Policy Updates

Number of Uninsured Children on the Rise

The number of children insured by Medicaid and CHIP has fallen by more than one million over the past two years after reaching an all-time low (by percentage) in 2016. Why? According to the New York Times, Some state and federal officials have portrayed the drop — 3 percent of enrolled children — as a success story, arguing that more Americans are getting coverage from employers in an improving economy. But there is growing evidence that administrative changes aimed at fighting fraud and waste — and rising fears of deportation in immigrant communities — are pushing large numbers of children [...]

iqtsupport2019-10-23T06:00:06-04:00October 23, 2019|Medicaid|

Court Upholds Delay of Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled. A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change. The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it [...]

iqtsupport2019-10-22T06:00:38-04:00October 22, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Grassley Questions Aspects of Graduate Medical Education

Graduate medical education is the subject of inquiry in a recent letter from Senate Finance Committee chairman Charles Grassley to Health and Human Services Secretary Alex Azar. In his letter to Secretary Azar, Senator Grassley asks for information about how federal GME money is spent and how much is spent, how federal money factors into the broader financing of hospital residency programs, and how the federal government ensures that GME programs engage in best practices. The letter also questions whether the indirect benefits of operating medical education programs are factored into how much the federal government spends on medical education, [...]

iqtsupport2019-10-21T06:00:09-04:00October 21, 2019|Medicare|

Immigrants Intimidated by New Public Charge Guidelines?

Immigrants served by community health centers appear less inclined than in the past to seek public aid to help them with their medical problems. And community health center staff believes this is the result of confusion and fear as a result of changing federal immigration policies. As stated in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients,” Health centers reported that, in recent months, immigrant patients have declined to enroll or reenroll themselves and/or their children in Medicaid for fear of public charge. Health center respondents [...]

iqtsupport2019-10-16T06:00:49-04:00October 16, 2019|Medicaid, Medicaid regulations|

No Primary Doc Shortage for Medicare Patients – at Least Not Yet

Medicare patients currently have adequate access to primary care physicians, according to the Medicare Payment Advisory Commission. But that could change in the near future, MedPAC warns. Amid long-term concerns about whether there are enough primary care doctors, a new MedPAC report found that there are even fewer primary care doctors than most people believe. MedPAC reached this conclusion after finding that approximately one out of every five doctors thought to be working as primary care physicians now labor instead as hospitalists. As a result, growth in the number of primary care physicians has been negligible during the current decade. [...]

iqtsupport2019-10-09T06:00:54-04:00October 9, 2019|Medicare, MedPAC|

Most Hospitals Hit With Medicare Readmissions Penalties

Nearly 2600 hospitals will be penalized by Medicare in FY 2020 for excessive patient readmissions under Medicare’s hospital readmissions reduction program, according to the Centers for Medicare & Medicaid Services. In all, 83 percent of hospitals covered by the program will be penalized, forfeiting up to three percent of their Medicare payments with an average penalty of 0.71 percent of those payments. The cumulative penalties for these hospitals will amount to $563 million in FY 2020. In all, 1177 hospitals will be penalized more than they were last year and 1148 will be penalized less. 56 hospitals will be assessed [...]

iqtsupport2019-10-08T06:00:52-04:00October 8, 2019|Medicare, Medicare reimbursement policy|

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 October agenda were: restructuring Medicare Part D improving Medicare payment for low-volume and isolated outpatient dialysis facilities updates to the methods used to assess the adequacy of Medicare’s payments for physicians and other health professionals population-based outcome measures: avoidable hospitalizations and emergency department visits aligning benefits and cost-sharing under a unified payment system for post-acute care policy options to modify the hospice aggregate cap MedPAC is an independent congressional agency that advises Congress on issues involving the [...]

iqtsupport2019-10-07T06:00:37-04:00October 7, 2019|Medicaid, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

New in Medicaid Medical Transportation: Uber and Lyft

State Medicaid programs focused on ensuring that beneficiaries keep their doctor appointments are increasingly looking to ride-sharing services to supplement the providers already participating in their medical transportation programs. Today, Lyft is working with approximately 35 state Medicaid programs while Uber, at least so far, participates only in Arizona’s program. While ride-sharing is not going to replace other medical transportation programs – for one thing, most Uber and Lyft cars are not equipped to serve individuals with serious disabilities – they can help supplement services that today typically require patients to reserve rides days ahead of time and then share [...]

iqtsupport2019-10-03T09:48:35-04:00October 3, 2019|Medicaid|

ACA May be Improving, Saving Lives

The insurance expansion made possible by the Affordable Care Act may be improving and even saving lives, some studies and anecdotal evidence suggest. While observers warn that it is difficult to attempt to render a final verdict on the reform law’s insurance expansion and its impact, various studies and observations point to encouraging developments. Among them: High blood pressure is being detected at a higher rate now among people who bought insurance as a result of the ACA than it was prior to the law’s passage. Fewer 19-26 year-olds, now permitted to remain on their parents’ health insurance, are choosing [...]

iqtsupport2019-10-02T15:48:44-04:00October 2, 2019|Affordable Care Act, Medicaid|

CMS Adopts Methodology for Medicaid DSH Cuts

Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services. But it is not clear when that new methodology may actually be used. Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans. While this has been the case, the decline in the number of uninsured has not been as great as expected. For this reason, Congress has on several [...]

iqtsupport2019-09-25T10:47:09-04:00September 25, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|