Policy Updates

CMS Proposes New Medicaid Managed Care Regulation

Just two years after a major overhaul of Medicaid managed care regulations, the Centers for Medicare & Medicaid Services is again proposing changes in how the federal government regulates the delivery of managed care services to Medicaid beneficiaries. Under the newly proposed regulation, states would: be free to implement more changes in their managed care programs without seeking federal permission; have slightly more flexibility in how supplemental payments are made to hospitals through managed care plans and implement some such changes without federal approval; be permitted to redefine what constitutes an adequate provider network for managed care plans; and not [...]

iqtsupport2018-11-14T06:00:22-05:00November 14, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations|

The Changing of the Congressional Health Care Guard

Last week’s elections will bring to office in January a new majority party in the House and changes in the Senate as well. Changes in leadership are coming in all of the House committees with jurisdiction over health care matters: Energy and Commerce, Ways and Means, Appropriations, and Oversight and Government Reform. New leadership may be coming to the Senate Finance Committee as well. Kaiser Health News has published a look at the relevant committees, their likely new leaders, and the priorities of those new leaders. Find that report here.

iqtsupport2018-11-13T06:00:56-05:00November 13, 2018|Uncategorized|

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|