The Government Accountability Office issues recommendations on fraud prevention

On December 5, 2017, the Government Accountability Office (GAO) issued a a report on Centers for Medicare and Medicaid Services (CMS) fraud prevention efforts, recommending that CMS more closely align its approach with the Fraud Risk Framework put forth by the GAO in 2015. Medicaid and Medicare fraud and abuse prevention has been increasingly in the ...

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), ...

Federal departments put out proposed rule to expand access to short-term health plans that are not ACA-compliant

On February 20, 2018, the Department of the Treasury (Treasury), the Department of Labor (DOL), and the Department of Health and Human Services (HHS) jointly promulgated a proposed rule on Short-Term, Limited-Duration Insurance (STLDI) plans. The proposed regulatory changes seek to carry out the directions given in Executive Order 13813, “Promoting Healthcare Choice and Competition ...

Health Policy News January 2018

As we enter this new year, and our third year publishing and distributing Health Policy News, we want to thank you all for continuing to support Health Policy News as a source for in-depth policy and regulatory analysis. The first few weeks of 2018 have been busy -- with federal guidance released on association health plans as well as ...

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 issues guidelines on mandating work and community engagement under Medicaid and approves the first work requirement waiver

On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) distributed a State Medicaid Director letter outlining new guidelines for states about mandating work and other community engagement activities for adult Medicaid beneficiaries who are not aged, disabled, or pregnant. CMS defines community engagement broadly, as encompassing activities such as job search, education, skills training, ...

Administration releases the proposed rule on association health plans

On January 4, the administration released the anticipated proposed rule broadening the ERISA definition of “employer” and expanding the options for small employers seeking insurance coverage, as foreshadowed in the President’s executive order on October 12, 2017. PCG subject matter experts reported on the potential impact of the President’s executive order back in October, and that article ...

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 ...

Health Policy News December 2017

As 2017 comes to a close, we take a look back at health policy developments from the last 12 months in this edition of Health Policy News, beginning with a close-up on health care provisions in the tax bill being negotiated in Congress as of publication. The remainder of this edition will reflect upon major ...

Health Policy News November 2017

Along with the changing weather, this time of year brings some typical health policy events, which are the focus of this month's edition of Health Policy News. We start with our in-depth analysis of the Proposed Notice of Benefit and Payment Parameters (NBPP) for 2019, which the Centers for Medicare & Medicaid Services (CMS) released ...

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