Policy Updates

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 March 2023 MACPAC meeting began with a staff presentation on potential recommendations for countercyclical disproportionate share hospital (DSH) allotments. Medicaid DSH payments offset hospital uncompensated care costs for Medicaid-enrolled and uninsured patients. During economic recessions, Medicaid enrollment and the number of people who are uninsured increases. During the October 2022 MACPAC meeting, Commissioners agreed that a countercyclical policy should be implemented during future economic recessions, and asked for additional analyses of the effects [...]

iqtsupport2023-03-10T06:00:08-05:00March 10, 2023|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations for long-term care|

MedPAC Meets

The government agency that advises Congress on Medicare payment matters met publicly in Washington, D.C. last week. During the virtual meeting, members of the Medicare Payment Advisory Commission discussed: reforming Medicare’s wage index system addressing the high prices of drugs covered under Medicare Part B a prototype design for a post-acute care prospective payment system favorable selection and future directions for Medicare Advantage payment policy aligning fee-for-service payment rates across ambulatory care settings MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding on either Congress or the administration, MedPAC is [...]

iqtsupport2023-03-09T13:00:37-05:00March 9, 2023|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, post-acute care|

Hospitals Seek Delay in Medicaid DSH Cuts

“Delay upcoming cuts in Medicaid DSH payments” is the message hospitals delivered to Congress recently in response to a reduction of $8 billion in Medicaid disproportionate share cuts scheduled to take effect on October 1. The cuts, mandated by the Affordable Care Act, have been delayed by Congress on several occasions over the years in response to the belief that far more people remain uninsured than was anticipated when the 2010 health care reform law was adopted. According to proponents of the delay, the safety-net hospitals that receive Medicaid DSH payments continue to provide free care to significant numbers of [...]

iqtsupport2023-03-09T06:00:35-05:00March 9, 2023|hospitals, Medicaid disproportionate share, Medicaid DSH|

Administration to Propose Extending Medicare Solvency and Lowering Beneficiary Costs

Later this week the Biden administration will offer proposals that seek to extend the solvency of the Medicare Trust Fund and reduce beneficiaries’ health care costs. As part of the proposed FY 2024 federal budget the administration will present this week, it will call for extending the solvency of the Medicare Trust Fund by increasing the Medicare tax rate on income greater than $400,000 a year; closing loopholes in current Medicare taxes and depositing Medicare net investment income tax proceeds into the Medicare Trust Fund; and crediting savings from proposed prescription drug reforms to that same trust fund. To reduce [...]

iqtsupport2023-03-08T13:00:58-05:00March 8, 2023|Medicare|

Seven Apply for Rural Emergency Hospital Designation

With more than 140 rural hospitals closing since 2010 and more currently in financial trouble, a modest number of such facilities are hoping to avoid a similar fate by applying to the Centers for Medicare & Medicaid Services to become “rural emergency hospitals,” a new Medicare provider type created to preserve access to care in rural areas. Hospitals that become rural emergency hospitals will receive an annual fee of more than $3 million from Medicare and a five percent increase in their Medicare payments but must retain 24-hour emergency services while limiting their inpatient services to leave just enough time [...]

iqtsupport2023-03-08T06:00:26-05:00March 8, 2023|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for March 3

The following is the latest health policy news from the federal government for February 27 to March 3. Some of the language used below is taken directly from government documents. No Surprises Act The Independent Dispute Resolution (IDR) entities empowered by the No Surprises Act to adjudicate disagreements between providers and payers may resume their work – but only some of it. CMS has directed IDRs entities to resume processing payment determinations on February 27 for disputes involving items or services furnished before October 25, 2022 but not to issue decisions involving items or services furnished on or after October [...]

iqtsupport2023-03-03T13:20:02-05:00March 3, 2023|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, MedPAC, Telehealth|

Medicaid Programs See Roadmap for Unwinding

With the end of the COVID-19 pandemic’s continuous Medicaid eligibility coming on April 1, the states now face the challenge of reviewing the eligibility of 90 million people currently on the nation’s Medicaid rolls. The process, commonly referred to as “Medicaid unwinding,” promises to be challenging to states and current Medicaid participants. While the federal government has provided considerable guidance on how Medicaid unwinding should proceed, the National Association of Medicaid Directors has ideas of its own that it has presented on the organization’s blog. Specifically, the group suggests to its members a three-part approach to tackling Medicaid unwinding. Phase [...]

iqtsupport2023-03-02T06:00:28-05:00March 2, 2023|Medicaid|

CMS Proposes Regulation Governing Medicare DSH

The Centers for Medicare & Medicaid Services has proposed altering its regulations governing the calculation of eligible hospitals’ Medicare disproportionate share payments (Medicare DSH). According to CMS, This proposed rule would revise our regulations on the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital's disproportionate patient percentage. This is essentially the same change CMS included in its proposed FY 2022 and FY 2023 inpatient prospective payment system rules and then did not adopt in the final rule. In proposing this change again CMS suggests that this [...]

iqtsupport2023-03-01T06:00:58-05:00March 1, 2023|Centers for Medicare & Medicaid Services, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations|

Some Surprise Billing Dispute Decisions to Resume

The Independent Dispute Resolution entities empowered by the No Surprises Act of 2020 to adjudicate disagreements between providers and payers may resume their work – but only some of it. According to the Centers for Medicare & Medicaid Services, On February 24, 2023, certified IDR entities were instructed to resume processing payment determinations on February 27, 2023, for disputes involving items or services furnished before October 25, 2022. But CMS also announced that Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further [...]

iqtsupport2023-02-28T06:00:13-05:00February 28, 2023|Uncategorized|

The Emergence of “Food as Medicine”

In both the public and private sectors, a growing movement is working to integrate food as part of medical treatment – and have health care payers foot the bill. From the administration’s granting of Medicaid waivers to Arkansas, Massachusetts, and Oregon to use state and federal money to pay for food for some beneficiaries to Congress tucking $2 million into an appropriations bill for a “food is medicine pilot program” to the NIH developing a $140 million grant program that will lead to the designation of “food is medicine centers of excellence,” providers and policy-makers are showing unprecedented interest in [...]

iqtsupport2023-02-27T06:00:08-05:00February 27, 2023|health equity, Medicaid, Medicare, social determinants of health|