The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to discuss potential recommendations for countercyclical disproportionate share hospital (DSH) allotments. Medicaid disproportionate share hospital (DSH) payments offset hospital uncompensated care costs for Medicaid-enrolled and uninsured patients. During economic recessions, Medicaid enrollment and the number of people who are uninsured increase. The Commissioners previously agreed that a countercyclical… (Colocho, March 3, 2023) #Disproportionate Share Hospitals (DSH)

The Medicaid and CHIP Payment and Access Commission (MACPAC) is interested in developing recommendations for policies to help state Medicaid fee-for-service (FFS) programs better serve beneficiaries. Today, a panel shared the perspectives of three states that use alternative approaches to contracting with full-risk managed care organizations. Notably, about 90 percent of Medicaid beneficiaries are enrolled in some form of managed… (Llamas, March 2, 2023) #Delivery Reform

The Medicaid and CHIP Payment and Access Commission (MACPAC) held a presentation on the results of a focus group study on the experiences of individuals who are fully dually eligible for both Medicare and Medicaid benefits and enrolled in integrated care models. MACPAC contracted with NORC at the University of Chicago to conduct focus groups and interview enrollees. For dually… (McClurg, March 2, 2023) #Dual Eligibles

Firearm injury prevention is a strategic imperative of the National Advisory Council for Nursing Research (NACNR). The Council held a meeting focused on the role nurse scientists and nursing research can play in firearm injury prevention.  Presentations outlined the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC)’s current firearm injury prevention research initiatives including the… (Colocho, February 22, 2023) #Prevention, #Public Health

The Centers for Medicare and Medicaid Services (CMS) announced that certified independent dispute resolution (IDR) entities can resume processing payment determinations on February 27, 2023 for payment disputes involving items or services furnished before October 25, 2022 (February 24 notice).   As a result of the decision in Texas Medical Association, et al. v. United States Department of Health and… (Llamas, February 28, 2023) #Coverage Decisions, #Insurance Reform

The Centers for Medicare and Medicaid Services (CMS) opened the portal for group health plans and health insurance issuers offering group or individual health insurance coverage to submit a Gag Clause Prohibition Compliance Attestation (GCPCA). Plans and issuers are prohibited from entering into provider agreements with gag clauses that restrict a plan or issuer from sharing certain price and quality… (Llamas, February 23, 2023) #Transparency

The U.S. Preventive Services Task Force (USPSTF) released a draft research plan on interventions to prevent perinatal depression. USPSTF aims to use data on population characteristics to explore the degree to which study findings are representative of different populations of persons at risk for perinatal depression, including groups categorized by various social determinants of health, such as education, age, and… (Colocho, February 23, 2023) #Health Equity, #Pediatrics, #Prevention, #Public Health, #Social Determinants of Health, #Women’s Health

The Center for Medicare and Medicaid Innovation (CMMI) announced it is now accepting applications for Medicare providers, suppliers, and accountable care organizations (ACOs) to participate in the forthcoming two-year extension of the Bundled Payments for Care Initiative (BPCI) Advanced Model. The model extension period will allow CMMI two additional years of testing (2024 and 2025) to determine whether updates to… (LaRosa, February 21, 2023) #Accountable Care Organizations, #Bundling, #Delivery Reform, #Demonstration Programs, #Value-Based Purchasing

The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) shared two reports to congress for 2021 on HIPAA compliance and breaches of unsecured protected health information (PHI) to help regulated entities better comply with the requirements of the HIPAA notification rules. In addition, the reports also share steps taken by OCR to investigate complaints, breach reports,… (Colocho, February 17, 2023) #Health Information Technology

The Centers for Medicare & Medicaid Services (CMS) is seeking nominations for a Technical Expert Panel (TEP) to contribute direction and thoughtful input to measure development and maintenance for the exchange health plan Quality Rating System (QRS) and Quality Improvement Strategy (QIS).   Details about the TEP follow in the table below.   Title Development and Evaluation of Exchange Health… (Testa, February 17, 2023) #Health Insurance Exchanges, #Qualified Health Plans, #Quality