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Final Process Evlauation of the Balancing

Final Process Evaluation of the Balancing Incentive Program

This is a follow-up to three earlier evaluation reports on the Balancing Incentive Program. The Balancing Incentive Program, legislated in the 2010 Affordable Care Act (ACA), offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS). Participation was limited to states that, as of 2009,
From: Final Process Evaluation of the Balancing Incentive Program
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Advancing Integrated Care: Lessons from Minnesota

Advancing Integrated Care: Lessons from Minnesota

Jhamirah M. Howard and Jennifer Baron Office of the Assistant Secretary for Planning and Evaluation Printer Friendly Version in PDF Format (8 PDF pages)
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Advancing Integrated Care: Lessons from Minnesota

Advancing Integrated Care: Lessons from Minnesota

This brief discusses how integrated care has taken shape in the State of Minnesota, highlights findings from a study of beneficiaries in the integrated care program in Minnesota, and discusses how the state is using demonstration authority to further build on this successful model.
From: Advancing Integrated Care: Lessons from Minnesota
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APPENDIX C: Data and Methodology for the SIPP

Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. APPENDIX C: Data and Methodology for the SIPP Analysis

For this analysis, we pooled the 1996, 2001, and 2004 panels of the SIPP, a nationally representative sample of the non-institutionalized civilian population who are 15 years old and older. SIPP respondents are interviewed once every four months for the duration of the survey panel. During each interview, they provide information about the precedi
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APPENDIX D: Supplemental Tables for Pre-

Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. APPENDIX D: Supplemental Tables for Pre-Application Work Activity and Program Participation of SSDI Applicants and At-Risk Group Members

TABLE D.1 . Employment and Income Characteristics of SSDI Applicants     37-42 Months   Before SSDI Application   31-36 Months   Before SSDI Application   25-30 Months   Before SSDI Application   19-24 Months  
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APPENDIX B: Methodology for the Literature

Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. APPENDIX B: Methodology for the Literature Searches

In this appendix, we detail the methodology we employed to conduct two targeted literature searches: one on employment programs and outcomes for people with psychiatric disorders and one on employment programs and outcomes for people with other disabilities. The literature search and review process for both searches consisted of five stages: (1) s
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APPENDIX A: Evidence Tables

Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. APPENDIX A: Evidence Tables

TABLE A.1 . Evidence for Improving Employment Outcomes Through SE: Studies Included in Systematic Reviews Systematic Review Source(s) Study Author, Country a Study Design a Intervention (sample size) b
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Appendices

Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. Appendices

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Health Care Spending Growth and Federal Policy

Health Care Spending Growth and Federal Policy

In this Issue Brief, we examine spending growth through 2014, the first year the Affordable Care Act’s coverage provisions were in effect, and 2015, where possible. We provide detailed cost growth trends for Medicare and the private insurance market. We also estimate the effect of recently introduced specialty drugs on current and future spendin
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Observations on Trends in Prescription Drug

Observations on Trends in Prescription Drug Spending

Key findings • Expenditures on prescription drugs are rising and are projected to continue to rise faster than overall health spending thereby increasing this sector’s share of health care spending. • ASPE estimates that prescription drug spending in the United States was about $457 billion in 2015, or 16.7 percent of overall personal
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Footnotes

Short-Term Fixes to the Sustainable Growth Rate Process . Footnotes

1 E.g., GAO, Medicare Physician Payments: Concerns about Spending Target System Prompt Interest in Considering Reforms. Washington GAO, Report #GAO-05-85, October 2004. 2 Data presented in this section are based on NORC’s analysis of allowed charges from the Physician/Supplier Procedure Summary Master Files (PSPSMFs) for years 1996-2004.
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Appendix. SGR Spending Predictions

Short-Term Fixes to the Sustainable Growth Rate Process . Appendix. SGR Spending Predictions

Data Sources.  Implementation of the SGR process requires that CMS use the most current information at its disposal to estimate components of the SGR formula, including spending, and components that are used to calculate the SGR (which in turn, are used to calculate annual target spending and cumulated target spending).  As noted in the text,
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6.0 Discussion

Short-Term Fixes to the Sustainable Growth Rate Process . 6.0 Discussion

The primary objective of this report has been to evaluate revisions to the current SGR physician payment update methodology with a focus on refinements to attributes of the SGR process and changes in the definition of target spending.  A spreadsheet model of the current SGR process was constructed for comparative study of effects of changes in th
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5.4 Additional Refinements

Short-Term Fixes to the Sustainable Growth Rate Process . 5.4 Additional Refinements

Refinements to the SGR process that have been discussed above can be considered simultaneously.  Tables 15a and 15b document effects on CFs of sequentially imposing two refinements on the rebased model with drug and lab spending excluded from SGR spending: use of the higher SGR values (displayed in Table 12), e.g., to accommodate desire for hig
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5.3 Elimination of Drug and Lab Spending from the

Short-Term Fixes to the Sustainable Growth Rate Process . 5.3 Elimination of Drug and Lab Spending from the SGR

An argument raised by some providers and critics of the SGR process is that the payment update should not be based on events beyond control of providers.  An example is spending for drugs and lab tests.  These components of SGR spending are less within the control of providers than services and procedures routinely provided under the MFS.  Drug
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5.2 Rebasing Target Spending

Short-Term Fixes to the Sustainable Growth Rate Process . 5.2 Rebasing Target Spending

The current SGR process was implemented with an initial target level based on actual spending levels in the late 1990s.  Since that time, each year’s target has been increased using the SGR.  Over time, the rate of spending has increased and the cumulated difference between annual actual and target spending levels has grown rapidly. 
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5.1 Effects of Changes in SGR Values

Short-Term Fixes to the Sustainable Growth Rate Process . 5.1 Effects of Changes in SGR Values

A fundamental explanation for payment update declines that have been recently experienced and are likely in the near future without significant changes to the SGR process is that spending increases faster than target spending levels.  This over-spending determines the penalty of the UAF, which can more than offset the MEI when the update is calcu
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5.0 Changes in Target-Setting Processes

Short-Term Fixes to the Sustainable Growth Rate Process . 5.0 Changes in Target-Setting Processes

Changes in the UAF formula can be used to change the size of penalties/rewards associated with over-/under-spending, which in turn changes the rate at which provider payments would change year to year.  An alternative approach is to alter the way in which target spending is defined or the composition of spending that is counted towards target spe
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4.2.2 The Size of the UAF Penalty

Short-Term Fixes to the Sustainable Growth Rate Process . 4.2.2 The Size of the UAF Penalty

In addition to changes in the UAF penalty floor, the size of the UAF penalty for over-spending can be reduced by lowering the weights applied to the measures of over-spending in the previous year and cumulated spending.  A rationale for the cumulated spending term of the UAF is that CFs can be adjusted to help the Medicare program recover a porti
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4.2.1 The UAF Floor

Short-Term Fixes to the Sustainable Growth Rate Process . 4.2.1 The UAF Floor

An option that retains some cost-containment incentives but does not lead to negative payment updates is to set the UAF floor such that the largest over-spending penalty would completely offset the MEI.  Under this option, the floor is a negative percent that would be just large enough in magnitude to offset the MEI, producing a 0-percent update.

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