ACO Final Rules Issued: CMS Bows To Provider Pressure, But Will It Be Enough?

The Centers for Medicare and Medicaid (CMS) released its final Accountable Care Organizations (ACOs) rules this past week and made a number of concessions to providers worried that the original regulations stymied the reform effort. The response to the final regulations has generally been positive, but many organizations are still non-committal or exhibiting caution as they continue to weigh the pros and cons of setting up the infrastructure demanded by CMS.

CMS Unveils Comprehensive Primary Care Initiative

While the Patient Protection and Affordable Care Act (PPACA) is best known for the health mandate, the coming exchange marketplaces, and other major commercial changes, its other major focus is reform of the ever-growing Medicare system for the elderly and disabled.

IOM Throws Curve Ball at Essential Benefits: Next up HHS

A number of external organizations have been tasked with advising the Department of Health and Human Services (HHS) on critical aspects of implementation of health reform. Earlier this year, the National Association of Insurance Commissioners (NAIC) took a very responsible approach toward defining minimum medical loss ratios (MLR) for commercial products. Certain “good spend” by health plans that improves quality will count in the minimum MLR. HHS bowed to NAIC’s expertise and long track record of fairness and adopted the recommendations in full.

Debt Crisis Could Lead To Major Medicaid Managed Care Expansion

With the debt crisis consuming national attention, entitlement reform is inevitable and Medicaid spending will almost certainly be on the chopping block.

Members of both parties begin to cower when questions about the future of Social Security and Medicare fly from reporters’ mouths. But while the Medicaid program is defended vigorously by Democrats, it is the least popular of the big three entitlements in the nation.