Gorman Health Group | Policy
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Stay connected to industry news and gain perspective on how to navigate the latest regulatory issues with Gorman Health Group’s Policy team consisting of our subject-matter experts, former health plan executives and seasoned healthcare regulators.

CMS Announced Two New Advanced APM Options for 2018

This week, CMS announced several new opportunities for clinicians to join an Advanced Alternative Payment Model (APM) and take advantage of the incentives.

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Special Enrollment Period Pilot

On Tuesday, CMS announced it is developing a pilot to evaluate a pre-enrollment verification process. CMS is still working on the scope but seeks to evaluate the impact of pre-enrollment verification of SEP eligibility on compliance, enrollment, continuity of coverage, the risk pool, and other outcomes.

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CMS Issues Final Medicare Inpatient Prospective Payment System Rule

CMS recently published a final rule that makes payment and policy changes under the Medicare inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals as well as for hospitals and hospital units that are paid on a cost or other basis.

These rules are applicable to payments beginning on October 1, 2016.


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Risk Adjustment Changes to the ACA

CMS released new risk adjustment and short-term policy proposals for the Health Insurance Marketplace and announced some additional new policies.


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The MSSP Final Rule

This week, CMS released the final Medicare Shared Savings Program (MSSP) Rule, making some significant improvements to the MSSP.  These new changes will no doubt help retain existing participants as well as help move some participants into tracks with risk-sharing arrangements.


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HHS Releases Final Non-Discrimination Rule

The Department of Health and Human Services (HHS) issued the Final Rule, Nondiscrimination in Health Programs and Activities, implementing the prohibition of discrimination under Section 1557 of the Affordable Care Act of 2010 (ACA).  Organizations should carefully review the new final rule to ensure compliance.
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From House V. Burwell to Insurer Participation: Lots Riding on Next Administration

The DC court recently ruled subsidy payments were wrongly paid out in the past two years to reimburse insurance companies for providing lower cost services to low- and moderate-income families.

Humana continued UnitedHealthcare’s trend of ruffling feathers by also announcing it will pull out of several states this year.

Much of what happens in House v. Burwell and the Affordable Care Act is riding on the next administration.


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UnitedHealth Exiting State-Based Exchanges

In Policy, the big news focused on UnitedHealth’s decision to exit the Exchanges in all but a “handful” of states for 2017. This move by the nation’s largest health insurer has drawn attention to questions about Obamacare as a whole.


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Covered California Proposes to Cut Poor Performing and High Cost Hospitals from Networks

Covered California is proposing to cut hospitals and providers from its networks for poor performance or high costs. The proposal is to be voted on by the board in April.


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2017 ACA Applicants and Network Transparency

The National Association of Insurance Commissioners (NAIC) completed their review of provider network rules and published a draft of a new Model Rule. This is the first update of network rules in over 20 years.


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CMS Proposes New Part B Prescription Drug Payment Model

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule which aims to test a new alternative payment design to pay for drugs covered under Medicare Part B.


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CMS’ Recent Enforcement Actions Shows Agency Means Business in 2017

As we predicted, the Centers for Medicare & Medicaid Services (CMS) is off to an aggressive start on the compliance front in the last year of this administration and shows no signs of slowing down with $832,250 worth of fines levied in the month of February alone.


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CMS Released Set of Standardized Core Quality Measures

On Tuesday, February 16, CMS and America’s Health Insurance Plans (AHIP) released a set of core quality measures as part of the Core Quality Measures Collaborative between healthcare system participants.


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Government Health Program Proposals in FY 2017 Budget

President Obama released the FY Budget request this week, containing many significant proposals to government healthcare programs. If incorporated into the Congressional Budget, several of these proposals would have a major impact on Medicare, MA, Medicaid and the Marketplaces.  In a new memo, the GHG policy team provides an overview of the noteworthy healthcare proposals included in the Budget Request.


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