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- R. Pennypacker on Compliance Highlights of the CY 2017 Draft Call Letter
- Kathleen Chapman on Is Value-Based Insurance Design All It’s Cracked Up To Be?
- Tracy Croxon on Compliance Highlights of the CY 2017 Draft Call Letter
- Ted Rever on Final Rule: The Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017
- Mindy Walker on Sales 2017 Readiness – Are You Maximizing Your Sales Potential Today?
President Obama released the Fiscal Year 2017 budget last Tuesday, which contains many significant proposals to government healthcare programs. Although both the Senate and House’s budget committees already rejected hearings from the President’s budget chief and unsurprisingly declared the bill “dead on arrival,” the proposals do contain many bipartisan provisions with significant cost savings. One such proposal organizations should watch carefully, for example, is using competitive bidding in Medicare Advantage plans.
The new year brings a slew of issues that will define government-sponsored health programs. Here’s what we’re watching closely, not necessarily in this order. Opportunities have never been greater in Medicare, Medicaid, and ObamaCare, but execution risk is rising fast. If this was an easy business, we’d be out of business.
Last week, the Senate passed an Affordable Care Act (ACA) repeal bill, with a vote of 52-47. Although largely symbolic, this marks the first time the Senate has been able to pass such a bill.
Policy changes governing risk adjustment in plans for Medicare-Medicaid dual eligibles may soon be coming.
The National Quality Forum (NQF) is a non-profit organization working to evaluate and endorse standardization of healthcare performance measures. Recently, NQF submitted a series of reports to the U.S. Department of Health and Human Services (HHS) outlining recommendations on new measures aimed at improving Medicaid beneficiary quality of care. For the last four years, NQF started providing strategies to HHS on improving care for dual eligibles, adults, and children in the Medicaid program. These new quality measures were created to improve healthcare quality for more than 70 million adults and children. The key area of concentration was the beneficiaries’ behavioral health and how it affects diabetic and cardiovascular care delivery.
As we anticipate additional information this week on the Centers for Medicare & Medicaid Services (CMS) network adequacy (pilot) audit, we can’t help but consider how CMS’ rigorous access and availability standards hamper Medicare Advantage (MA) plans’ ability to be on the cutting edge of innovative network design. The Affordable Care Act, in comparison, has allowed for Marketplace plans to offer narrow networks as long as the networks have sufficient numbers and types of providers to deliver services without “unreasonable delay,” leaving states to define the meaning of “unreasonable.” This difference in network adequacy standards has widened the gap in plan offerings.