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Implementing Health Reform: IRS Proposes Modification To Minimum Value Rule
Premium tax credits to assist with purchasing qualified health plans through the marketplaces are available to individuals with modified adjusted gross household incomes between 100 and 400 percent of...
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Implementing Health Reform: Federal Court Rules On March for Life v. Burwell...
September 2 update: On September 2, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that it has awarded $67 million in 2015-2016 grants to 100 navigator organizations in 34 states...
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CMS’ Proposed Changes To The Two-Midnight Rule: Partial Restoration Of...
On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes to the controversial Two-Midnight Rule. This payment rule clarifies the circumstances under which...
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Community Health Center Strategies For Pursuing Accountable Care
Accountable care strategies are spreading from Medicare and commercial insurance arenas to Medicaid programs, thus extending the benefits of payment and delivery reform to the safety net. Medicaid...
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Creating The Next Generation: The Payment Model We Need From Medicare
Four years of nation-wide testing by The Centers for Medicare and Medicaid Services (CMS) has now proven that the current shared savings payment models do not work effectively for low-cost Accountable...
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Maryland’s Progress On The Path To The Triple Aim
Nearly 18 months ago, in January 2014, I wrote in this publication about a historic agreement between the State of Maryland and the Centers for Medicare and Medicaid Services (CMS) that, for the first...
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CMS Initiative For Hip And Knee Replacements Supports Quality And Care...
The Centers for Medicare & Medicaid Services (CMS) recently published the final rule for the Comprehensive Care for Joint Replacement (CJR) model, a mandatory bundled payment model for lower...
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Risk Corridor Payments, UnitedHealth, Cooperatives, And The Marketplaces
Implementing Health Reform. On November 19, 2015, the Centers for Medicare and Medicaid Services (CMS) released national and insurer level data on the results of the 2014 medical loss ratio program and...
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National Health Spending 1960-2013
The last two years have seen two notable events for the U.S. health care industry. In 2014, the implementation of the Affordable Care Act (ACA) led to the largest expansion of health insurance coverage...
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Health Policy Brief: Bundled Payments For Care Improvement Initiative
A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) describes the Bundled Payment for Care Improvement (BPCI) initiative, four new payment models being tested by the...
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2014 National Health Spending: The Great Moderation Likely Is Not Over
Two weeks ago, the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) released their 2014 US health spending estimate showing the highest national health spending growth rate...
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Hospice Payment Reforms Are A Modest Step Forward, But More Changes Are Needed
On August 6, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare hospice payment rates and wage index. This change was made in response to Section...
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CMS’ Standardized Plan Option Could Reduce Discrimination
In their recently proposed rule, the Centers for Medicare and Medicaid Services (CMS) created a “standardized option” for plans at the bronze, silver, and gold metal levels. Insurers could elect—but...
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It’s Time To Fix Meaningful Use
With the release of the final rule for Stage 3 of Meaningful Use (MU) of health information technology (IT), and modifications to Stage 2 of MU for 2015 – 2017, the Centers for Medicare and Medicaid...
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Supplemental Benefits Under Medicare Advantage
Medicare Advantage has grown rapidly since the 2003 Medicare Modernization Act, and now covers 17 million or 33 percent of the 54 million Medicare beneficiaries — up from 13 percent a decade ago. This...
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CBO Lowers Marketplace Enrollment Projections, Increases Medicaid Growth...
Implementing Health Reform (January 28 update). On January 15, 2016, the Marketplace made available a new tool on HealthCare.gov to help taxpayers with completing form 8962 to reconcile their advance...
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Put The ‘Network’ In Measures Of Network Adequacy
According to the Urban Institute more than 11 million people were enrolled in Affordable Care Act (ACA) marketplace health plans in 2015. While enrollment numbers tell us how many people are covered,...
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New CMS Guidance Regarding CO-OPs And CLAS Data And Additional Enrollment...
Implementing Health Reform. On January 27, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a couple of guidances affecting insurers issuing coverage under the Affordable Care Act...
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The 2016 Open Enrollment Tally: 12.7 Million Selected Plans, 1 Million More...
On February 4, 2016, the Centers for Medicare and Medicaid Services released its final enrollment snapshot for the 2016 open enrollment period which ended on January 31, 2016. Overall, 12.7 million...
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First Medical Loss Ratio Audits Suggest Need For Clearer Standards (Update)
Implementing Health Reform (March 31 update). The Implementing Health Reform series has closely followed litigation involving the Affordable Care Act (ACA), but has focused primarily on litigation...
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