On May 26, the New York State Department of Health (“DOH”) published the 2022 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual, available on the DOH website. Value Based Payment (VBP) refers to...more
While the fight in Washington has been focused on the future of Obamacare, here in New York a healthcare revolution is well underway. Over the past several years, major changes in New York healthcare laws and regulations have...more
Earlier this month the New York State Department of Health released the first results of its recently adopted Medicaid redesign efforts, the Delivery System Reform Incentive Payment (“DSRIP”), in four core areas: (1) metric...more
CMS has recently approved five-year extensions for Medicaid Demonstration Waivers under Section 1115 of the Social Security Act in New York and Arkansas. Both extensions allow each state to continue innovative pilot...more
Oregon’s hospitals see improved financial performance following the ACA; CMS denies Indiana’s request for an additional lockout period in the Medicaid expansion program; and a new Manatt Health report details Medicaid funding...more
CMS targets short-term insurance plans in efforts to stabilize the individual market risk pool; Illinois mandates Medicaid coverage for opioid addiction treatment; and Michigan seeks to restructure State Medicaid financing....more
Editor's note: Medicaid is the largest healthcare payer in virtually every state. States are increasingly leveraging that position to drive payment and delivery system reform efforts. One powerful tool to enable...more
Medicaid Accountable Care Organizations - On April 14, 2016, the Massachusetts Executive Office of Health and Human Services released new details on a proposed restructuring of the MassHealth (Massachusetts Medicaid)...more
CMS's sweeping final rule aligns Medicaid and CHIP managed care with QHP and Medicare Advantage regulations; New York's DSRIP is enabling change in the State's Medicaid delivery system; and Medicaid expansion reduces...more
On January 5, 2016, New Hampshire secured a five-year, $150 million Medicaid 1115 waiver to transform the state's delivery system for Medicaid beneficiaries with mental health and substance use disorders. Known as the...more
The IRS releases guidance on resolving Form 1095 conflicts; New Hampshire's Medicaid expansion renewal clears a hurdle in the State; and New York providers get $1.5 billion in long-awaited DSRIP capital and infrastructure...more
On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved California's request to renew its waiver under Section 1115 of the Social Security Act. A significant component of the waiver is the Delivery...more
The Centers for Medicare and Medicaid Services (CMS) has approved a new section 1115 Medicaid demonstration for the state of California. Under the demonstration, the California Department of Health Care Services (DHCS) will...more
Arizona seeks Medicaid Waiver to implement new coverage restrictions for Medicaid expansion enrollees and delivery system reform; Tennessee’s uninsured rate continues to drop; and Louisiana gubernatorial candidates line up...more
Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more
CMS offers a special enrollment period for HealthCare.gov enrollees whose incomes were miscalculated due to system error; California Marketplace announces two new insurers; and Connecticut’s budget reduces eligibility levels...more
In the wake of the implementation of the Affordable Care Act, the recent Medicare Managed Care Proposed Rule (the Proposed Rule) exemplifies the accelerated push by the Department of Health and Human Services and Centers for...more
Lessons From the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace - Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are...more
Introduced originally in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York, Delivery System Reform Incentive Payment or DSRIP programs are a key feature of the dynamic and evolving Medicaid...more
In an April 22, 2015 letter to the New York State Department of Health (DOH), the Federal Trade Commission (FTC) cautioned that part of the State’s Medicaid reform program may sanction anticompetitive behavior. The FTC’s...more
This week, Medicaid expansion gains traction in Montana, California submits its waiver application to renew DSRIP and to propose several new delivery system transformation and alignment initiatives, and the Supreme Court...more
In the waning days of 2014 and the first weeks of 2015, key developments have continued to unfold for Performing Provider Systems and participating providers in the Delivery System Reform Incentive Payment Program (DSRIP)....more
Designed by New York State to seek a federal waiver for the expenditure of Medicaid funds, the Delivery System Reform Incentive Program (DSRIP) will allocate 6.42 billion dollars to health care providers in New York State to...more
Social and economic factors such as income, educational attainment, access to food and housing, and employment status have a profound impact on health. In fact, these nonmedical factors account for as much as 40 percent of...more