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Coverage and Delivery Expansion

Coverage Expansion | Demonstrations and CMMI | Patient Care Quality

The Affordable Care Act (ACA) calls for new programs and initiatives that will transform how healthcare is delivered. Innovative pilot programs specified in the legislation, such as accountable care organizations (ACOs), are currently being implemented. The ACA also created the Centers for Medicare and Medicaid Innovation (CMMI), which is tasked with developing and funding demonstration projects to improve the quality of care for patients. CMMI launched programs such as the Pioneer ACO, Bundled Payments for Care Improvement, and the Health Care Innovation Challenge.

The ACA also establishes new requirements for health insurance coverage. Starting in 2014, consumers and small businesses will be able to purchase coverage through state-level exchanges. These exchanges will offer insurance options, aid consumers in selecting plans, and coordinate eligibility for premium tax credits. Also in 2014, Medicaid will expand to cover those at or below 133 percent of the federal poverty level.

Related: Geographic Variation | Inpatient Prospective Payment System


News and Updates


Final Rules Released on Religious and Moral Exemptions and Accommodation for Coverage of Contraceptive Services Under ACA

November 9, 2018

The Departments of Health and Human Services, Treasury, and Labor Nov. 7 issued two final rules to provide broader conscience protections for entities and individuals who have religious or nonreligious moral objections to health insurance that covers contraceptive methods and/or sterilization procedures, and whose health plans are subject to the mandate of contraceptive coverage as preventative health services through guidance issued under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152).


AAMC Submits Comments on CMS’s Medicare Shared Saving Program ACO Proposed Rule

October 18, 2018

The AAMC Oct. 16 submitted comments on the Centers for Medicare and Medicaid Services’ (CMS) “Accountable Care Organizations – Pathways to Success” proposed rule, which would make significant changes to the Medicare Shared Savings Program (MSSP).


HHS OIG Issues Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements Civil Monetary Penalty

August 30, 2018

Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Aug. 27 released a Request for Information (RFI) regarding the anti-kickback statute and beneficiary inducements civil monetary penalty (CMP) seeking input from the public on addressing regulatory provisions in Medicare and state health programs that may act as barriers to coordinated or value-based care.


CMS Issues Proposed Rule Making Significant Changes to the Medicare Shared Savings Program

August 17, 2018

The Centers for Medicare and Medicaid Services (CMS) Aug. 9 proposed significant changes to the Medicare Shared Savings Program (SSP) in a proposed rule entitled “Accountable Care Organizations – Pathways to Success.”


CMS Releases Final Rule on Short-Term, Limited-Duration Health Plans

August 3, 2018

The Centers for Medicare and Medicaid Services (CMS), the Internal Revenue Service (IRS), and the Department of Labor (DOL) Aug. 1 released the final rule outlining changes to short-term, limited-duration insurance.


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