Updates & Analysis

New York State has issued an RFP for the development and operation of 1,200 units of Supportive Housing for homeless persons with special needs, available here. Up to $25,000 per unit of services and operations funding will be awarded, for a total of $300 million. This RFP is the first opportunity to receive funding under…

On April 25th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The final rule aligns the rules governing Medicaid managed care with those of other major sources of coverage, including Qualified Health Plans and Medicare Advantage plans. The rule…

On April 27th, the Department of Health and Human Services (HHS) issued a proposed rule to implement provisions of the Medicare Access and CHIP Reauthorization Act (MACRA). Under the proposed rule, the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule would be replaced with the two-tracked Quality Payment Program (QPP).…

On April 21st, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule for FY 2017 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). Attached please find a summary of this rule. CMS will accept comments through June…

On April 21st, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to update the FY 2017 Medicare payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs). CMS will accept comments on the proposed rule until June 20th. This document summarizes several major provisions of the proposed rule,…

On April 11th, the Centers for Medicare and Medicaid Services (CMS) announced that the Comprehensive Primary Care Plus (CPC+) model will succeed the existing Comprehensive Primary Care (CPC) initiative, which is due to expire on January 1, 2017. The new advanced primary care medical home model will be tested through the Center for Medicare and…

Late last week, the New York State Legislature passed the 2016-2017 Fiscal Year Budget. Attached please find SPG’s summary of highlighted health care-related provisions from the legislation.

On April 4th, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Rate Announcement and Call Letter, which makes payment and policy updates to Medicare Advantage (MA) and Medicare Part D prescription drug plans. This comes after CMS accepted comments on the Advance Notice and draft Call Letter that was released on February…

New York State has released an updated draft of the Delivery System Reform Incentive Payment (DSRIP) Value Based Payment (VBP) Roadmap (available here). The document outlines the State’s plan to make 80% of managed care Medicaid payments through VBP arrangements by the end of the DSRIP waiver period in 2020. The updated draft has been…

On March 8th, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would implement new Medicare Part B drug payment models and clinical decision support tools. The Center for Medicare and Medicaid Innovation would test the alternative payment models over a five-year period to assess the effect on beneficiary health outcomes…

One major focus of New York State’s Medicaid Redesign Team (MRT) reforms is allowing providers to offer integrated primary care and behavioral health services in community-based settings. However, in New York, each clinic site traditionally requires a separate license to offer a given type of service: an Article 28 license from the Department of Health…

On February 19th, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Advance Notice and draft Call Letter, which propose payment and policy updates for Medicare Advantage (MA) and Medicare Part D prescription drug plans. CMS will be accepting comments through March 4th. Attached please find a summary of this information. The final…