Policy Updates

Hundreds of Hospitals Penalized for Medical Mistakes

786 hospitals will see their Medicare payments slashed one percent for a year because of their performance under Medicare’s hospital-acquired conditions reduction program. That program penalizes the 25 percent of hospitals with the highest rate of patient safety problems, such as infections and injuries. Among the more interesting aspects of this year’s program results: Among those being penalized are seven of the 21 hospitals on the S. News “best hospitals” list. Three hospitals also on that list have never been penalized. 145 hospitals will be penalized for the first time. 16 hospitals that have been penalized every year since the [...]

iqtsupport2020-02-05T06:00:24-05:00February 5, 2020|Medicare, Medicare regulations, Medicare reimbursement policy|

Not Surprisingly, Higher Medicaid Rates Improve Access

Higher Medicaid payments for substance abuse disorder treatment lead to better access to such treatment, a new report by the U.S. Government Accountability Office has concluded. According to the study, which focused on six states, State officials and SUD [substance abuse disorders] providers in the selected states with larger rate changes reported greater effects on SUD service availability compared to those in states with smaller changes. For example, state officials said that larger rate increases helped increase the number of SUD providers participating in Medicaid, but did not generally note SUD service availability effects for smaller rate increases. Providers in [...]

iqtsupport2020-02-04T06:00:57-05:00February 4, 2020|Medicaid|

CMS Introduces New Approach to Medicaid Block Grants

States would be able to convert part of their Medicaid programs into block grants under a new program introduced by the federal government. The program, which the Centers for Medicare & Medicaid Services calls “Healthy Adult Opportunity,” would encompass services only for adults under the age of 65 who are not eligible for Medicaid because of disability or the need for long-term care, services, and supports and who are not otherwise eligible for the pre-Affordable Care Act Medicaid program. Under the program, states can develop either a total expenses model or per enrollee model for their block grants and would [...]

iqtsupport2020-01-31T06:00:43-05:00January 31, 2020|Affordable Care Act, Medicaid|

Supreme Court Lifts Public Charge Rule Ban

The U.S. can now reject visa and green card applicants based on their financial prospects after a new Supreme Court ruling this week. This ruling has potential long-term implications for health care providers. Last August a new Department of Homeland Security regulation took effect that authorized the federal government to reject immigrants’ applications for visas and green cards if their financial situation and employment prospects suggested that they might become a “public charge” and dependent on government safety-net programs like Medicaid and food stamps. A number of groups sued to prevent the rule’s implementation and federal courts imposed an injunction [...]

iqtsupport2020-01-30T06:00:23-05:00January 30, 2020|hospitals, Medicaid|

GAO Finds Obstacles to Treatment for Opioid Abuse

Several obstacles get in the way of Medicaid patients receiving treatment for opioid use and addiction. So concludes the U.S. Government Accountability Office in a recent study. According to the GAO, the barriers to Medicaid patients receiving medication-assisted treatment for opioid use and addiction – a combination of behavioral therapy and certain medications – include: The failure of state Medicaid programs to cover such services. GAO found that 40 percent of state Medicaid programs do not cover certain drugs widely used to treat opioid addiction. Prior authorization requirements can slow the process of patients receiving the treatment they need. Some [...]

iqtsupport2020-01-29T06:00:28-05:00January 29, 2020|Medicaid|

340B Doesn’t Drive Up Hospital Drug Spending, MedPAC Says

Hospitals do not prescribe more expensive drugs because they know the 340B program will help pay for them. That is the conclusion drawn in a recent analysis by the Medicare Payment Advisory Commission. Prescription drug spending has risen markedly in recent years and the pharmaceutical industry maintains that part of that increase can be attributed to hospitals that participate in the section 340B prescription drug discount program, which requires pharmaceutical companies to give discounts to hospitals and other selected providers that care for especially large numbers of low-income patients. A new analysis by the Medicare Payment Advisory Commission, however, concludes [...]

iqtsupport2020-01-28T09:36:25-05:00January 28, 2020|340b, MedPAC|

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 January agenda were: The Medicare prescription drug program (Part D): status report and options for restructuring Redesigning the Medicare Advantage quality program: initial modeling of a value incentive program Hospital inpatient and outpatient payments Physician payments Outpatient dialysis payments Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments Hospice and ambulatory surgery center payments The 340B program ACO beneficiary assignment MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. [...]

iqtsupport2020-01-22T06:00:06-05:00January 22, 2020|Accountable Care Organization, ACO, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

States Not Waiting for Feds to Act on More Affordable Health Insurance

Frustrated over the inability of the federal government to develop and implement policies that make health insurance more affordable, a number of states are taking matters into their own hands in a variety of ways. In 2018 and 2019 at least a dozen states enacted policies designed to make health insurance more affordable. Among the steps they took where: premium stabilization programs requirements to maintain adequate coverage financial assistance to improve coverage affordability regulation of non-Affordable Care Act-compliance coverage rules to promote marketplace competition state coverage options standard plan designs open enrollment extensions transitional policies Learn more about what states [...]

iqtsupport2020-01-21T06:00:27-05:00January 21, 2020|Affordable Care Act|

GAO: Feds Need Better Oversight of 340B Eligibility

The federal government needs to do a better job of ensuring that non-government hospital participants in the 340B prescription drug discount program are eligible for that program, the U.S. Government Accountability Office concluded in a recent report. With growing numbers of non-government hospitals now participating in the 340B program, the GAO found that the federal Health Resources and Services Administration, which oversees the program, is not doing enough to ensure that these hospitals meet the criteria for inclusion in the program. In particular, the GAO found, HRSA needs to do more to ensure that such hospitals have valid contracts with [...]

iqtsupport2020-01-17T06:00:47-05:00January 17, 2020|340b|

Medicaid Expansion Slows Opioid Deaths

Opioid deaths are less likely to occur in states that expanded their Medicaid programs under the Affordable Care Act, according to a new study. According to the study, Adoption of Medicaid expansion was associated with a 6% lower rate of total opioid overdose deaths compared with the rate in nonexpansion states... Counties in expansion states had an 11% lower rate of death involving heroin… and a 10% lower rate of death involving synthetic opioids other than methadone… compared with counties in nonexpansion states. In addition, Medicaid expansion, the study found, has made treatment for substance abuse disorders more widely available. [...]

iqtsupport2020-01-16T06:00:49-05:00January 16, 2020|Affordable Care Act, Medicaid|