Standardized plan requirements for ACA coverage in 2023
James C. Capretta | May 17, 2022 | Federal
Medicare and inflation
James C. Capretta | Apr 18, 2022 | Federal
Implications of the President’s 2023 budget for health care
James C. Capretta | Mar 29, 2022 | Federal
The status of Public Health Emergency declarations
James C. Capretta | Mar 16, 2022 | Federal
Medicare Advantage in 2022
James C. Capretta | Mar 1, 2022 | Federal
Medicare-directed managed care has come a long way in four decades. What began in 1985 as a limited option available only in select markets—it was initially known as “HMO risk contracting”—has evolved into Medicare Advantage (MA), which is a major book of business for much of the private health insurance
Background on CMMI’s Direct Contracting Model
James C. Capretta | Feb 18, 2022 | Federal
The Biden administration has come under pressure in recent weeks to modify, or even pull back entirely, the Center for Medicare and Medicaid Innovation’s Direct Contracting Model, which was originally developed during the Trump era. (The administration has indicated it will announce its plans for the model “soon”.) The following
The CMS-Georgia waiver battle
James C. Capretta | Jan 28, 2022 | Federal
Georgia Gov. Brian Kemp has been engaged in a multi-year back-and-forth with federal officials over the state’s Medicaid and insurance market waiver programs, as reflected in the following timeline of the most notable steps taken by both sides. A final resolution of the standoff is not yet in sight, or
Medicaid’s budget neutrality rules for section 1115 waivers
James C. Capretta | Jan 18, 2022 | Federal
For decades, a focus in Medicaid has been on state proposals that fall outside what is allowable under the program’s normal rules. The Secretary of Health and Human Services (HHS) has wide discretion under section 1115 of the Social Security Act to “waive” legal or regulatory impediments to state initiatives
The status of federal price transparency requirements
James C. Capretta | Dec 28, 2021 | Federal
The health sector has long resisted revealing the prices it charges payers and consumers, but bipartisan pressure from Washington is forcing it to change. New rules are beginning to take effect, or will in the coming years, which will push into the public domain a flood of pricing data. The
The 2020 national health expenditures report
James C. Capretta | Dec 16, 2021 | Federal
The COVID-19 pandemic has been a transformative global event with far-reaching effects that are still unfolding. The recent annual report on national health spending from the Office of the Actuary’s National Health Expenditures Accounts Team in the Centers for Medicare and Medicaid Services (CMS) documents some of the dramatic shifts