Centers for Medicare & Medicaid Services

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|

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|

Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C. During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health. Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on [...]

iqtsupport2019-10-31T13:00:29-04:00October 31, 2019|Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Verma Hints at More Medicaid Changes, Deregulation

Stay tuned for more Medicaid changes, Centers for Medicare & Medicaid Services administrator Seema Verma told a Las Vegas health care gathering last week. CMS, she told her audience, will …soon outline new opportunities for states to flip the Medicaid paradigm and free themselves from federal micromanagement. While Verma offered few details, one idea clearly emerged: there will be more deregulation. She insisted, for example, that Medicaid work requirements are not dead. While such requirements have run into trouble in the courts in recent months, she explained that CMS is developing new implementation guidelines to address some of the challenges [...]

iqtsupport2019-10-31T06:00:04-04:00October 31, 2019|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Court Upholds Delay of Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled. A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change. The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it [...]

iqtsupport2019-10-22T06:00:38-04:00October 22, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

CMS Adopts Methodology for Medicaid DSH Cuts

Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services. But it is not clear when that new methodology may actually be used. Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans. While this has been the case, the decline in the number of uninsured has not been as great as expected. For this reason, Congress has on several [...]

iqtsupport2019-09-25T10:47:09-04:00September 25, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Court Halts Medicare Site-Neutral Payment Changes

The Centers for Medicare & Medicaid Services did not have the authority to implement the site-neutral payment system for Medicare-covered outpatient services that it introduced last year, a federal court has concluded. According to the court, CMS exceeded its authority because it …was not authorized to ignore the statutory process for setting payment rates in the Outpatient Prospective Payment System and to lower payment rates only for certain services provided by certain providers. In general, hospitals oppose the movement toward site-neutral payments and independent physician groups support it. The court did not order CMS to reimburse affected physician practices for [...]

iqtsupport2019-09-19T06:00:43-04:00September 19, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, Medicare reimbursement policy|

Stakeholders Respond to CMS “Patients Over Paperwork” RFI

More than 400 stakeholders responded to the federal government’s request for ideas to reduce the administrative burden associated with serving publicly insured patients. The request was disseminated via a Centers for Medicare & Medicaid Services request for information that was part of the agency’s “Patients over Paperwork” initiative. Among the groups that responded were the American Hospital Association, The American Association of Colleges of Nursing, the Critical Access Hospital Coalition, the Coalition of Long-Term Acute-Care Hospitals, the National Rural Association of Rural Health Clinics, the American Academy of Ophthalmology, the American Academy of Family Physicians, the American Hospital Association, and [...]

iqtsupport2019-08-16T10:27:17-04:00August 16, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

CMS Chief Criticizes Health Care Proposals

In an address to the Better Medicare Alliance 2019 Medicare Advantage Summit, Centers for Medicare & Medicaid Services Administrator Seema Verma criticized Medicare for All proposals, said Medicare “public option” proposals are no better, and called the Affordable Care Act a failure,. Verma also insisted that greater reliance on market forces would improve Medicare and Medicaid, said the 340B prescription drug program is harming the health care system, and called for a reduction of federal regulations that limit how and where people can receive care. She said reduced regulations have spurred hundreds of new plans to participate in the Medicare [...]

iqtsupport2019-07-23T10:10:59-04:00July 23, 2019|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare regulations|

CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services. In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals. Now, CMS proposes rescinding this requirement, writing in a news release that This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries. CMS anticipates [...]

iqtsupport2019-07-16T10:33:57-04:00July 16, 2019|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|