2019 November

Hospitals Sue HHS Over Payment Cut

Medicare cut hospital payments $840 million a year more than it should have and now, hospitals are suing to get their money back. According to the lawsuit, Congress authorized Medicare to include a cut of 0.7 percent in hospital inpatient payments through FY 2017 to recoup past Medicare overpayments but Medicare continued the cut, without Congress’s approval, in FY 2018 and FY 2019. The 600 hospitals that filed the suit estimate that the allegedly illegal cut cost them about $200,000 each and now, they want their money back – with interest. Learn more in the Becker’s Hospital Review article “622 [...]

iqtsupport2019-11-26T06:00:10-05:00November 26, 2019|hospitals, Medicare cuts, Medicare reimbursement policy|

Medicaid DSH Cut Delayed

Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20. A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress. If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025. Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible [...]

iqtsupport2019-11-25T06:00:44-05:00November 25, 2019|Affordable Care Act, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Administration Reveals Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” The statement, an annual OMB document, organizes the priorities as follows: Facilitating patient-centered markets Fixing health care financing through protecting private insurance and Medicare Fixing health care financing through reforming the individual market Fixing health care financing through making the ACA and Medicaid fiscally sustainable Bringing value to health care through price and quality transparency Bringing value to health care through patient-centered health IT Bringing value to health care [...]

iqtsupport2019-11-22T06:00:34-05:00November 22, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations, Medicare, Medicare regulations|

Medicaid Block Grants Hit Bump in Road

The drive toward encouraging states to implement Medicaid block grants hit a bump in the road last week when the formal guidance for states that Centers for Medicare & Medicaid Services administrator Seema Verma suggested was imminent apparently became not-so imminent. At the time Verma spoke, draft guidance from CMS to the states was under review by the federal Office of Management and Budget. Last week, however, CMS withdrew that draft, which also was to address state Medicaid per capita cap programs. The bump in the road does not, however, appear to be more than a temporary detour. While CMS [...]

iqtsupport2019-11-21T06:00:51-05:00November 21, 2019|Medicaid|

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019. According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments. The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments. Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion. CMS maintains that the improper [...]

iqtsupport2019-11-20T06:00:32-05:00November 20, 2019|Centers for Medicare & Medicaid Services, Medicaid|

Improper Medicare Payments Down in FY 2019

The amount of improper Medicare payments made by the federal government fell $7 billion in federal fiscal year 2019, the Centers for Medicare & Medicaid Services reports. FY 2019 marked the third consecutive year that improper fee-for-service payments have fallen. In FY 2018, improper payments accounted for 8.12 percent of Medicare fee-for-service spending but in FY 2019 that portion fell to 7.25 percent. In FY 2019, CMS estimates that it made $28.9 billion in improper fee-for-service payments. $5.32 billion of the $7 billion reduction came through corrective actions in Medicare home health payments. Other Medicare Part B services accounted for [...]

iqtsupport2019-11-19T14:00:06-05:00November 19, 2019|Medicare, Medicare reimbursement policy|

Verma Addresses Medicaid Issues

Earlier this week, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors. In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed: Medicaid demonstration programs Medicaid work requirements a shift toward value-based payments better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare) enrollment issues improvements in the efficiency of the federal Medicaid bureaucracy Read Verma’s complete remarks here.

iqtsupport2019-11-15T06:00:58-05:00November 15, 2019|Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid upper-payment limit|

MACPAC Posts Meeting Transcript

The Medicaid and CHIP Payment and Access Commission met in Washington, D.C. earlier this month. The issues on MACPAC’s agenda were: state readiness to report mandatory core set measures analysis of buprenorphine prescribing patterns among advanced practitioners in Medicaid Medicaid’s statistical information system (T-MSIS) Medicaid disproportionate share hospital payment (Medicaid DSH) allotments Medicaid policies related to third-party liability Medicaid and maternal health A transcript of the MACPAC meeting is now available. Find it here.

iqtsupport2019-11-14T06:00:13-05:00November 14, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Feds Open Door for Exemptions from Medicaid IMD Exclusion

New federal guidelines will make it easier for state Medicaid programs to cover mental health services provided in institutions for mental diseases (IMD). For years, Medicaid regulations greatly limited the ability of states to pay for care – generally, care related to substance abuse disorder treatment – provided in IMDs; this was generally known as the IMD exclusion. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act, which was passed in 2018, opened the door for more exceptions to these limits, and last week, [...]

iqtsupport2019-11-13T06:00:36-05:00November 13, 2019|Centers for Medicare & Medicaid Services, Medicaid|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s November agenda were: congressional request on health care provider consolidation increasing the supply of primary care physicians redesigning the Medicare Advantage quality bonus program reforming the benchmarks in the Medicare Advantage payment system considerations for plans serving low-income beneficiaries in the restructuring of Medicare Part D post-acute care spending under the Medicare Shared Savings Program MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on [...]

iqtsupport2019-11-12T06:00:16-05:00November 12, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

November 2019