Policy Updates

States Introduce Changes on Medicaid Unwinding

With more than five million people already dropped from state Medicaid rolls and the federal government telling them they are not doing a good job, some states are introducing changes in how they review the eligibility of their Medicaid population as part of the Medicaid unwinding process. With the end of the formal public health emergency and continuous Medicaid eligibility, states have begun the significant challenge of reviewing the eligibility of all of their Medicaid participants. Last month the Centers for Medicare & Medicaid Services sent letters to all 50 states outlining their individual shortcomings in their efforts so far. [...]

iqtsupport2023-08-23T06:00:10-04:00August 23, 2023|Medicaid|

No Surprises Act’s Dispute Resolution Suspended

When a federal court in Texas rejected an increase in the fee for providers to initiate payment challenges under the No Surprises Act’s Independent Dispute Resolution process, the Centers for Medicare & Medicaid Services quickly suspended use of that process while it reviewed the court ruling – suspended both the adjudication of current complaints and the filing of new ones. Almost as quickly, CMS announced that it would reduce the fee required to initiate payment disputes between providers and payers under the 2020 law that sought to prevent surprise medical bills from $350 to $50 – but it did not [...]

iqtsupport2023-08-18T06:00:20-04:00August 18, 2023|Uncategorized|

Hospitals Continue to Protest Medicare DSH Cut

The regulation has already been finalized but hospitals continue to protest Medicare’s intention to reduce their Medicare disproportionate share (Medicare DSH) uncompensated care payments. The cut, proposed at $115 million in April, when the Centers for Medicare & Medicaid Services proposed it, ended up just shy of $1 billion in the final regulation. The major change, according to CMS, comes because the agency’s actuaries have projected a lower uninsured rate than when CMS proposed the $115 million cut in the spring. Medicare DSH payments are intended to help hospitals that care for especially large numbers of uninsured patients with the [...]

iqtsupport2023-08-17T06:00:38-04:00August 17, 2023|Centers for Medicare & Medicaid Services, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Feds Pointing Fingers on Medicaid Unwinding Shortcomings

After months of vague, general assertions about shortcomings in states’ efforts to redetermine the eligibility of their Medicaid participants as part of the post-pandemic continuous Medicaid unwinding process, the federal government is now revealing which states are having problems – and what those problems are. In public letters to the 50 states, the Centers for Medicare & Medicaid Services cites three major shortcomings in states’ efforts: paperwork problems, long call center waiting times, and the slow processing of applications. According to the letters, 36 states are falling short on at least one of these measures and five are failing on [...]

iqtsupport2023-08-16T06:00:38-04:00August 16, 2023|Medicaid|

Federal Health Policy Update for August 10

The following is the latest health policy news from the federal government for August 4-10. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has temporarily suspended the federal Independent Dispute Resolution process, which adjudicates problems involving surprise medical bills, in the wake of a federal court ruling that found some of the process’s underlying regulations invalid. CMS has directed the certified Independent Dispute Resolution entities to pause all dispute resolution activities. As a result, providers and insurers temporarily cannot initiate new disputes. Learn more from this CMS notice. CMS [...]

iqtsupport2023-08-10T16:32:27-04:00August 10, 2023|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for August 3

The following is the latest health policy news from the federal government for July 29-August 3. Some of the language used below is taken directly from government documents. Medicare Payment Regulations CMS has issued a final rule updating Medicare payment policies and rates for inpatient and long-term-care hospital services under its inpatient prospective payment system and long-term care prospective payment system for FY 2024. The final rule increases hospital inpatient rates 3.1 percent and LTCH rates 3.3 percent in FY 2024. Other highlights include a nearly $1 billion cut in Medicare disproportionate share (Medicare DSH) and Medicare DSH uncompensated care [...]

iqtsupport2023-08-03T15:28:05-04:00August 3, 2023|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|

Millions Cut From Medicaid, CHIP Rolls

Nearly four million Americans have already had their Medicaid or CHIP eligibility terminated as part of the so-called Medicaid unwinding process, according to data compiled by KFF Health News from state and federal sources. That figure, moreover, accounts for only 38 states and the District of Columbia. According to the KFF Medicaid Enrollment and Unwinding Tracker, At least 3,790,000 Medicaid enrollees have been disenrolled as of July 27, 2023, based on the most current data from 38 states and the District of Columbia. There is wide variation in disenrollment rates across reporting states, ranging from 82% in Texas to 10% [...]

iqtsupport2023-07-31T12:00:53-04:00July 31, 2023|Medicaid|

Federal Health Policy Update for July 28

The following is the latest health policy news from the federal government for July 21 -28. Some of the language used below is taken directly from government documents. Medicare Payment Regulations CMS has published a final rule to update Medicare payment policies and rates under its inpatient rehabilitation facility (IRF) prospective payment system and IRF quality reporting program for FY 2024. The final rule includes a 3.4 percent rate increase and changes in the outlier threshold, the case-mix-group relative weights and average length of stay values, and the wage index. In addition, this rule rebases and revises the IRF market [...]

iqtsupport2023-07-28T14:28:17-04:00July 28, 2023|Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|

Administration Seeks to Improve Access to Mental Health Care

New regulations introduced by the Department of Health and Human Services would require health insurers to improve access to mental health services for their members. The newly proposed regulations seek to strengthen the 2008 Mental Health Parity and Addiction Equity Act by requiring health care payers to analyze their members’ access to mental health services by looking at their medical management processes, the adequacy of their provider networks, and the rates they pay those providers. This, HHS believes, would help ensure that insured individuals’ access to such services is as good as their access to physical health care services. Insurers [...]

iqtsupport2023-07-27T06:00:29-04:00July 27, 2023|health equity|

HHS Review Questions Medicaid Managed Care Plans

Medicaid managed care plans may be shortchanging their members on care – or so suggests a new review by the Department of Health and Human Services’ Office of the Inspector General. According to the OIG, the Medicaid managed care plans it audited in 37 states rejected one out of every eight requests for prior authorization, with more than ten percent of the audited plans denying prior authorization requests more than 25 percent of the time. Such findings, the OIG concluded, “…raise(s) concerns about health equity and access to care for Medicaid managed care enrollees.” To address this problem, the OIG [...]

iqtsupport2023-07-26T06:00:12-04:00July 26, 2023|Centers for Medicare & Medicaid Services, Medicaid, Medicaid managed care|