Policy Updates

Proposed Public Charge Regulation Causes Confusion in Clinics, Elsewhere

A Trump administration proposal to redefine what constitutes a “public charge” is making life challenging for low-income immigrants and the clinics and other providers to which they turn for Medicaid-covered health care. The proposed regulation from the Department of Homeland Security would establish new criteria for determining whether a person is a “public charge,” based on their participation in certain public programs, and therefore in jeopardy of losing their legal immigration status. Some Medicaid patients who come to clinics ask if receiving Medicaid-covered services might jeopardize their legal immigration status; others fail to keep appointments or forego seeking care out [...]

iqtsupport2019-01-23T06:00:04-05:00January 23, 2019|Medicaid|

S&P: Stable 2019 for Non-Profit Hospitals

Non-profit hospitals should experience a relatively stable 2019, according to S&P Global Financial. The bond-rating company estimates that 81 percent of such hospitals will be stable this year, with roughly equal numbers of hospitals looking at upgrades and downgrades. This stability is being driven by strong balance sheets and diversification while challenges to hospital financial performance and stability include the possibility of a recession, rising costs for serving an aging population, changes in Medicaid eligibility and payment policies, and the continued emergence of non-traditional health care providers. S&P also concludes that hospital operating margins are recovering after years of investment [...]

iqtsupport2019-01-22T06:00:30-05:00January 22, 2019|hospitals|

Could Medicaid Buy-In Push Aside Medicare for All?

Officials in ten states are giving consideration, in one form or another, to permitting uninsured low-income residents to buy into their Medicaid programs. So while Washington considers the possibility of Medicare for all, the ten states – Nevada, New Mexico, California, Delaware, Oregon, Washington, Connecticut, Illinois, Minnesota, and Wisconsin – are tackling the many issues they must address if they intend to pursue such a ground-breaking option. Among them: Who would be eligible to participate? What benefits would be offered? Would health plans be available on Affordable Care Act health exchanges, and if so, would ACA subsidies be available to [...]

iqtsupport2019-01-21T06:00:06-05:00January 21, 2019|Medicaid|

“Oh Say Can We See?”: Ways & Means Leaders Seek CMMI Transparency

The chairman and ranking member of the House Ways and Means Committee have written to CMS administrator Seema Verma to ask her to address the lack of transparency in the Center for Medicare and Medicaid Innovation. In the bipartisan letter, committee chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX) note that “…Congress established CMMI to test different innovative delivery system and payment models to improve quality and reduce costs for Medicare and Medicaid beneficiaries” but observe that “…significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the [...]

iqtsupport2019-01-18T06:00:19-05:00January 18, 2019|Center for Medicare and Medicaid Innovation|

New ACO Incentive: Exemption From 3-Day Stay SNF Requirement

In an effort to encourage more Medicare accountable care organizations to assume financial risk for the care of their patients, the Centers for Medicare & Medicaid Services is extending its exemption from the three-day inpatient stay requirement before Medicare ACOs can discharge their patients to skilled nursing facilities to ACOs participating in selected ACO model programs that involve two-sided risk under preliminary prospective assignment with retrospective reconciliation. This move expands the waiver from the three-day SNF requirement that ACOs that assume greater financial risk already receive. Details about the new policy, including the ACO models that qualify for this exemption [...]

iqtsupport2019-01-17T06:00:00-05:00January 17, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

End Run Around Congress for Medicaid Block Grants?

The Trump administration reportedly is considering introducing Medicaid block grants through regulations rather than legislation, according to published reports. Those reports explain that the administration may seek to offer states an opportunity to apply to the federal government to use Medicaid block grants by obtaining section 1115 Medicaid waivers, a commonly used tool for states seeking exemptions from federal legislative or regulatory requirements. As reported by the online publication The Hill, …the Trump administration is now considering issuing guidance to states encouraging them to apply for caps on federal Medicaid spending in exchange for additional flexibility on how they run [...]

iqtsupport2019-01-16T06:00:01-05:00January 16, 2019|Centers for Medicare & Medicaid Services, Medicaid|

New Client

DeBrunner & Associates is pleased to welcome our newest client: AristaCare Health Services, a provider of post-acute rehabilitation, memory care, and long-term-care services based in Cranford, New Jersey. Welcome!

iqtsupport2019-01-15T06:00:07-05:00January 15, 2019|Uncategorized|

Readmissions Reduction Program Results Overstated?

A new study suggests that the encouraging results of Medicare’s hospital readmissions reduction program may not actually be as encouraging as people thought. According to a new study published in the journal Health Affairs, data on reduced readmissions may be more the result of changes in hospital coding practices than improved quality performance by hospitals. The report suggests that new industry standards for reporting were implemented at roughly the same time Medicare launched the value-based purchasing program and may account for most or even all of the reported improved performance by hospitals. Learn more from the Health Affairs study “Decreases [...]

iqtsupport2019-01-14T06:00:42-05:00January 14, 2019|Medicare, Medicare reimbursement policy|

Hospital Uncompensated Care Unchanged in 2017

Despite a modest increase in the uninsured rate, hospital uncompensated care in 2017 was $38.4 billion, essentially the same as it was in 2016 and down from the all-time high of $46.8 billion in 2013. This comes from an American Hospital Association survey that also found that in 2017, hospital admissions and inpatient days rose modestly hospital outpatient visits and surgeries increased emergency room visits declined the proportion of for-profit hospitals declined the number of rural hospitals fell Learn more in the Healthcare Dive article “Uncompensated care costs flat in 2017 despite uptick in uninsured.”

iqtsupport2019-01-11T06:00:13-05:00January 11, 2019|hospitals|

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report. According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially. The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices. Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers [...]

iqtsupport2019-01-09T14:43:28-05:00January 9, 2019|Medicaid managed care|