Policy Updates

Medicaid Block Grants Hit Bump in Road

The drive toward encouraging states to implement Medicaid block grants hit a bump in the road last week when the formal guidance for states that Centers for Medicare & Medicaid Services administrator Seema Verma suggested was imminent apparently became not-so imminent. At the time Verma spoke, draft guidance from CMS to the states was under review by the federal Office of Management and Budget. Last week, however, CMS withdrew that draft, which also was to address state Medicaid per capita cap programs. The bump in the road does not, however, appear to be more than a temporary detour. While CMS [...]

iqtsupport2019-11-21T06:00:51-05:00November 21, 2019|Medicaid|

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019. According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments. The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments. Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion. CMS maintains that the improper [...]

iqtsupport2019-11-20T06:00:32-05:00November 20, 2019|Centers for Medicare & Medicaid Services, Medicaid|

Improper Medicare Payments Down in FY 2019

The amount of improper Medicare payments made by the federal government fell $7 billion in federal fiscal year 2019, the Centers for Medicare & Medicaid Services reports. FY 2019 marked the third consecutive year that improper fee-for-service payments have fallen. In FY 2018, improper payments accounted for 8.12 percent of Medicare fee-for-service spending but in FY 2019 that portion fell to 7.25 percent. In FY 2019, CMS estimates that it made $28.9 billion in improper fee-for-service payments. $5.32 billion of the $7 billion reduction came through corrective actions in Medicare home health payments. Other Medicare Part B services accounted for [...]

iqtsupport2019-11-19T14:00:06-05:00November 19, 2019|Medicare, Medicare reimbursement policy|

Verma Addresses Medicaid Issues

Earlier this week, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors. In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed: Medicaid demonstration programs Medicaid work requirements a shift toward value-based payments better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare) enrollment issues improvements in the efficiency of the federal Medicaid bureaucracy Read Verma’s complete remarks here.

iqtsupport2019-11-15T06:00:58-05:00November 15, 2019|Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid upper-payment limit|

MACPAC Posts Meeting Transcript

The Medicaid and CHIP Payment and Access Commission met in Washington, D.C. earlier this month. The issues on MACPAC’s agenda were: state readiness to report mandatory core set measures analysis of buprenorphine prescribing patterns among advanced practitioners in Medicaid Medicaid’s statistical information system (T-MSIS) Medicaid disproportionate share hospital payment (Medicaid DSH) allotments Medicaid policies related to third-party liability Medicaid and maternal health A transcript of the MACPAC meeting is now available. Find it here.

iqtsupport2019-11-14T06:00:13-05:00November 14, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Feds Open Door for Exemptions from Medicaid IMD Exclusion

New federal guidelines will make it easier for state Medicaid programs to cover mental health services provided in institutions for mental diseases (IMD). For years, Medicaid regulations greatly limited the ability of states to pay for care – generally, care related to substance abuse disorder treatment – provided in IMDs; this was generally known as the IMD exclusion. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act, which was passed in 2018, opened the door for more exceptions to these limits, and last week, [...]

iqtsupport2019-11-13T06:00:36-05:00November 13, 2019|Centers for Medicare & Medicaid Services, Medicaid|

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: congressional request on health care provider consolidation increasing the supply of primary care physicians redesigning the Medicare Advantage quality bonus program reforming the benchmarks in the Medicare Advantage payment system considerations for plans serving low-income beneficiaries in the restructuring of Medicare Part D post-acute care spending under the Medicare Shared Savings Program MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on [...]

iqtsupport2019-11-12T06:00:16-05:00November 12, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

MACPAC Looks at Medicaid DSH

At a time when cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) are still scheduled for the current fiscal year and some in Congress are calling for a new approach to allotting DSH funds among the states, the Medicaid and CHIP Payment and Access Commission has released its annual analysis of Medicaid DSH allotments to the states. The report includes: data about changes in the uninsured rate demographic information about the uninsured information about the cost of hospital uncompensated care perspectives on hospital Medicaid shortfalls a comparison of hospital uncompensated care costs when calculated using different methodologies data about [...]

iqtsupport2019-11-08T06:00:27-05:00November 8, 2019|hospitals, MACPAC, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

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 Commission devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed. After lunch, MACPAC staff briefed the Commission on [...]

iqtsupport2019-11-07T06:00:47-05:00November 7, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Medicaid Expansion Brings Improvements to Expansion States

States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study. Specifically, they experienced: a 3.1 percent decline in inpatient days a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia a reduction of nearly three percent in hospital costs. Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study “Medicaid Expansion Associated [...]

iqtsupport2019-11-06T06:00:39-05:00November 6, 2019|Affordable Care Act, Medicaid|