Medicaid regulations

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. to review a number of Medicaid- and CHIP-related issues. MACPAC members heard presentations on and discussed the following issues: Multistate Collaboration: Panel on State Perspectives Themes from Interviews on the Development of Hospital Payment Policies DSH Payments: Policy Changes and Policy Options Operational Considerations for Work and Community Engagement Requirements Medicaid Coverage of New and High Cost Drugs Managed Care Oversight Oversight of UPL Payments: Additional Analyses and Policy Options Mandated Report: Therapeutic Foster Care Find outlines of these subjects and additional materials by clicking the links [...]

iqtsupport2018-09-25T06:00:56-04:00September 25, 2018|MACPAC, Medicaid, Medicaid managed care, Medicaid regulations|

Hospitals, Others Oppose Easing Medicaid Access Requirements

Hospital groups and other health care interest organizations have expressed strong opposition to a Centers for Medicare & Medicaid Services proposal to ease requirements that states ensure adequate access to care for their Medicaid population. Under current federal Medicaid law, states must periodically review their Medicaid provider networks to ensure that Medicaid recipients have adequate access to care. Under a March CMS proposal, that requirement would exempt states from performing such reviews if at least 85 percent of their Medicaid population is enrolled in a managed care plan and similarly exempt them from reviewing the impact on their provider networks [...]

iqtsupport2018-06-01T06:00:07-04:00June 1, 2018|Medicaid, Medicaid managed care, Medicaid regulations|

HHS Unveils Spring Regulatory Agenda

The U.S. Department of Health and Human Services has published a comprehensive list of the regulatory actions it plans to take in the coming months. Included on the list are regulations that have been proposed, that are being finalized, and that are currently under development. They address Medicare, Medicaid, Food and Drug Administration endeavors, medical devices, the 340B prescription drug discount program, and more. Among the policy changes contemplated through future regulations are measures to reduce regulatory burdens for hospitals, address the opioid problem, facilitate the use of non-Affordable Care Act-compliant health insurance plans, and more. Go here to see [...]

iqtsupport2018-05-14T06:00:28-04:00May 14, 2018|340b, Affordable Care Act, Medicaid, Medicaid regulations, Medicare, Medicare regulations|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP issues, met publicly in Washington, D.C. last week. The following is MACPAC’s own summary of its two days of meetings. The April 2018 meeting began with session on social determinants of health. Panelists Jocelyn Guyer of Manatt Health Solutions, Arlene Ash of the University of Massachusetts Medical School, and Kevin Moore of UnitedHealthcare Community & State discussed state approaches to financing social interventions through Medicaid. In its second morning session, the Commission reviewed a draft [...]

iqtsupport2018-04-23T06:00:05-04:00April 23, 2018|MACPAC, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations|

GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office. Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population. As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches. According to a new GAO study, however, those reports are not always [...]

iqtsupport2018-02-22T06:00:25-05:00February 22, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well. Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including: establishing time limits on how many months or years individuals may be enrolled in Medicaid; locking out for a [...]

iqtsupport2018-02-09T06:00:25-05:00February 9, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Medicare Penalizes Hospitals for Avoidable Injuries, Illnesses

Medicare is reducing payments to 751 hospitals because of the high rate at which their patients have suffered avoidable injuries and illnesses while in the hospital. The penalties come under Medicare’s Hospital-Acquired Condition Reduction Program, which was established by the Affordable Care Act. Among the penalized hospitals, more than half were penalized last year as well 115 are academic medical centers – about one-third of all such facilities more than one-third of all safety-net hospitals were penalized Learn more about the program, the penalties, and why the penalties were assessed in this Kaiser Health News report.

iqtsupport2017-12-26T06:00:25-05:00December 26, 2017|Affordable Care Act, Medicaid regulations|

Hospitals Improving on Medicare Value-Based Measures

U.S. hospitals continue to improve their performance under Medicare’s value-based purchasing program. In FY 2018, 57 percent of hospitals will receive Medicare bonuses from the program, up from 55 percent in FY 2017. Bonuses are generally small but for some hospitals will be more than three percent. Roughly half of all hospitals will experience changes in their Medicare base rates. The worst performers will see their payments decline 1.65 percent. In FY 2018, hospitals that succeed in the program will share $1.9 billion in bonus payments. Funding for those payments in this budget-neutral program comes from CMS withholding two percent [...]

iqtsupport2017-11-10T06:00:07-05:00November 10, 2017|Medicaid regulations, Medicare|

CMS Shares Vision for Medicaid

Medicaid is about to undergo major changes, CMS administrator Seema Verma outlined in a news release yesterday and in a speech to state Medicaid directors. According to the news release, those changes include: re-establishing a state-federal partnership that Verma believes has become too much federal and not enough state giving states greater freedom to innovate offering new guidelines for how states can align their individual programs with federal Medicaid objectives new guidance on section 1115 waivers longer section 1115 waivers with simpler review processes CMS willingness to consider proposals to impose work requirements on Medicaid beneficiaries Medicaid and CHIP “scorecards” [...]

iqtsupport2017-11-08T13:00:50-05:00November 8, 2017|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

New Rules Facilitate Integration of Physical, Behavioral Care

New federal regulations are facilitating better integration of physical and behavioral health services for the Medicaid population. Two developments, in particular, are advancing this integration: the 2016 Medicare managed care rule and a 2016 rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Together, these rules encourage providers to perform comprehensive assessments of their patients, increase flexibility for providers in how they use Medicaid payments, and pave the way for improvements in the use of information technology that foster better integration of physical and behavioral medical care. A new issue brief from the Commonwealth Fund presents in [...]

iqtsupport2017-10-31T06:00:27-04:00October 31, 2017|Medicaid managed care, Medicaid regulations|