Medicaid

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts. But that may be changing. The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care [...]

iqtsupport2017-12-04T06:00:13-05:00December 4, 2017|Medicaid|

Telehealth on the Upswing

A number of recent developments suggest that serving patients with the assistance of telehealth services will become more commonplace in the near future. The Medicare MACRA and MIPS payment programs will include new billing codes for telehealth services, according to regulations published earlier this month. Also earlier this month, the House passed legislation, The Vets Act (H.R. 2123), that would authorize the Veterans Administration to make greater use of telehealth. And when the U.S. Department of Health and Human Services’ Office of the Inspector General recently announced plans to audit Medicaid programs for telehealth payments, it cited among its reasons [...]

iqtsupport2017-11-28T06:00:17-05:00November 28, 2017|Medicaid, Medicare, Medicare regulations|

Medicaid Retroactive Eligibility: A Dying Practice?

A growing number of states are ending or limiting retroactive eligibility for Medicaid: the practice of Medicaid reimbursing providers for the care they deliver to Medicaid-eligible patients for up to three months even if those patients had not previously enrolled in Medicaid. Arkansas, Indiana, and New Hampshire have ended the practice for some categories of Medicaid patients and Iowa joined them on November 1. In addition, Delaware, Maryland, Massachusetts, and Utah impose some limits on retroactive Medicaid eligibility for at least some Medicaid-eligible individuals. While the purpose of retroactive eligibility ostensibly is to ensure a health care safety-net for low-income [...]

iqtsupport2017-11-16T06:00:09-05:00November 16, 2017|Medicaid|

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|

CMS Offers States New Medicaid Path for Opioid Treatment

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance to states advising them on how they can use section 1115 Medicaid waivers to improve access to treatment for Medicaid recipients struggling with opioid abuse problems. According to the 14-page guidance letter from CMS to state Medicaid directors, CMS is now offering a more flexible, streamlined approach to accelerate states’ ability to respond to the national opioid crisis while enhancing states’ monitoring and reporting of the impact of any changes imsplemented through these demonstrations. As the opioid crisis continues to raise alarm and highlight the need for better [...]

iqtsupport2017-11-08T06:00:52-05:00November 8, 2017|Centers for Medicare & Medicaid Services, Medicaid|

Despite Uncertainty, States Plan to Raise Medicaid Rates

Even though events in Washington leave the future of Medicaid unclear, 44 states still intend to raise at least some of their Medicaid rates in 2018. Inpatient payments to hospitals are not among the major targets of the planned rate increases: only 17 states plan to increase Medicaid inpatients payments while the others plan to keep those rates as they are or even reduce them. Learn more about trends in Medicaid enrollment, spending, and rates in the Kaiser Family Foundation’s annual survey of state Medicaid programs, the results of which can be found here.

iqtsupport2017-10-26T06:00:12-04:00October 26, 2017|Medicaid|

Braving the Unknown, States Increase Medicaid Benefits

Despite the prospect of Congress and the administration enacting major reductions of federal Medicaid spending as part of repealing and replacing the Affordable Care Act, more than half the states expanded their Medicaid programs in 2017 and many plan to do so in 2018 as well. In all, 26 states expanded or enhanced Medicaid benefits this year while 17 plan to do so next year. Most of the changes involve enhancing mental health and substance abuse treatment services. Learn more about expanded Medicaid benefits in the face of anticipated reductions in Medicaid spending in this Healthcare Finance News report.

iqtsupport2017-10-23T06:00:49-04:00October 23, 2017|Medicaid|

Suit Claims Low Medicaid Rates are Discriminatory

A lawsuit filed in state courts in California argues that the state’s low Medicaid payments amount to discrimination against the state’s large Hispanic Medicaid population. California pays among the lowest rates in the country to physicians, making health care inaccessible for some, and the suit maintains that this is a civil rights issue in which low rates amount to discrimination. The suit is based on state anti-discrimination and equal protection laws, and many other states have similar laws on the books. Observers question whether the low rates constitute discrimination against the suit’s Hispanic plaintiffs because the low rates affect the [...]

iqtsupport2017-10-03T10:00:05-04:00October 3, 2017|Medicaid|

GAO: Improvement Needed in MLTSS Oversight

The Centers for Medicare & Medicaid Services needs to improve the job it does overseeing state Medicaid programs of managed long-term services and supports. According to a new report by the U.S. Government Accountability Office, 22 states use MLTSS programs to help qualified seniors continue living independently in the community and to save money on nursing home costs. CMS’s oversight of these efforts, and of the use of federal funds, is inconsistent and often falls short when monitoring key considerations such as provider network adequacy, critical incidents, and appeals and grievances. To address these concerns, the GAO recommends that CMS [...]

iqtsupport2017-09-21T06:00:37-04:00September 21, 2017|Medicaid, Medicaid long-term services and supports|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. Among the issues MACPAC commissioners discussed during their two-day meeting were: delivery system reform incentive payment programs Medicaid enrollment and renewal processes managed care oversight monitoring and evaluating section 11115 demonstration waivers Medicaid coverage of telemedicine services MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues. It is a non-partisan agency of the legislative branch of government. Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during [...]

iqtsupport2017-09-20T06:00:11-04:00September 20, 2017|MACPAC, Medicaid, Medicaid managed care, Medicaid regulations|