By Tricia McGinnis, M.P.P., M.P.H.

The Department of Health and Human Services (HHS) recently released long-awaited proposed regulations for implementing the Affordable Care Act's Medicaid primary care rate increase. Reimbursement rates for all types of health care services provided to Medicaid beneficiaries have historically lagged behind fees paid to providers treating Medicare beneficiaries or people with private insurance. As of 2008, Medicaid fee-for-service provider payments were only 66 percent of Medicare rates on average, with just five states paying rates close to the Medicare level.

By Sara R. Collins and Tracy Garber

The Affordable Care Act requires each state to establish by 2014 a new health insurance marketplace or “exchange” where individuals and small businesses can purchase affordable health insurance plans. The exchanges are the centerpiece of the reform law: they will be the main portals where people without employer-sponsored health insurance will go, either in person or online, to both find a health plan and learn about and apply for any federal subsidies for which they are eligible. The Congressional Budget Office estimates that by 2020, 22 million people will enroll in health plans offered through their state exchange.

In order to establish an exchange, states must give themselves the legal authority to do so. State legislatures can accomplish this by crafting and passing legislation for their governors to sign. In the absence of state legislation, governors in some states may pursue other mechanisms to give them the authority to establish and operate an exchange, such as an executive order. In states that do not opt to run their own exchanges, the federal government will operate a “federally facilitated exchange” in their state. But according to new guidance released by the Department of Health and Human Services last week, within the federally facilitated exchange, states may also choose a “state partnership exchange” in which they would operate exchange functions related to plan management and/or consumer assistance.¹

HHS’s new guidance also gives states until November 16, 2012 to submit an “Exchange Blueprint” that will lay out how they intend to operate their exchanges, or whether they are electing to participate in a state partnership exchange.² HHS will grant approval to states to run their own exchanges by January 2013. HHS may grant conditional approval of an exchange if a state is at an advanced stage in the development of their exchanges but cannot demonstrate complete readiness by January 2013. In addition, states that do not have exchanges ready for operation in 2014 may apply to operate the exchange in 2015 or in subsequent years.

 By Meredith Rosenthal, Ph.D., Melinda K. Abrams, M.S., and Asaf Bitton, M.D., M.P.H.

There are currently more than 90 commercial health plans, 42 states, and three federal initiatives testing the patient-centered medical home (PCMH) model. Yet, while elements of the medical home have been shown to be associated with better quality and lower cost, there are only a few high-quality, published evaluations of the impact of the PCMH model as a whole. There is an urgent need for rigorous data to strengthen the evidence base of the medical home as well as to improve implementation. In an effort to harness and share lessons from the many disparate medical home pilots and evaluations under way, The Commonwealth Fund established the Patient-Centered Medical Home Evaluators' Collaborative in 2009.