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 ...

Health Policy News March 2016

March was another big month in Federal health policy - with the Centers for Medicare and Medicaid Services (CMS) issuing final guidance on the 2017 certification standards for Qualified Health Plans (QHPs) on February 29, 2016 and a major Supreme Court case decided on March 1, 2016.  As such, in the March issue of Health ...

Behavioral Health’s Move Toward Value-Based Purchasing

“Alternative payment models are not an option for behavioral health providers,” Arizona Medicaid Director Tom Betlach said, “They are your growth strategy.” Betlach’s point was very clear and it resonated with the more than 5,500 attendees at NatCon, where Payment Reform – be it alternative payment methodologies (APMs) or value-based purchasing (VBP) models like Delivery ...

CCBHC Is The Start of Something Good!

CCBHCs! That’s Certified Community Behavioral Health Centers, for those not familiar with the billion dollar investment that the Substance Abuse and Mental Health Services Administration (SAMHSA) will soon make to state behavioral health systems. In 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental ...

The Science of Addiction

Research presented by Dr. Nora Volkow, Director of the National Institute on Drug Abuse, at NatCon used brain imaging to dramatically illustrate how addiction changes brain function.  Dr. Volkow’s research demonstrates, for example, that the frontal cortex – or reward center – of the brain weakens as a result of alcohol and illicit drug use. ...

Supreme Court issues decision on major health care case

Members of PCG Health’s Health Innovation Policy Information Technology (HIPIT) center of excellence have been keeping an eye on Gobeille vs Liberty Mutual Insurance Company given its direct impact on All-Payer Claims Databases (APCD), which many PCG state clients rely on to gather data necessary to analyze data on health care services and impact rising ...

Health Policy News February 2016

Quality has been top of focus across the health care world.  Whether it be related to coverage, care or other consumer services, there has been ongoing movement to advance quality. Broadly, the definition of "quality" includes buzzwords we are all familiar with: access, cost effectiveness, cost transparency, value and high level of care. This edition ...

Current state of CMS quality rating programs

For Marketplace plans, quality is coming to the forefront as Quality Rating System (QRS) and Quality Improvement Strategy (QIS) requirements are rolled out for Qualified Health Plans (QHPs) starting in 2017. In short, pending the approval of proposed regulations,the following changes are coming for 2017: CMS will be publicly displaying QHP quality rating information on ...

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 ...

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