Policy Updates

Election Brings Good News for Medicaid

Medicaid came out on top in elections throughout the country last week. With the arrival of a Democratic majority in the House, attempts to repeal the Affordable Care Act, including its Medicaid expansion, appear to have come to an end – at least for now. Voters in three states approved ballot questions to expand their states’ Medicaid programs. And two states elected governors likely to expand their states’ Medicaid programs. Learn more about what the mid-term elections meant to Medicaid and its future in this Washington Post story.

iqtsupport2018-11-12T06:00:13-05:00November 12, 2018|Medicaid|

North Carolina Proposal Could be Precedent-Setting

Under a new proposal by North Carolina’s state treasurer, health care for state employees could be reimbursed based on a percentage of Medicare rates. North Carolina’s State Health Plan insures more than 700,000 state employees and public school teachers, and under the proposal, doctors, hospitals, and other providers that participate in the plan would agree to accept an as-yet unstated percentage of Medicare rates. The state treasurer estimates that this approach would save the State Health Plan $300 million a year and save plan participants another $60 million a year. According to North Carolina Health News, the state’s hospitals are [...]

iqtsupport2018-11-09T06:00:39-05:00November 9, 2018|Uncategorized|

CMS Releases New Home Health Regulation for 2019

A new regulation will bring changes in how Medicare pays for and regulates home health services in 2019. Included in the regulation released last week are: A 2.2 percent increase in home health payments. Creation of remote patient monitoring benefit for home health patients. Creation of a home infusion benefit. Removal of some measures from the home health quality reporting program. Changes in the home health value-based purchasing model. For a complete look at the changes coming to how Medicare will treat home health services in 2019, go here to see a CMS fact sheet on the new regulation and [...]

iqtsupport2018-11-07T06:00:06-05:00November 7, 2018|Medicare regulations, Medicare reimbursement policy|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s November agenda were: MedPAC’s mandated report on long-term care hospitals patient functional assessment data used in Medicare payment and quality measurement modifying advanced alternative payment model (A-APM) payments modifying the Medicare-dependent hospital program promoting greater Medicare-Medicaid integration in dual-eligible special-needs plans the Medicare Advantage quality bonus program Medicare Advantage encounter data MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on either Congress or the [...]

iqtsupport2018-11-06T06:00:50-05:00November 6, 2018|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

New Home Health Reg Brings Changes

A new home health care regulation finalized by the Centers for Medicare & Medicaid Services brings major changes in how Medicare will pay for home health services in the future. In addition to updating Medicare payment rates, the new rule also: introduces a new home health payment system called the Patient-Driven Groupings Model that de-emphasizes the volume of care provided; authorizes Medicare payments for remote patient monitoring; adds a new home infusion therapy benefit; and reduces the amount of quality data home health providers must report. To learn more about the new regulation, which takes effect on January 1, 2019, [...]

iqtsupport2018-11-02T06:00:49-04:00November 2, 2018|Centers for Medicare & Medicaid Services, Medicare regulations, Medicare reimbursement policy|

CMS Proposes Increasing Use of Telehealth by Medicare Advantage Plans

Medicare Advantage plans would be authorized to make greater use of telehealth services under a new regulation to be proposed by the Centers for Medicare & Medicaid Services. The proposal, part of a broader regulation addressing a variety of Medicare programs, would authorize wider use of telehealth services in caring for Medicare Advantage enrollees while improving provider payments for those services. According to a CMS fact sheet about the proposed regulation, The Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” not otherwise available in Original Medicare to enrollees starting in plan year 2020. Under this [...]

iqtsupport2018-10-31T06:00:06-04:00October 31, 2018|Medicare, Medicare regulations, Medicare reimbursement policy|

MACPAC: Let’s “hit the pause button” on Medicaid Work Requirements

The non-partisan legislative branch agency that advises Congress and the administration on Medicaid issues will ask the administration to delay approving any more state Medicaid work requirements. That was the decision reached by the Medicaid and CHIP Payment and Access Commission when it met last week. MACPAC warned that the work requirement currently being implemented in Arkansas, the first state to introduce such a requirement, is flawed and needs further work before moving forward. The agency also believes the federal government should increase its oversight of new Medicaid work requirements before additional states begin implementing similar, already-approved Medicaid work requirements. [...]

iqtsupport2018-10-30T06:00:17-04:00October 30, 2018|Medicaid, Medicaid regulations|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The October 2018 MACPAC meeting covered a range of front-line issues in Medicaid, leading off with an analysis of disproportionate share hospital (DSH) allotments on Thursday morning. Following the analysis, the Commission discussed options for March recommendations on how to structure DSH allotment reductions that are scheduled to begin in fiscal year 2020. The Commission later resumed the discussion it began in September on work and community engagement requirements, presenting new data from Arkansas [...]

iqtsupport2018-10-29T06:00:58-04:00October 29, 2018|Medicaid, Medicaid regulations|

APM Use Rising

Alternative payment models now account for more than one-third of health care payments, according to a new analysis. Leading the way is Medicare Advantage plans, which expend nearly half of their Medicare payments through APMs. Learn more about this trend in health care delivery and payments in the report “APM Measurement: Progress of Alternative Payment Models,” which was prepared by the Health Care Payment Learning & Action Network and can be found here.

iqtsupport2018-10-26T06:00:53-04:00October 26, 2018|Alternative payment models|

House Members Protest Site-Neutral Payment Proposal

138 members of the House of Representatives have written to Centers for Medicare & Medicaid Services administrator Seema Verma to protest CMS’s proposal to extend Medicare outpatient site-neutral payment policies to off-campus, provider-based outpatient departments specifically exempted from such policies by Congress under the Bipartisan Budget Act of 2015. In questioning CMS’s rationale for the proposed policy, the House members wrote that It is unclear how CMS has deemed all of the OPD [outpatient department] services at the grandfathered off-campus HOPDs [hospital outpatient departments] as cause of an unnecessary increase in volume of OPD services, and we ask you to [...]

iqtsupport2018-10-25T06:00:25-04:00October 25, 2018|Medicare regulations, Medicare reimbursement policy|