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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Coverage and Delivery Expansion

Coverage Expansion | Demonstrations and CMMI | HIT | 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

CMS Proposes Cancellation of Episode Payment Models and Significant Changes to the Comprehensive Care for Joint Replacement Model

August 17, 2017

The Centers for Medicare and Medicaid Services (CMS) August 15 released a proposed rule entitled “Medicare Program; Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model (CJR)”. The rule proposes to: 1) eliminate the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model, and 2) reduce the number of metropolitan statistical areas (MSAs) required to participate in CJR. Comments on the proposed rule are due October 16.

Court Allows States to Intervene in Case Challenging the Administration’s Authority to Pay CSRs

August 4, 2017

The U.S. Court of Appeals for the District of Columbia Circuit August 1 issued an order allowing states and the District of Columbia to intervene in the lawsuit brought by the House of Representatives to challenge the authority of the U.S. Department of Health and Human Services (HHS) to issue cost sharing reductions (CSRs). 

Senate Continues its Efforts to Repeal the Affordable Care Act

July 21, 2017

n response to continued opposition to the Senate health care reform bill, the Better Care Reconciliation Act (BCRA), Senate Majority Leader Mitch McConnell (R-Ky.) July 18 announced his intent to vote on an updated version of a 2015 repeal of the Affordable Care Act (ACA), the Obamacare Repeal Reconciliation Act (ORRA).

Revised Version of Senate Health Care Bill Released; Senate Plans to Work into August Recess

July 14, 2017

Senate Leader Mitch McConnell (R-Ky.) July 13 released an updated version of the Better Care Reconciliation Act of 2017 (BCRA).

GAO Recommends CMS Ensure Lower Quality Hospitals Do Not Receive Bonuses under HVBP Program

July 7, 2017

The U.S. Government Accountability Office (GAO) released a June 30 report on the Medicare Hospital Value-based Purchasing (HVBP) program, which aims to improve quality of care and efficiency by creating financial incentives for participating hospitals.

On Government Affairs

Testimony and Correspondence

External Resources