NASHP

OCTOBER 13, 2023

The Affordable Care Act (ACA) requires health insurance plans to spend at least 80 to 85 percent (for large group plans) of an enrollee’s premium dollars on medical care and quality improvement rather than on administrative costs and profits. This is known as the Medical Loss Ratio (MLR).

Regulations 78

Regulations Quality Improvement Accountability 78

Sheppard Health Law

JANUARY 10, 2022

CMS believes its proposals would improve Federal and State oversight of certain D-SNPs (and their affiliated MCOs) through greater information-sharing among government regulators. Past Performance Methodology to Better Hold Plans Accountable for Violating CMS Rules (§§ 422.502 and 422.503).

Medicare 98

Medicare Medicaid Integration Regulations 98

NASHP

MARCH 22, 2024

State Medicaid programs, behavioral health authorities, public health, departments of insurance, human and social service agencies, departments of education, departments of corrections, housing, and employment can collaborate to align overlapping efforts, align policies, and braid funding and accountability mechanisms.

Accountability 52

Accountability Medicaid Primary Care Quality Improvement 52

Briggs Healthcare

APRIL 7, 2022

In this context, with support from a coalition of sponsors, the National Academies of Sciences, Engineering, and Medicine (NASEM) formed the Committee on the Quality of Care in Nursing Homes to examine how the United States delivers, finances, regulates, and measures the quality of nursing home care.

Nursing 52

Nursing Quality of Care Quality Assurance Home Care 52

NASHP

DECEMBER 10, 2021

ACO Accountable Care Organizations. RAE Regional Accountable Entity. Rhode Island’s Medicaid Accountable Entities (similar to ACOs) may use funds earned through the Health System Transformation Project Incentive Fund to fund CHW services. Acronym Guide. APM Alternative Payment Model. CBO Community Based Organization.

Medicaid 122

Medicaid Primary Care Prevention Nursing 122

NASHP

OCTOBER 20, 2022

High-quality, integrated care requires strong system-level partnerships, information and data sharing, and family-centered practices. Yet, states often face barriers to integrated care including a lack of trust across agencies, privacy regulations that may hinder data sharing, and misaligned eligibility, enrollment, and referral systems.

Medicaid 98

Medicaid Integration Accountability Quality Improvement 98

NASHP

NOVEMBER 8, 2024

Tennessee operates a VBP program called the Quality Improvement in Long Term Services and Supports initiative (QuILTSS ). In 2024, quality categories include satisfaction (35 points), culture change/quality of life (30 points), staffing/staff competency (25 points), and clinical performance (10 points).

Medicaid 52

Medicaid Nursing Quality Improvement Accountability 52

NASHP

JANUARY 13, 2022

Department of Health and Human Services (HHS) released its proposed Notice of Benefit and Payment Parameters for the 2023 plan year, the annual regulation governing health insurance plans and marketplaces for the upcoming year. Addressing disparities through quality improvement strategies (QIS). Prohibits QHP advertising.

Regulations 52

Regulations Quality Improvement Accountability Healthcare 52

Accountable Care Doctors

OCTOBER 21, 2020

The 31 multi-specialty medical groups and integrated health systems that are part of the Council of Accountable Physician Practices (CAPP), their 85,000 physicians, and hundreds of thousands of staff are at the forefront of the battle for their patients’ lives.

Primary Care 59

Primary Care Integration Remote Care Population Health 59

NASHP

MAY 26, 2023

States understand that an individual’s care plan should not be a snapshot in time, but rather malleable to account for unexpected changes in a care recipient’s life. As promulgated in Iowa’s Human Service’s regulation 441-78.3 As codified in Iowa’s Human Service’s regulation 441-78.34(13)

Medicaid 121

Medicaid Nursing Regulations Integration 121

Sheppard Health Law

MAY 16, 2022

Considering the impact social risk factors and unmet social needs can have on health, CMS asserts these changes will help better identify the risk factors that may inhibit enrollees from accessing care and achieving optimal health outcomes, enabling MA SNPs to take these risk factors into account in enrollee care plans.

Medicare 52

Medicare Medicaid Accountability Integration 52

NASHP

MARCH 28, 2022

Partner with Community College Systems: Tennessee’s Medicaid agency, TennCare, worked with Tennessee’s Quality Improvement in Long Term Services and Supports (QuILTSS) Institute to develop a career and education pathway for direct care workers that allows workers to “learn and earn,” while acquiring credentials with value in the labor market.

Nursing 98

Nursing Medicaid Home Care Rehabilitation 98

NASHP

MARCH 22, 2024

As major purchasers, administrators, and regulators of behavioral health treatment and supports, states play a critical role in system transformation. This is one section of Modernizing Behavioral Health Systems: A Resource for States. See the full resource guide. Colorado Colorado is engaged in multi-pronged behavioral health reform.

Medicaid 52

Medicaid Urgent Care Primary Care Hospitals 52

NASHP

NOVEMBER 29, 2021

The Department of Health Care Policy and Financing (the Medicaid program administrator) does not specifically require the Regional Accountable Entities (RAEs), care coordinating entities contracted with Colorado’s Medicaid program, or other managed care entities to cover CHW services, nor does the Department pay for CHW services under FFS.

Medicaid 52

Medicaid Primary Care Prevention Nursing 52

NASHP

MARCH 22, 2024

In addition to funding mobile response services, Connecticut has also established a Mobile Crisis Intervention Services Performance Improvement Center (PIC) to support the collection and analysis of data, implement quality improvement activities, and support providers to enhance their clinical competencies and delivery of MCIS.

Medicaid 52

Medicaid Integration Primary Care Nursing 52

NASHP

APRIL 15, 2022

ECM will be delivered through the managed care 1915(b) waiver and contracting with MCPs and is accounted for in capitation rates. Regular meetings over the five-year period will include development of implementation plans and service gap analysis, service delivery challenges, and quality improvement processes.

Medicaid 59

Medicaid Public Hospital Hospitals Nursing 59

NASHP

DECEMBER 20, 2022

The hotline, supported by both a federal Overdose to Action grant as well as the state’s CARES Act behavioral health funding , takes advantage of SAMHSA’s modified regulations during the public health emergency, providing immediate access to tele-induction of buprenorphine and linkage to continued outpatient treatment.

Medicaid 52

Medicaid Prevention Hospitals Integration 52

NASHP

JUNE 22, 2022

Recruit providers to support system improvements. Support quality improvement efforts. Guide quality measurement and evaluation. Advise on evidence-based improvement practices. [1] 1] National Improvement Partnership Network. Establishing a Child Health Improvement Partnership: A How-to Guide.

Care Transition 52

Care Transition Medicaid Doctors Regulations 52

NASHP

DECEMBER 23, 2022

Monitor and evaluate quality improvement and outcomes and address barriers to care. Doulas must also be trained in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPPA) and adult and infant CPR. Monitor and Evaluate Quality Improvement and Outcomes and Address Barriers to Care.

Medicaid 59

Medicaid Nursing Hospitals Regulations 59

Sheppard Health Law

NOVEMBER 13, 2023

Enhance Guardrails for Agent and Broker Compensation Over the last few years, CMS has issued new regulations and subregulatory guidance intended to address abusive marketing practices by third party marketing organizations (“TPMOs”) that sell MA and Part D plans.

Medicare 59

Medicare Medicaid Regulations Integration 59