Bulletin Board
Bulletin Board
Insurer Use of Prior Authorization Down
The insurance industry appears to be making good on its pledge to reduce its use of prior authorization for services and to make that process simpler for providers and patients Last June, some of the leading health insurers agreed to work to address prior authorization challenges. Now, an AHIP-Blue Cross Blue Shield Association survey has found that they have reduced by 11 percent the number of procedures and services that require prior authorization, which translated into 6.5 million fewer requests. Medicare Advantage plans went even further, eliminating 15 percent of [...]
Search for Undocumented Medicaid Participants Not Yielding Major Results
An administration effort to identify undocumented U.S. residents illegally enrolled in Medicaid is not turning up many undocumented residents illegally enrolled in Medicaid. At least not so far. Last fall, the administration sent the names of hundreds of thousands of suspected illegal Medicaid participants to the states and directed them to review the eligibility of those individuals. Data from five states, however, has not turned up many such individuals. Between them, Colorado and Pennsylvania reviewed 79,000 names and found none illegally enrolled in their state Medicaid programs. Texas reviewed 28,000 [...]
States Looking to Swap Medicaid Taxes
With Medicaid provider taxes on the road to oblivion as a result of passage of last year’s H.R. 1, often referred to as “The One Big Beautiful Act Law,” a number of states are looking to Medicaid managed care plan taxes to replace at least some of the tax revenue they will lose from the demise of Medicaid provider taxes. Iowa has already adopted such a tax, more than tripling its Medicaid managed care plan tax in the middle of its fiscal year. The state even increased taxes on managed [...]
Federal Health Policy Update for April 3
The following is the latest health policy news from the federal government for March 27 to April 3. Some of the language used below is taken directly from government documents. Proposed and Final CMS Medicare Regulations Proposed FY 2027 Medicare Inpatient Rehabilitation Facilities Payment Rule CMS has published a proposed rule updating Medicare payment policies and rates for inpatient rehabilitation facilities (IRF) under its IRF prospective payment system and updating the IRF quality reporting program for FY 2027. CMS proposes updating FY 2027 IRF rates by 2.4 percent based on [...]
Hospitals Sue Over Medicare DSH Payments
More than 100 hospitals have sued the Department of Health and Human Services, arguing that the manner in which the Centers for Medicare & Medicaid Services calculates their Medicare disproportionate share payments shortchanges hospitals that care for especially large numbers of low-income patients – the very hospitals Medicare DSH payments were created to help. According to the hospitals, CMS’s Medicare DSH payment methodology undercounts the number of low-income patients hospitals serve, thereby reducing the Medicare DSH payments yielded under the Medicare DSH payment calculation formula adopted in 2023. Learn more [...]