Policy Updates

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C. During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects: a Medicare Advantage status report a Medicare prescription drug program (Part D) status report hospital inpatient and outpatient payments physician payments ambulatory surgical center, dialysis center, and hospice payments post-acute care facility payments the hospital readmissions reduction program telehealth accountable care organizations Go here to see the issue briefs and presentations used during the meetings.

iqtsupport2018-01-18T06:00:18-05:00January 18, 2018|Accountable Care Organization, ACO, Medicare, Medicare post-acute care, MedPAC|

Administration Lays Groundwork for Medicaid Work Requirements

The Centers for Medicare & Medicaid Services has issued guidelines for states interested in adding a work requirement component to their Medicaid programs. With nearly a dozen states applying to implement controversial Medicaid work requirements, CMS has issued a guidance letter to state Medicaid directors outlining the criteria it will use when considering such applications. The new policy does not mandate work requirements in state Medicaid programs; it only presents the parameters CMS will use when considering the applications of states wishing to impose such requirements. For more information about the new policy, see the following resources: CMS’s news release [...]

iqtsupport2018-01-16T06:00:52-05:00January 16, 2018|Centers for Medicare & Medicaid Services, Medicaid|

A New Use for Section 1115 Medicaid Waivers?

Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility. But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations. According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid. In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of [...]

iqtsupport2018-01-16T06:00:16-05:00January 16, 2018|Centers for Medicare & Medicaid Services, Medicaid|

E&C Calls for Action on 340B

The section 340B prescription drug program has flaws and needs change, a report by the House Energy and Commerce Committee has concluded. The program, which requires pharmaceutical companies to provide discounts on prescription drugs to be dispensed on an outpatient basis to qualified providers that serve large numbers of low-income patients, has been controversial in recent years. As the number of providers eligible for the program has grown, pharmaceutical companies have claimed that the program is expensive, is being abused, and is responsible for driving up prescription drug costs while providers insist that 340B is a vital tool in helping [...]

iqtsupport2018-01-12T06:00:38-05:00January 12, 2018|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|

CMS Unveils New Bundled Payment Program

The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.” Under this new program – participation in which will be voluntary – participants can, as CMS explains …earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. The following are a few highlights of BPCI Advanced. It encompasses 32 types of clinical episodes (29 inpatient and three outpatient). These episodes, of 90 days, may change in the future. Participating providers can waive the Medicare requirement [...]

iqtsupport2018-01-11T06:00:30-05:00January 11, 2018|Centers for Medicare & Medicaid Services, Medicare|

Medicaid Expansion Helps Save Hospitals

Hospitals in states that took advantage of the Affordable Care Act to expand their Medicaid programs are six times less likely to close than hospitals in non-expansion states. And the impact of Medicaid expansion is even more beneficial for hospitals that serve rural communities. These are among the new findings in a new study that examines the effect of Medicaid expansion on hospital finances and hospital closures. Among those findings, We found that the ACA’s Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of [...]

iqtsupport2018-01-10T06:00:57-05:00January 10, 2018|Affordable Care Act, hospitals, Medicaid|

Report Looks at Work Requirements

As a growing number of states consider implementing work requirements as a condition for Medicaid eligibility, the Urban Institute has released a report that describes work requirements in various government cash assistance, nutrition assistance, and housing assistance programs and considers the degree to which those requirements have achieved their policy objectives. The report also describes the applications that eight states have submitted to the federal government seeking permission to introduce a work requirement in their Medicaid programs. Go here to see the Urban Institute report Work Requirements in Social Safety Net Programs: A Status Report of Work Requirements in TANF, [...]

iqtsupport2018-01-09T06:00:48-05:00January 9, 2018|Medicaid|

The Telehealth Trend

Patients, insurers (including government), and providers are all looking toward telehealth as a means of enhancing access to care and improving the health of people. In recognition of this trend, the web site Healthcare Finance News has published a series of articles looking at telehealth: Growing demand for telemedicine fueling multibillion dollar market growth Telemedicine can lower costs for health systems by $24 a patient, study finds CMS to waive restrictions to reimburse for telemedicine in the joint replacement payment model Almost all large employers plan to offer telehealth in 2018, but will employees use it? Why telehealth is fueling [...]

iqtsupport2018-01-08T06:00:05-05:00January 8, 2018|Uncategorized|

Medicare Penalizes Hospitals for Avoidable Injuries, Illnesses

Medicare is reducing payments to 751 hospitals because of the high rate at which their patients have suffered avoidable injuries and illnesses while in the hospital. The penalties come under Medicare’s Hospital-Acquired Condition Reduction Program, which was established by the Affordable Care Act. Among the penalized hospitals, more than half were penalized last year as well 115 are academic medical centers – about one-third of all such facilities more than one-third of all safety-net hospitals were penalized Learn more about the program, the penalties, and why the penalties were assessed in this Kaiser Health News report.

iqtsupport2017-12-26T06:00:25-05:00December 26, 2017|Affordable Care Act, Medicaid regulations|

Medicaid Directors Meet

The National Association of Medicaid Directors held its fall conference recently outside Washington, D.C. This is an important event at which policy-makers and policy experts meet to discuss Medicaid programs, trends, challenges, and opportunities. Many of the materials used during that conference are now publicly available, including video clips from speeches by CMS Administrator Seema Verma and others and presentations on a number of subjects, including: delivering care across rural and frontier America Medicaid’s role in supporting community engagement and economic mobility busting the silos of physical and behavioral health care alternative payment models and addressing the social determinants of [...]

iqtsupport2017-12-21T06:00:09-05:00December 21, 2017|Medicaid|