iqtsupport, Author at DeBrunner & Associates

MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress. Included in the report are sections on: Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties. Restructuring Medicare Part D for the era of specialty drugs. Medicare payment strategies to improve price competition and value for Part B drugs. MedPAC’s mandated report to Congress on clinician payments. Issues in Medicare beneficiaries’ access to primary care. Assessment of the Medicare Shared Savings Program’s effect on Medicare spending. Ensuring the accuracy and completeness of Medicare Advantage encounter data. Redesigning the Medicare Advantage quality bonus [...]

iqtsupport2019-06-19T11:57:26-04:00June 19, 2019|Alternative payment models, Centers for Medicare & Medicaid Services, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Surprise! Teaching Hospitals Cost Less Than Non-Teaching Hospitals

30-day and episode-of-care costs are lower for care provided by major teaching hospitals than they are for other teaching hospitals and non-teaching hospitals. Or so concludes a new study published by JAMA Open Network. According to the study: Major teaching hospitals’ initial hospitalization costs are higher. Major teaching hospital costs are less than other hospitals after 30 days of care and over entire episodes of care. Major teaching hospitals’ costs are similar to those of other teaching hospitals and non-teaching hospitals over a 90-day episode of care. Major teaching hospitals’ patients incurred lower costs for post-acute care. Major teaching hospitals [...]

iqtsupport2019-06-13T06:00:38-04:00June 13, 2019|hospitals, Medicare|

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services. In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve” reporting and documentation requirements coding and documentation requirements for Medicare or Medicaid payment prior authorization procedures policies and requirements for rural providers, clinicians, and beneficiaries policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries beneficiary enrollment and eligibility determination CMS processes for issuing regulations and policies Comments are [...]

iqtsupport2019-06-12T06:00:42-04:00June 12, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

PACE Regulation Updated

PACE programs will have new flexibility under a recent update of regulations governing Programs of All-Inclusive Care. As described by the National Association of Medicaid Directors, the new regulation Allows PACE team members to fulfill multiple roles on the care team; Allows certain non-physician providers to serve in the place of primary care physicians on the care team; Clarifies that PACE programs offering prescription drug benefits are subject to Medicare Part D regulations; Eliminates requirements for PACE organizations to seek waivers for several of the most commonly waived aspects of PACE regulation; and Updates CMS's enforcement actions to promote accountability [...]

iqtsupport2019-06-11T06:00:59-04:00June 11, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

ACA Tied to Reduced Disparities in Cancer Care

Improved access to health insurance has led to reduced racial disparities in the diagnosis and treatment of cancer. As reported by the Washington Post, According to researchers involved in the racial-disparity study, before the ACA went into effect, African Americans with advanced cancer were 4.8 percentage points less likely to start treatment for their disease within 30 days of being given a diagnosis. But today, black adults in states that expanded Medicaid under the law have almost entirely caught up with white patients in getting timely treatment, researchers said. Another study found that since the reform law’s implementation in Medicaid [...]

iqtsupport2019-06-10T06:00:04-04:00June 10, 2019|Affordable Care Act, Medicaid|

Some Readmissions From Nursing Homes to Hospitals Hard to Avoid

Improvements in the delivery of care cannot prevent some skilled nursing facility patients from being readmitted to hospitals, a new study has concluded. According to the study, when advanced practice nurses brought best practices to 16 nursing homes participating in a Medicare pilot program, they enjoyed considerable success reducing hospital readmissions but found themselves unable to stop some, including readmissions caused by residents or their families calling ambulances on their own; patients refusing treatment and then demanding hospitalization because of the effects of the denied treatment; and patients in hospice deciding they want surgery. These were among the findings in [...]

iqtsupport2019-06-07T06:00:44-04:00June 7, 2019|Medicare post-acute care|

Administration Ramps Up Scrutiny of Immigrants’ Use of Public Benefits

Immigrants’ sponsors could be more likely to be held financially responsible for the cost of public benefits those immigrants receive under a new memorandum issued by the White House. The requirement itself is not new; the purpose of the memorandum is to encourage federal agencies to enforce existing laws that state that, according to the memorandum, …when an alien applies for certain means-tested public benefits, the financial resources of the alien’s sponsor must be counted as part of the alien’s financial resources in determining both eligibility for the benefits and the amount of benefits that may be awarded. Financial sponsors [...]

iqtsupport2019-06-06T06:00:08-04:00June 6, 2019|Medicaid, Medicaid regulations|

Proposed Immigration Rule Discourages Medicaid Enrollment

A proposal by the U.S. Department of Homeland Security is discouraging participation in Medicaid and other government safety-net programs. A proposed Homeland Security regulation would establish new criteria for determining whether individuals seeking admission into the U.S. might eventually become “public charges”: people who would depend on public resources to meet their needs rather than the resources of friends, family, sponsors, or private organizations or be able to provide for themselves or their families. Among those criteria are past use of government aid programs and current income and health status. Since the regulation was proposed last October, many legal immigrants, [...]

iqtsupport2019-06-03T15:21:21-04:00June 3, 2019|Medicaid|

Medicaid Waiver Process Often Lacks Transparency, GAO Finds

States’ applications for federal Medicaid waivers often lack transparency, according to a new report by the U.S. Government Accountability Office. According to the GAO, the chief problem with the transparency of state applications for Medicaid waivers arises when states either seek to amend waivers they have already obtained or amend waiver applications currently under review by the Centers for Medicare & Medicaid Services. Too often, the GAO found, states neither subject such amendments to public review and comment nor adequately explain to stakeholders the implications of the amendments they are proposing. To address this problem, the GAO recommends that CMS [...]

iqtsupport2019-05-23T09:52:40-04:00May 23, 2019|Medicaid|

More Medicaid Matching Funds for Only Partial Medicaid Expansion?

The federal government is considering providing an unusual amount of federal Medicaid matching funding for only partial state Medicaid expansion. At least that’s what Centers for Medicare & Medicaid Services administrator Seema Verma told a health care conference in Georgia last week. The state of Georgia has proposes partially expanding its Medicaid population. Under the Affordable Care Act, states that fully expand their Medicaid programs under the terms established by the 2010 health care law receive nine dollars in federal matching funds for every one dollar they spend on their Medicaid expansion population. States that only partially expand their Medicaid [...]

iqtsupport2019-05-15T06:00:11-04:00May 15, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid|

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