Policy Updates

Medicare Site-Neutral Outpatient Payment Proposal Would Have Disproportionate Impact

The Centers for Medicare & Medicaid Services’ proposal to make more Medicare outpatient payments on a site-neutral basis would significantly cut Medicare’s overall outpatient spending but most of that cut would be borne by just a few hospitals. A report prepared for the Integrated Health Care Coalition concluded that …CMS’ Off-Campus Site-Neutral Proposal in the FY 2019 CMS OPPS [note: outpatient prospective payment system] NPRM [note: notice of proposed rulemaking] will disproportionate affect about six percent of 3,333 hospitals that participate in the program. 200 hospitals will shoulder 73 percent of the proposed payment reductions….For the top 200, the average [...]

iqtsupport2018-10-05T06:00:43-04:00October 5, 2018|hospitals, Medicare regulations|

DSRIP Evolves

Medicaid Delivery System Reform Incentive Payment waivers, unleashed by the Affordable Care Act and other Obama administration initiatives, sought to foster a greater focus on value in the delivery of health care. Medicaid DSRIP waivers typically provided new Medicaid funds to health care organizations that met performance goals for improving the quality of care, improving health care outcomes, and improving health care infrastructure in ways that improved care quality and outcomes. To a significant extent, early DSRIP programs helped protect Medicaid payments to hospitals that were jeopardized by hospital-specific and state-wide upper-payment limit problems. State DSRIP initiatives are now moving [...]

iqtsupport2018-10-04T06:00:03-04:00October 4, 2018|Medicaid|

Verma Speaks at Medicaid Managed Care Summit

Centers for Medicare & Medicaid Services administrator Seema Verma recently addressed the Medicaid Managed Care Summit, which was held in Washington, D.C. Ms. Verma’s speech focused on four major areas: Empowering states to function as laboratories for innovation by giving them the flexibility to introduce changes that work best for their own citizens. Developing Medicaid and CHIP scorecards that present data on health outcomes, quality metrics, and CMS’s administrative performance. Improving Medicaid program integrity, including through “…targeted audits to ensure that provider claims for actual health care spending match what the [Medicaid managed care] health plans are reporting financially.” Strengthening [...]

iqtsupport2018-10-03T06:00:33-04:00October 3, 2018|Medicaid managed care|

OIG: Medicare Advantage Plans May be Denying Access to Save Money

The Office of the Inspector General of the U.S. Department of Health and Human Services is concerned that Medicare Advantage plans may be denying their members access to services to save money and increase profits. According to the OIG, those Medicare Advantage plans overturn 75 percent of their own denials of service upon appeal and independent reviewers are overturning still more denials. In the OIG’s view, this high rate of service denials raises concerns that Medicare Advantage plans, which today serve more than 20 million seniors, are denying their members access to needed medical services so they can cut costs [...]

iqtsupport2018-10-02T06:00:41-04:00October 2, 2018|Medicare|

New Approach to Readmissions Program to Take Effect October 1

Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals. The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve. The readmissions performance of hospitals is then compared only to other hospitals within each peer group. As [...]

iqtsupport2018-10-01T06:00:29-04:00October 1, 2018|Medicare, Medicare regulations|

State Court Upholds Non-Profit Hospital Tax Exemption

The Illinois Supreme Court has ruled in favor of non-profit hospitals in response to a challenge to their exemption from local property taxes. Upholding a 2016 lower court ruling, the state Supreme Court affirmed that non-profit hospitals’ charitable expenditures can be used to offset their local property tax liabilities. Learn more about the court’s decision in this article in Crain’s Chicago Business.

iqtsupport2018-09-28T06:00:35-04:00September 28, 2018|hospitals|

Operating Margins Lag for Non-Profit Hospitals

Non-profit hospitals’ operating margins fell from a median of 2.8 percent in 2016 to 1.9 percent in 2017, according to Fitch Ratings. Non-profit hospitals’ profitability also declined. Despite this, Fitch finds that these hospitals have strong balance sheets, with cash on hand and cash-to-debt ratios rising in the past year. It warns, though, that continuing declines in operating margins could eventually threaten those healthy balance sheets. Learn more about Fitch’s analysis in this summary of its ratings report.

iqtsupport2018-09-27T06:00:41-04:00September 27, 2018|hospitals|

Nursing Home Occupancy Declines

Nursing home occupancy fell to 81.7 percent during the second quarter of 2018, according to the National Investment Center for Seniors House & Care. Among the reasons for this decline in the use of skilled nursing facilities are policy changes that seek to shorten length of stay and competition from home health services and assisted living facilities. Occupancy among seniors enrolled in Medicare Advantage plans has been flat, with those living in urban areas more than twice as likely to spend time in skilled nursing facilities than those who reside in rural areas. Learn more about this latest trend in [...]

iqtsupport2018-09-26T06:00:39-04:00September 26, 2018|Medicare post-acute care|

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|

CMS Proposes Easing Regulatory Requirements

In a newly proposed rule, the Centers for Medicare & Medicaid Services proposes easing the regulatory burden on health care providers. The proposed regulation, which weighs in at 285 pages, covers a broad range of government regulation of health care providers and would, CMS projects, save hospitals more than $1 billion a year while cutting millions of hours of administrative work. Learn more about what CMS proposes by reading its fact sheet on the proposed regulation or going here to see the proposed regulation itself.

iqtsupport2018-09-24T06:00:42-04:00September 24, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations|