule follows guidance from President Trump’s executive order in October of 2017.  The order instructs HHS to increase...


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National Healthcare Expenditures Expected to Reach $5.5T by 2026

by Thomas Beaton

The CMS Office the Actuary forecasts that national healthcare expenditures will reach $5.5 trillion by 2026 due to a 5.5 percent yearly growth rate. CMS said that the anticipated average growth rate of healthcare spending is lower than the 2000...

NQF Aims to Improve Medicaid Use of Social Determinants Data

by Thomas Beaton

Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum (NQF)....

CMS Releases Proposed Medicare Advantage, Part D Changes

by Thomas Beaton

CMS has released the second part of its proposed Medicare Advantage (MA) and Medicare Part D changes, which include administrative upgrades to assist with combating the nation’s the opioid crisis and allowing payers to incorporate supplemental...

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

by Thomas Beaton

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers that overprescribe...

GAO: Medicaid Home, Community Care Create Financial Conflicts

by Thomas Beaton

Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local agencies,...

KY Gets Approval for 1115 Medicaid Waiver with Work Requirements

by Thomas Beaton

Kentucky is the first state to receive approval for a 1115 Medicaid waiver demonstration that adds work requirements in order for able-bodied adults to be eligible for the public health insurance program. The Kentucky Health program demonstration...

CMS to Test Medicaid Waiver “Community Engagement” Incentives

by Thomas Beaton

CMS plans to support the addition of “community engagement” incentives to state 1115 Medicaid waivers that contain work eligibility requirements for able-bodied adults, the agency announced in a press release. The new policy guidance...

MS Awarded 10-Year Extension of 1115 State Medicaid Waiver

by Thomas Beaton

Mississippi will be the first state to receive a 10-year extension of a 1115 Medicaid waiver, CMS announced.  The waiver originally implemented in 2003, expands eligibility requirements for individuals who can receive family planning benefits....

MI Requests Renewal of “Healthy Behaviors” 1115 Medicaid Waiver

by Thomas Beaton

Michigan is asking CMS for a renewal of its 1115 Medicaid waiver demonstration that increased the number of insured individuals in the state and led to a reduction in unhealthy behaviors. The demonstration, entitled the “Healthy Michigan...

Medicare Advantage Cost Benchmarks Create Plan Inefficiencies

by Thomas Beaton

New research from the Commonwealth Fund found that the Medicare Advantage (MA) benchmark bidding system, which was intended to reduce plan inefficiencies, has allowed health plans to benefit financially while remaining cost inefficient. Since...

CMS Asked to Bolster Value-Based Payment Models for Providers

by Thomas Beaton

The American Academy of Physicians, Aledade, the Texas Medical Association, Iora Health, and the Medical Group Management Association (MGMA) are among provider advocates urging CMS to create more opportunities for providers interested in value-based...

State Medicaid 1115 Waivers Expand Eligibility, Stabilize Premiums

by Thomas Beaton

A number of state governments have submitted Medicaid 1115 waivers to CMS in order to expand Medicaid eligibility requirements, stabilize their in-state premium rates, manage public health issues, and improve behavioral health access. Currently,...

2016 Healthcare Spending Growth Slowed, Totaled $3.3 Trillion

by Thomas Beaton

US healthcare spending totaled $3.3 trillion in 2016, representing a 4.3 increase in the spending growth rate since 2015. While spending continued to rise, the rate of increase was actually slower than the 5.8 percent growth rate between...

HHS Pilot Encourages Streamlined Health Plan HIPAA Compliance

by Thomas Beaton

HHS is launching a pilot program that streamlines reviews of health plan HIPAA compliance, the organization announced in an email to the CMS listserv. The HHS HIPAA Administrative Simplification Optimization Project pilot is an effort to achieve...

CMS Updates Payer Guidelines for 2019 Qualified Health Plans

by Thomas Beaton

CMS has issued a draft letter that outlines guidelines, dates, reporting, and regulatory requirements for payers that want to sell qualified health plans (QHPs) in 2019. The Annual Letter to Insurers includes new information, and updates from...

Medicare Advantage Value-Based Insurance Design Updates for 2019

by Thomas Beaton

The Medicare Advantage (MA) Value-Based Insurance Design Model (VBID) for 2019 will extend into fifteen new states, allow Chronic Condition Special Needs plans to participate in the model, and allow all participating plans to specialize benefits,...

Medicare Advantage, Part D Updates to Shift Control to Health Plans

by Thomas Beaton

CMS is proposing regulatory changes that would offer health plans additional flexibility to design and implement Medicare Advantage (MA) and Part D Medicare benefits.   The rule would reduce administrative burdens by allowing plans to communicate...

Medicare Advantage Consumers Seek New Plans as Risk Scores Rise

by Thomas Beaton

Medicare Advantage (MA) consumers who switch to new health plans may have higher risk scores than beneficiaries who are content with their current options, indicates a Congressional Budget Office (CBO) report.   Payers who are actively recruiting...

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

by Thomas Beaton

AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group believes...

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