On April 26, 2016 the Department of Health and Human Services (HHS) announced the finalized version of a new rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The “rule advances delivery system reform, strengthens quality and consumer protections, promotes accountability, and aligns Medicaid managed care rules with other health insurance coverage programs.”
The Centers for Medicare & Medicaid Services is testing some new reimbursement and payment models for drugs, some of which mirror models currently used in the private sector. Medicare hopes working with providers, like many private payer networks, will lead to more efficiencies in prescriptions and eventually to lower costs.
The Centers for Medicare and Medicaid Services (CMS) announced the launch of Comprehensive Primary Care Plus (CPC+), a new initiative that hopes to help transform and improve the ways primary care is delivered and paid for. CPC+ will help primary care practices move away from traditional fee-for-service models and the "one size fits all" mentality, to a more unified system of care where doctors have the freedom to provide the highest quality targeted care for their patients.
The Centers for Medicare and Medicaid Services (CMS) have announced the finalization of a new rule that will help strengthen access to mental health and substance-use services for individuals who receive Medicaid benefits though managed care organizations and those who have Children's Health Insurance Program (CHIP) coverage. According to CMS' press release, this "final rule strengthens access to mental health and substance use disorder benefits for low-income Americans." The new provisions of this rule will benefit the over "23 million people enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP."
2016 is going to be a big year for Behavioral Health, thanks to The Excellence in Mental Health Act (ExACT) passed in 2014. the ExACT is a crucial step towards taking Behavioral healthcare off the back burner and sparking an important discussions on mental health. According to the National Council for Behavioral Health the program will “increase Americans’ access to community mental health and substance use treatment services while improving Medicaid reimbursement for these services.” The program has allocated over $1 billion to help protect and enhance community based mental health programs, which is the largest federal investment in behavioral health services in a very long time. Let’s take a look at the progress the Excellence in Mental Health Act has already made and what might be in store for 2016.
Medicaid spending soared nearly 14 percent last year—its biggest annual increase in at least two decades—as a result of millions of newly eligible low-income enrollees signing up under the Affordable Care Act, according to a report released Thursday by the Kaiser Family Foundation. Total spending was highest in the 29 states that expanded Medicaid, the government insurance program for low-income and disabled people, under the health law. In those states, total Medicaid spending jumped nearly 18 percent in the fiscal year that for most states ended June 30, the Kaiser researchers found. (KHN is an editorially independent program of the foundation). In the other states that did not expand, Medicaid spending rose about 6 percent, the report found.
It might still be early in the year, but it looks like 2015 is already shaping up to be a big year for value-based purchasing initiatives. In large part thanks to the announcement by the Department of Health and Human Services last week outlining the year’s worth of expectations for hospitals and healthcare providers. HHS’ goal is that by 2016, 85% of Medicare’s payments to providers will be under the VBP model, rather than fee-for-service. The shift to VBP from fee-for-service has been ongoing, but the pressure is on for providers and healthcare systems who have been lagging behind in embracing alternative payment models.
Medicare cuts have been crying wolf for almost a decade now; each year the cuts are proposed and then postponed, with the deficits continuing to pile up, meaning the financial impact of any intended “fix” would be astronomical.
Recent reports show that 89 new Accountable Care Organizations have now joined the Medicare Shared Savings Program, so that over 400 ACOs are participating in the program. So what are the new regulations for this group of ACOs? They seem to be changing over time.