Medicaid

Rural Hospitals Losing Money, Slashing Services, Mulling Future

Roughly half of rural hospitals lost money last year, according to a new report. Those struggles, moreover, are not a one-time thing: more than 40 percent were in the same position a year ago and more such hospitals are expected to be in this position a year from now. The problem is worse, moreover, for hospitals in states that did not take advantage of the Affordable Care Act option of expanding their Medicaid programs. In response to these challenges, some rural hospitals are discontinuing services like obstetrics – a serious challenge for hospitals located in isolated communities; exploring Medicare’s new [...]

joe2024-03-13T14:54:41-04:00March 13, 2024|hospitals, Medicaid, Medicare|

Federal Health Policy Update for March 7

The following is the latest health policy news from the federal government for March 1-7. Some of the language used below is taken directly from government documents. Congress On Wednesday, March 16 the House passed, by a vote of 339-85, the first package of spending bills to fund some federal agencies through the remainder of the 2024 federal fiscal year. The House bills include several health care provisions extending programs that were set to expire on Friday, March 8. The bills would extend the following provisions and programs through December 31, 2024: The continued delay of cuts to Medicaid disproportionate [...]

joe2024-03-07T21:42:53-05:00March 7, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for February 29

The following is the latest health policy news from the federal government for February 23-29. Some of the language used below is taken directly from government documents. Congress This afternoon the House passed H.R. 7463, which changed the dates for the March 1 and March 8 funding deadlines to March 8 and March 22 and includes no new health care policies. Health care extenders included in the current continuing resolution, including the delay to Medicaid DSH cuts, are not included in the bill that passed the House; the March 8 expiration date still applies to those extenders. The new continuing [...]

joe2024-02-29T22:41:47-05:00February 29, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy|

Medicaid DSH Cut In, Medicare Site-Neutral Payments Out of Health Bill?

With Congress at a stalemate on spending legislation, lawmakers are considering a narrower scope of issues to address in near-term health care legislation. According to published reports, scheduled cuts in Medicaid disproportionate share allotments to states (Medicaid DSH), already delayed several times, could be delayed once again. In addition, a proposal to require Medicare to pay for outpatient services on a site-neutral basis, rather than paying higher rates to hospital-based outpatient departments higher rates, might not be included. Also under consideration: restoring some cuts in Medicare’s payments to physicians and additional funding for community health centers. Also in jeopardy at [...]

joe2024-02-27T18:53:55-05:00February 28, 2024|Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy|

New Way of Calculating Medicaid DSH

Hospitals will soon see federal regulators take a new approach to calculating their Medicaid DSH payments. Specifically, their Medicaid disproportionate share hospital-specific payment limit. A new CMS regulation changes how third-party payments are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. That limit, in turn, affects hospitals’ Medicaid DSH payments. This final rule implements changes CMS proposed last year to comply with a congressional mandate to include in the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limits only costs and payments for services furnished to beneficiaries for whom Medicaid is the primary payer; this means [...]

joe2024-02-23T16:37:23-05:00February 26, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH|

Federal Health Policy Update for February 22

The following is the latest health policy news from the federal government for February 16-22. Some of the language used below is taken directly from government documents. CMS and Medicaid DSH Payments CMS has published a final rule governing how third-party payers are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. This change requires that the calculation be based solely on Medicaid costs and payments and that costs and payments associated with dually eligible (Medicare and Medicaid) patients be excluded from the calculation of that limit. The effect of this change is that hospitals that are [...]

joe2024-02-22T22:00:03-05:00February 22, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Proposal Would Establish New “Essential Health System” Designation

The newly proposed “Reinforcing Essential Health Systems for Communities Act” would create a new federal hospital designation that would create a mechanism for directing more federal resources to safety-net hospitals that care for more low-income and uninsured patients. The bipartisan bill, sponsored by Representatives Lori Trahan (D-MA) and David Valadao (R-CA), would, according to Rep. Trahan, … provide federal lawmakers with the avenues necessary to target funding and resources to these critical facilities – just as we’ve done with other types of hospitals that serve specific populations or regions. Hospitals would qualify for “essential health system” status by meeting one [...]

joe2024-02-20T17:02:55-05:00February 20, 2024|Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for February 15

The following is the latest health policy news from the federal government for February 9-15. Some of the language used below is taken directly from government documents. Department of Health and Human Services HHS has released a 2023 update of its Equity Action Plan. The plan outlines five priority areas to advance equity: prevent neglect and improve care to help children thrive in their families and communities; promote accessible and welcoming health care for all; improve maternal health outcomes for rural, racial, and ethnic minority communities; prioritize the behavioral health of underserved populations; and increase clinical research and trial diversity [...]

joe2024-02-15T20:56:54-05:00February 15, 2024|health equity, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy|

Looming Medicaid Challenges

State Medicaid programs are facing significant financial challenges in the coming years. Among them: less federal Medicaid matching money, a continued call by providers for increased payments, and a growing demand to use Medicaid to help address behavioral health challenges. In addition, proponents of investing more Medicaid money in home- and community-based services can be expected to ask state Medicaid programs to cover more services while those programs face a growing demand to use Medicaid resources to address social determinants of health such as poor housing and hunger. At the same time, large numbers of individuals continue to fall off [...]

joe2024-02-13T19:59:13-05:00February 15, 2024|Medicaid, Medicaid and homelessness, Medicaid and housing, social determinants of health|

Millions Dropped From Medicaid Rolls

With the two-year “Medicaid unwinding” process nearly half complete, 9.5 million Americans have lost their Medicaid coverage – among them more than 3.7 million children. To date, 48 million of the 71 million people enrolled in Medicaid at pandemic’s end have had their eligibility reviewed. So far, many of those who were at first ruled ineligible were dropped for procedural reasons, such as failing to file paperwork on time, but many of those people eventually had their benefits restored. Still, estimates that 15 million people would lose their Medicaid eligibility by the time the process ended appear to be overlying [...]

joe2024-02-08T22:22:10-05:00February 13, 2024|Medicaid|