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Medicare, Medicaid, Health Reform

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Monthly Archives: November 2012

Employee Retirement Health Benefits: Workers Increasingly Do Not Expect Retiree Health Coverage

Employers have made major changes to their health benefits in the past decade. Premiums for employer-sponsored health insurance increased more than 60 percent from 2001 to 2009, and the employee’s share of premiums went up more than 90 percent. There has also been a decline in the numbers of businesses who offer benefits to retirees. For example, the Agency for...

Health Care Quality in Health Insurance Exchanges: CMS Request for Information on Health Plan Quality Management

To help determine the value of health care provided by qualified health plans (QHPs) that will contract with Health Insurance Exchanges, the Centers for Medicare and Medicaid Services (CMS) is seeking information on best practices in health plan quality management and reporting. Through a Request for Information (RFI), CMS seeks information on existing quality measures and rating systems, strategies and requirements...

Medicare Special Needs Plans for Dual Eligibles: Recommended Improvements to D-SNP Oversight by CMS and State Medicaid Agencies

Special Needs Plans for dual eligibles (D-SNPs) account for a large and growing category of Medicare Advantage Special Needs Plans (SNPs), reaching 1.2 million or 83 percent of SNP enrollees in 2012. Medicare Advantage Special Needs Plans for dual eligibles, commonly an HMO, are often key players in new integrated Medicare-Medicaid health plan demonstrations under development in several states - Ohio and Minnesota,...

Medicaid Accountable Care Organizations: 10 Core Considerations for Implementing Medicaid ACOs

Leading-edge state Medicaid agencies across the country are exploring the potential of accountable care organizations (ACOs) to drive improvements in quality, delivery, and cost-effectiveness for Medicaid beneficiaries. Seven states in particular – Maine, Massachusetts, Minnesota, New Jersey, Oregon, Texas, and Vermont – are creating ACO models for Medicaid. The Center for Health Care Strategies (CHCS) designed Advancing Medicaid Accountable Care...

Congressional Liaison Offices of Federal Health Agencies

Federal health agencies, like the Centers for Medicare and Medicaid Services and the Food and Drug Administration, must maintain large congressional liaison offices. Below is a listing of congressional liaison offices of federal health agencies, including CMS, FDA, CDC, AHRQ, and NIH, as well as shops like OMB and CBO that have considerable impact on health care programs. The primary duties of these...

Price Transparency in Health Care: Guidelines for Healthcare Purchasers from Catalyst for Payment Reform

Opaque prices – the norm in U.S. health care – in a key driver of inefficient, ineffective medical care and rapid cost increases.  Transparency of health care prices - public reporting of prices - is an essential ingredient for a high-value, cost effective health care system. In recent years, rising prices have driven up health care costs for people under the...

Medicare and Medicaid Fraud: Breakdown of Types of Healthcare Provider Fraud and Abuse Cases

Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion annually. Together with state Medicaid agencies and state attorneys general, several federal offices, such as the Department of Health and Human Services (HHS) Office...

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