The Center for Medicare and Medicaid Innovation (CMMI) officially announced the Cell and Gene Therapy (CGT) Access Model, with sickle cell disease as the initial focus of the model (fact sheet, FAQs) The model is pursuant to President Biden’s executive order entitled “Lowering Prescription Drug Costs for Americans and, subsequently, CMMI’s February 2023 report detailing three potential models to be… (Slifer, January 30, 2024) #Demonstration Programs, #Drug Pricing, #Prescription Drugs

The Centers for Medicare & Medicaid Services (CMS) announced participation data for accountable care organization (ACO) initiatives in 2024. CMS reports that about 13.7 million people with Traditional Medicare are aligned to an ACO in 2024, which is a three percent increase since 2023 and represents nearly half of Traditional Medicare beneficiaries. The press release emphasizes that ACOs have been shown to have… (McClurg, January 29, 2024) #Accountable Care Organizations, #Health Equity, #Rural Health

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a panel focused on policies and activities related to the public health emergency, particularly highlighting a crucial provision in the American Rescue Plan Act (ARPA) that provided states with additional financial resources for investments in home- and community-based services (HCBS). MACPAC has been actively monitoring federal and state activities supporting this ARPA investment… (Colocho, January 29, 2024) #Budget, #Costs, #COVID-19, #Home Health, #Public Health, #Quality, #Transparency, #Workforce

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to discuss key themes derived from interviews with key stakeholders regarding state Medicaid agency contracts (SMACs). The Commissioner’s discussion will inform future policy options to be presented at the March meeting. Background. Staff explained how Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) are tailored to meet the unique needs of… (Colocho, January 26, 2024) #Care Coordination, #Dual Eligibles, #Quality, #Special Needs Plans

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to examine policy options for improving the transparency of Medicaid financing. Principal Analyst Rob Nelb explained how  the Medicaid statute allows states to fund the non-federal portion of Medicaid spending through various means, such as state general funds, health care-related taxes (provider taxes), intergovernmental transfers (IGTs), and certified public expenditures (CPEs)…. (Colocho, January 26, 2024) #Costs, #Hospitals, #Physicians, #Transparency

The Medicaid and CHIP Payment and Access Commission (MACPAC) met to vote on updated recommendations to improve the managed care appeals process to be included in the March 2024 report to Congress. All of the recommendations were approved, but some commissioners disagreed that recommendation 2.1 is necessary following the Commission’s discussion about the draft recommendations yesterday (Impact summary). Recommendation 2.1 To bring… (McClurg, January 26, 2024) #Program Integrity, #Quality

The Medicaid and CHIP Payment and Access Commission (MACPAC) held a discussion about the findings from an expert roundtable on the effect of Medicaid payment changes on beneficiary access to physician services. The themes of this discussion will inform future MACPAC research. Background. Staff began by recognizing the common conception that physicians are less likely to serve patients covered by Medicaid than those… (McClurg, January 26, 2024) #Health Equity, #Physicians

Below please find highlights from the Biden Administration’s recent announcements on improving behavioral health systems across the nation. HHS Releases Fact Sheet on the Agency’s Accomplishments Since Releasing the Roadmap for Behavioral Health Integration  Last year, the Department of Health and Human Services (HHS) released its Roadmap for Behavioral Health Integration which includes specific policies to help integrate mental health and substance use… (Marceno, January 23, 2024) #Mental and Behavioral Health, #Opioids, #Public Health, #Social Determinants of Health, #Women’s Health, #Workforce

House Education and Workforce Committee Chairwoman Virginia Foxx (R-NC) issued a request for information (RFI) to inform legislative reforms to employer-sponsored health care (press release). Comments are due March 15.   The RFI is part of the Committee’s efforts to lower costs and improve access to health care in employer-sponsored coverage, which was the focus of a hearing convened by the Subcommittee on Health,… (Llamas, Lewis, January 23, 2024) #Insurance Coverage, #Insurance Reform

As part of the 51st Anniversary of Roe v. Wade, the Department of Health and Human Services (HHS) announced a series of new actions to protect and expand access to contraception (press release).   Letter to stakeholders on contraceptive coverage obligations: HHS reminds Medicare care plans, private insurance plans, and state Medicaid and CHIP programs of their obligations to comply… (Llamas, Slifer, January 22, 2024) #Women’s Health