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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

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.

AAMC Responds to VA Request for Information Regarding Health Care Access Standards

August 3, 2018

The AAMC July 30 submitted comments to a Department of Veteran’s Affairs (VA) request for information regarding health care access standards as the VA begins to develop regulations for its new community care program.

Senate HELP Committee Holds Hearing on the Rising Cost of Health Care

June 29, 2018

The Senate Health, Education, Labor and Pensions (HELP) committee June 27 held a hearing titled “How to Reduce Health Care Costs: Understanding the Cost of Health Care in America.” The hearing is a first in a planned series of hearings to examine health care costs, which will include a hearing on administrative costs, waste, how to improve transparency, and private sector solutions.

On Government Affairs

Testimony and Correspondence

External Resources