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Some States Struggling With Medicaid Eligibility Redeterminations

As many as 12 states have struggled to comply with federal guidelines for redetermining eligibility of their Medicaid population – enough so that the federal government has had to intervene. The Centers for Medicare & Medicaid Services has reportedly halted Medicaid eligibility redeterminations in six states since April and worked closely with six more after concluding that they were not complying with its guidelines for how to go about redetermining the eligibility of the nearly 94 million Americans who were on the Medicaid rolls when the COVID-19 public health emergency [...]

July 24, 2023|Categories: Centers for Medicare & Medicaid Services, COVID-19, Medicaid|Tags: COVID-19 continuous Medicaid eligibility, Medicaid eligibility redetermination, medicaid unwinding|

Federal Health Policy Update for July 20

The following is the latest health policy news from the federal government for March 13-16. Some of the language used below is taken directly from government documents. Congress Senator Bernie Sanders (I-VT), chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, has introduced a bill, the “Primary Care and Health Workforce Expansion Act.” The bill would: Increase funding for community health centers by $65 billion over five years, fund the National Health Service Corps at $8.3 billion over five years, and provide $250 million for HRSA coordination for [...]

July 20, 2023|Categories: Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy|Tags: CDC Bridge Access Program for COVID-19 Vaccines, COVID-19 Uninsured Program, CY 2024 Medicare proposed outpatient prospective payment system rule, CY 2024 Medicare proposed physician fee schedule, CY 2024 proposed Medicare outpatient rates, CY 2024 proposed Medicare physician rates, Federal Trade Commission and merger guidelines, HHS Office of the Inspector General, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid and COVID-19 vaccines, Medicaid managed care, medicaid unwinding, Medicare and behavioral health care, Medicare and telehealth, Medicare proposed intensive outpatient program, Medicare value-based care programs, MLN Connects, provider relief fund|

Inadequate Data Hinders Federal Approach to Health Equity

Federal efforts to develop and improve payment models and other programs designed to foster health equity are often hamstrung by poor data: inconsistent data requests from program to program and flawed and incomplete data reporting by those participating in those programs. As a result, federal policymakers often are unable to tell whether programs – both those developed specifically to address health equity and those that are not – are having the desired effect on health equity. The result, according to a new study from the Centers for Medicare & Medicaid [...]

July 19, 2023|Categories: Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity|Tags: Alternative payment models, Center for Medicare and Medicaid Innovation, health equity, Medicaid, Medicare|

Federal Health Policy Update for July 13

The following is the latest health policy news from the federal government for June 30 – July 13. Some of the language used below is taken directly from government documents. 340B CMS has published a proposed regulation outlining how it plans to reimburse hospitals for reductions in 340B prescription drug payments that it implemented from 2018 to 2022 but that a federal court found to be illegal. The agency calculates that it owes participating 340B providers $9 billion, which it proposes paying to those providers in single lump-sum payments. CMS [...]

Price Transparency Compliance Rises With Penalties

Raising penalties for failure to comply with federal hospital price transparency requirements is increasing compliance with those requirements. Or so concludes a new JAMA Network report. According to a recently published study that examined nearly 4400 acute-care hospitals, … compliance with the 2021 Centers for Medicare & Medicaid Services Price Transparency Rule increased from 70.4% in 2021 to 87.7% in 2022. Increases in compliance were significantly positively correlated with penalty size, which changed from a flat rate to a function of hospital bed counts. Compliance with the requirement, which [...]

July 6, 2023|Categories: hospitals|Tags: hospital price transparency requirement, Hospital price transparency rule|

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