Policy Updates

HHS Chief Derides Medicare Wage Index System

U.S. Department of Health and Human Services Secretary Alex Azar criticized the current Medicare area wage index system during a hearing of the Senate Finance Committee last week. Reminding senators that he told them last year that they need to revise the system and warning that HHS’s ability to change it is limited without legislation, Azar referred to the system as an “absurdity” as individual senators pointed out what they view to be inequities in the system that hurt hospitals in their own states. Medicare’s area wage index system adjusts Medicare payments to hospitals based on geographic differences in the [...]

iqtsupport2019-03-21T06:00:01-04:00March 21, 2019|Medicare, Medicare regulations|

MACPAC Makes DSH, UPL Recommendations

Changes could come in Medicaid DSH and UPL payments if new MACPAC recommendations are adopted. Last week the Medicaid and CHIP Payment and Access Commission released its annual report to Congress, with most of the report focusing on its analysis and recommendations for policy updates involving Medicaid disproportionate share hospital payments (Medicaid DSH) and Medicaid upper payment limit payments (UPL payments). With Affordable Care Act-mandated cuts in Medicaid DSH payments scheduled to start in FY 2020 – this coming October – MACPAC recommended that these cuts be reduced and phased in over a longer period of time “…to give states [...]

iqtsupport2019-03-20T13:00:48-04:00March 20, 2019|hospitals, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid upper-payment limit|

HHS Talking to States About Medicaid Block Grants

In the absence of legislation to turn Medicaid into a block grant program, the U.S. Department of Health and Human Services is talking to some states about granting waivers that permit them – voluntarily – to turn their individual Medicaid programs into block grants. HHS Secretary Alex Azar acknowledged this last week during a hearing of the Senate Finance Committee. He did not disclose which states, or how many, with which HHS has had such discussions and he also noted that his staff is talking to state officials about waivers to permit them to adopt Medicaid per capita spending limits. [...]

iqtsupport2019-03-20T06:00:51-04:00March 20, 2019|Medicaid|

MedPAC Offers Recommendations on FY 2020 Rates, More

Last week the Medicare Payment Advisory Commission released its annual report to Congress. Included in this report are MedPAC’s Medicare rate recommendations for the coming year. They are: hospital inpatient rates – a two percent increase hospital outpatient rates – a two percent increase physician and other health professional services rates – no update skilled nursing facilities – no 2020 increase home health agencies – a five percent rate reduction inpatient rehabilitation facilities – a five percent rate reduction long-term-care hospital services – a two percent increase hospice services – a two percent rate reduction MedPAC also recommended that the [...]

iqtsupport2019-03-19T06:00:37-04:00March 19, 2019|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, Uncategorized|

“Rejected” Medicaid Reforms May Resurface

Partial Medicaid expansion, desired by some Republican governors but rejected by the Trump administration last year, may not be so rejected after all. At least not according to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, which oversees the federal Medicaid program. In a recent interview, Verma said the administration is reconsidering its rejection of partial Medicaid expansion, an idea she supports and that What I have said to states and to governors [is] “Tell me what you want to do, and it’s my job to help you get to where you want to go.” To emphasize [...]

iqtsupport2019-03-18T06:00:23-04:00March 18, 2019|health care reform, Medicaid|

MedPAC Discusses ED Coding Changes

Members of the Medicare Payment Advisory Commission discussed the possibility of recommending to Congress that it call for national guidelines for how hospitals code emergency department services. The change may be needed, the commissioners suggested at their March meeting, because hospitals have gravitated toward coding for higher intensity services as time passes. Such a change, if implemented, could result in less emergency department revenue for some hospitals. Learn more in the Healthcare Dive article “MedPAC eyes changes to ED coding, Part B drug pricing.”

iqtsupport2019-03-15T06:00:51-04:00March 15, 2019|Medicare, MedPAC|

Sneak Preview of Medicaid Spending Limits?

The imposition of spending limits for individual Medicaid recipients has been discussed in Washington policy circles for years and was offered in the White House’s recent FY 2020 budget proposal. While deliberations on such a proposal have never advanced in a meaningful way, the state of Utah is doing more than talking about such an approach: it has petitioned the Centers for Medicare & Medicaid Services for a Medicaid waiver that would enable it to introduce such a system in its state Medicaid program. Under the state’s proposed Medicaid waiver, Utah asks the federal government to limit its own Medicaid [...]

iqtsupport2019-03-14T13:00:42-04:00March 14, 2019|Medicaid|

Administration Asks if Providers Should Reveal Negotiated Rates

A proposed regulation published by the Centers for Medicare & Medicaid Services asks stakeholders if they believe hospitals, doctors, and other providers should be required to share with their patients the rates they are paid by insurers for services, medical devices, prescription drugs, and more. Such transparency, on one hand, would give consumers a better sense of the cost of the services they receive and how their insurers reimburse providers for those costs. Providers, suppliers, and insurers, on the other hand, might be concerned about the loss of what they have come to regard as confidential, proprietary information. Hospitals are [...]

iqtsupport2019-03-14T06:00:19-04:00March 14, 2019|Medicare regulations|

MedPAC Debates Post-Acute Payments

As the Centers for Medicare & Medicaid Services continues to develop a unified payment system for all post-acute-care providers, Congress’s advisors on Medicare payment policy appear ready to weigh in on an important aspect of such a system: Whether payments should be based on entire episodes of care or individual stays in post-acute-care facilities. And at least for now, the Medicare Payment Advisory Commission is leaning toward recommending that post-acute-care payments be based on individual stays. At their March public meeting, MedPAC commissioners expressed concern that post-acute-care payments based on entire episodes of care might create financial incentives for providers [...]

iqtsupport2019-03-13T14:55:27-04:00March 13, 2019|Medicare post-acute care, MedPAC|

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. MACPAC looked ahead to its June 2019 report to Congress on the initial day of the March 2019 Commission meeting. In the morning, sessions focused on potential recommendations to create a grace period for states to determine coverage policies for outpatient prescription drugs and removing or raising the rebate cap; a uniform definition of therapeutic foster care; and treatment of third-party payment when determining hospitals’ Medicaid shortfall for disproportionate share hospital payments. In the [...]

iqtsupport2019-03-13T06:00:16-04:00March 13, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|