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Insurance Coverage: CMS
On August 9, 2019, New York announced it will submit a Section 1115 Medicaid Demonstration waiver application to CMS to provide Medicaid services to certain incarcerated individuals about to be released from county jails and New York State prisons.
Prescription Drug: Legislation
Senate Finance Committee posts description of the Chairman’s mark of its legislation addressing prescription drug pricing.
Payment Innovation: Other
Recommendations for the 2020 Medicaid and CHIP Core Set are open through August 5.
Payment Innovation: Other
On July 18, 2019, CMS updated the data within the Medicaid and CHIP Scorecard.
Prescription Drug: Pricing
The Administration has announced it is no longer pursuing its drug pricing proposal that would have required pharmacy benefit managers to pass rebates directly on to the patient.
Payment Innovation: Other
CMS released a Notice of Funding Opportunity for planning grants to address the opioid crisis.
Payment Innovation: Other
President Trump signed an executive order on June 24 containing guidance regarding price, quality and data transparency.
Insurance Coverage: Regulation
On May 8, 2019, South Carolina submitted a new 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS). The waiver includes work requirements, expands coverage for children, pregnant women and parents, and expands coverage for certain individuals with substance use disorders, who are chronically homeless or who are involved in the justice…
Payment Innovation: Other
On June 6, CMS issued an RFI on Patients over Paperwork.
Insurance Coverage: Regulation
On May 31, 2019, Utah released its 1115 waiver proposal, “Per Capita Cap.” This waiver requests authority to implement the provisions of Senate Bill 96 “Medicaid Expansion Adjustments”, which passed during the 2019 Utah legislative session. Provisions of the waiver include implementing a per capita cap, seeking enhanced Federal Medical Assistance Percentages (FMAP) for the…
Payment Innovation: Innovation Center
The Innovation Center recently posted several documents to their website.
Payment Innovation: Other
On May 17, the GAO released a report recommending an improved transparency policy for Section 1115 waivers.
Payment Innovation: Quality Payment Program
CMS is holding a webinar on May 21 on the All-Payer Combination Option.
Payment Innovation: Quality Payment Program
CMS posted the eCQM specifications for 2020 reporting.
Payment Innovation: Innovation Center
The Innovation Center released updated FAQs for the InCK Notice of Funding Opportunity.
Payment Innovation: Innovation Center
The Innovation Center will host a webinar on the InCK model on May 15.
Insurance Coverage: Legislation
Senators Jeff Merkley (D-OR), Chris Murphy (D-CT), and Dianne Feinstein (D-CA) introduced the Choose Medicare Act, which would allow for any individual who is not already enrolled in Medicare or Medicaid to enroll in Medicare as an individual. This would be known as Medicare Part E and would be offered on all state and federal…
Insurance Coverage: Legislation
Representatives Rosa DeLauro (D-CT) and Jan Schakowsky (D-IL) introduced the Medicare for America Act. The bill would expand coverage in Medicare and Medicaid to include prescription drugs, dental, vision, hearing, and long-term support services. Those who are uninsured or do not have employer-sponsored health insurance, including those in the individual marketplace, would be auto-enrolled into…
Payment Innovation
On April 24, 2019, CMS sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid.
Payment Innovation: Innovation Center
The Innovation Center is holding its second webinar on the InCK Model Notice of Funding Opportunity.
Insurance Coverage: Regulation
On June 22, 2018, Utah submitted an 1115 waiver amendment to CMS seeking to implement a partial and capped Medicaid expansion, as well as Medicaid work requirements for certain populations. Following that waiver amendment, on February 6, 2019, Utah submitted an additional 1115 waiver amendment lifting the Medicaid Institution for Mental Disease (IMD) exclusion for…
Payment Innovation: Innovation Center
The Innovation Center will hold a webinar on the MOM Model application process on April 4, 2019.
Insurance Coverage: Original Analysis
On March 15, 2019, CMS approved Ohio’s Medicaid 1115 waiver, allowing the state to implement work requirements for certain Medicaid recipients.
Payment Innovation: Other
CMS published guidance for states on 1115 waiver evaluations.
Payment Innovation: Other
CMS updated its drug spending dashboards with 2017 data.
Prescription Drug: Original Analysis
The White House FY 2020 budget proposal
Insurance Coverage: Stakeholder Engagement
An American Academy of Actuaries report out today breaks down criteria and implications for “Medicare for All” and less sweeping approaches, including Medicare and Medicaid buy-ins.
Payment Innovation: Other
Colorado has become the latest state to receive approval from CMS for negotiating drug prices for Medicaid recipients using value-based contracting arrangements.
Payment Innovation: Innovation Center
CMMI is holding a webinar on February 21 from 2:00 to 3:15 pm ET to review the Maternal Opioid Misuse (MOM) model Notice of Funding Opportunity and Grants.gov application process.
Insurance Coverage: Legislation
On February 14, 2019, Senator Brian Schatz (D-HI) introduced the State Public Option Act (S. 489) which allows states to provide a public option through Medicaid for individuals not otherwise covered under Medicaid or enrolled in other insurance.
Payment Innovation: Innovation Center
The CMS Innovation Center has announced a funding opportunity for the Integrated Care for Kids model and a webinar on Feb. 19.
Payment Innovation: Innovation Center
The CMS Innovation Center will execute up to 12 cooperative agreements with states whose Medicaid agencies will implement the Maternal Opioid Misuse model with one or more “care-delivery partners” in their communities. The Notice of Funding Opportunity is now available.
Payment Innovation: Other
HHS and OIG release proposed rule targeting pharmacy benefits managers.
Payment Innovation: Innovation Center
This handy CMMI payment model tracker will allow you to easily follow changes and help you better understand the evolution of value-based payment in the Medicare and Medicaid program.
Insurance Coverage: Legislation
On January 24, 2019, the Medicaid Extenders Act of 2019 (H.R. 259) was signed into law. This law extends the Money Follows the Person program, among other things.
Payment Innovation: Other
CMS releases various payment innovation-related announcements.
Payment Innovation: Other , Quality Payment Program
CMS announces Medicaid demonstration to expand mental health treatment services.
Payment Innovation: Other
Survey results released by the Institute for Medicaid Innovation find that around half of Medicaid managed care organizations launched population-specific value-based purchasing models last year, and around 10 percent of plans had extensive value-based purchasing arrangements in place.
Payment Innovation: Innovation Center
CMS announces the Material Opioid Misuse (MOM) model as part of the agency’s strategy for combating the opioid crisis.
Payment Innovation: Other
Health Care Payment Learning and Action Network released a new report on alternative payment model adoption.
Payment Innovation: Innovation Center
On August 23, 2018, CMS announced a new model that is intended to address the opioid crisis for children.
Insurance Coverage: Budget Information
The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19.
Payment Innovation: Innovation Center
Insurance Coverage: Litigation
Insurance Coverage: Regulation
Insurance Coverage: Stakeholder Engagement
On March 16, 2017, four Republican governors (John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada and Asa Hutchison of Arkansas) sent congressional leaders a letter criticizing the American Health Care Act and proposing an alternative framework for reforming the Medicaid program. The four governors endorse per capita caps and block grants,…
Insurance Coverage: Stakeholder Engagement
January 12, 2017 report examining how repeal legislation could affect Medicaid.
Insurance Coverage: Congress
In a letter to the Republican Governors Association dated December 13, 2016, the Senate Finance Committee announced that it will convene a Governor Roundtable in January 2017 to discuss the sustainability and future of the Medicaid program.
Insurance Coverage: Regulation
Insurance Coverage: Stakeholder Engagement
November 18, 2016 report from the Commonwealth Fund examining the President-elect Trump and some congressional leaders’ calls for absolute limits on the federal government’s spending on Medicaid. This report explores the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending, regardless of enrollment; and caps…