Tagged with Healthcare Reform

NJ – State Seeks Input on Reorganization Plan for Mental Health, Addiction Services

New Jersey has launched a six-week outreach effort aimed at aiding staff, providers, and consumers understand the potential benefits and timeline of the state’s Reorganization Plan 001-2017 which would transfer mental health and addiction functions from the Department of Human Services (DHS) to the Department of Health (DOH).

TX – Medicaid Proposes Reimbursement Cuts of at least 10% for Several Specialties

Texas Medicaid has proposed to reduce reimbursement rates by at least 10% for several specialties and services. The newly proposed reimbursement rates would take effect on October 1, impacting such specialties as Ears, Nose, and Throat, Radiation Oncology, Nuclear Medicine, Physician Administered Drugs, Substance Use Disorder Services, Hospital Outpatient Imaging, and Rural Hospital Outpatient Imaging.

Uninsured Rate Swells to 11.3% in Q1

Gallup-Healthways Well-Being Index poll shows uninsured rate increased to 11.3% in the first quarter of 2017 from a record low of 10.9% in the last half of 2016.

CMS 2018 MA, Part D Final Payment Rates Announced with 0.45% Increase

CMS has released 2018 Medicare Advantage and Part D payment rates, announcing a 0.45% average rate increase. According to CMS, the changes made aim at providing benefit flexibility and efficiency which will allow Medicare enrollees to choose the care that best fits their health needs.

PA – Report Links over 850 Medication Errors to Health Information Technology

The Pennsylvania Patient Safety Authority released an in-depth analysis of health information technology (HIT) related medication errors. The report indicates that 889 medication-error events were reported by health care facilities between January 1 and June 30, 2016, all of which indicated health information technology as a contributing factor.

New Final Rule Targets Pass-Through Payments

CMS’ newest Medicaid managed care final rule will prevent increases in pass-through payments as well as the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established.

PA – New Global Capitation Model for Rural Hospitals

CMS has announced a new global capitation model for rural hospitals in Pennsylvania. Under the new model participating critical access hospitals and acute care hospitals will receive all-payer global budgets for a fixed amount of money that is set in advance and funded by all participating insurers, to cover inpatient and outpatient services.

UnitedHealth Group to Buy Outpatient Surgery Chain for $2.3 Billion

UnitedHealth Group has announced plans for its health services unit, Optum, to acquire Surgical Care Affiliates (SCA). Under the acquisition, Optum would add to its footprint SCA 205 surgical facilities, which SCA operates in partnership with thousands of surgeons in 33 states.

Study Finds New Payment Models May Potentially Reduce Health Care Disparities

A new study from Harvard Medical School claiming to have found “meaningful” improvements in quality, outcomes, and spending for all patients in the Alternative Quality Contract (AQC) between suggests binding insurers’ physician payments to quality metrics can narrow disparities between low- and higher-income patients.

CMS Releases Third Innovation Center Report to Congress

As mandated by section 1115A(g) of the Social Security Act, the CMS Innovation Center recently released its third Report to Congress. The report highlights activities between October 1, 2014 and September 30, 2016, but also highlights a number of important activities started during that time period that were announced between September 30, 2016 and December 31, 2016.

ACA Repeal Efforts Begin, while Sign-Ups Continue to Rise

As senate and legislative efforts to repeal the Affordable Care Act (ACA) pick-up, the American Medical Association sent a letter to congressional leaders called on lawmakers to outline plans to replace the ACA before they repeal the law. Despite these efforts, it was recently announced that 8.8 million U.S. residents have signed up for health plans through the federal exchange.

NJ – OIG Report Reveals Improper Medicaid Payments

A report released by the HHS Office of Inspector General (OIG) states, over a four-year span, New Jersey has received an estimated $95 million in improper Medicaid payments. According to the report, “The deficiencies occurred because the state … did not adequately monitor [its] partial care services program to ensure that providers complied with [the program’s] requirements.”

NY – New Law Grants Clinicians Access to Patient Data for Minors

New York based clinicians participating in the regional health information organization serving the western part of the state, HEALTHeLINK, are now able to access health data for patients who are between 10 and 17 years old with parents or legal guardians signed consent.