Policy Updates

The Role of Medicaid in Addressing Social Determinants of Health

Medicaid can play a major role in addressing the social determinants of health. Or so argues a recent post on the Health Affairs Blog. According to the post, social determinants of health – income, education, decent housing, access to food, and more – significantly influence the health and well-being of individuals – including low-income individuals who have adequate access to quality health care. Medicaid, the post maintains, can play a major role in addressing social determinants of health. The post outlines the role state Medicaid programs can play in addressing social determinants of health; describes tools for such action such [...]

iqtsupport2019-07-10T06:00:27-04:00July 10, 2019|Medicaid|

Study Finds Surprise in Sources of Medicaid, CHIP Growth

While enrollment in Medicaid and CHIP has been greatest among low-income families working full-time for small businesses, growth in Medicaid and CHIP among low-income families employed full-time by big businesses has been rising faster in recent years. According to a new study published in the journal Health Affairs, Medicaid and CHIP enrollment among low-income families employed full-time by large companies rose from 45 percent to 69 percent between 2008 and 2016. The driving force behind this growing reliance on public insurance appears to be the shift of health insurance costs from companies to employees: employee share of health insurance premiums [...]

iqtsupport2019-07-08T14:40:03-04:00July 8, 2019|Medicaid|

CMS Outlines New Medicaid Program Integrity Activities

The federal government will introduce a number of initiatives to combat Medicaid waste, fraud, and abuse in the coming months. In an article on the Centers for Medicare & Medicaid Services’ blog, CMS administrator Seema Verma outlined her agency’s major Medicaid program integrity efforts of the past year, including: Oversight of state Medicaid claiming and program integrity Disallowing unallowable claims of federal funding Increased audits and oversight Data sharing and partnerships Education, technical assistance, and collaboration Reducing improper payments Initiatives to be introduced in the coming months include (as described in the blog post): A proposed comprehensive update to Medicaid’s [...]

iqtsupport2019-07-03T10:12:38-04:00July 3, 2019|Centers for Medicare & Medicaid Services, Medicaid|

Readmissions Higher for Medicare Advantage Patients

Medicare Advantage patients are more likely to be readmitted to the hospital for existing medical problems than participants in traditional Medicare, a new study has found. According to a report published in the Annals of Internal Medicine, Medicare Advantage patients suffering from acute myocardial infarction, congestive heart failure, and pneumonia were readmitted to hospitals because of those medical problems at slightly higher rates than patients served by traditional Medicare. Learn more from the Annals of Internal Medicine study “Hospital Readmission Rates in Medicare Advantage and Traditional Medicare: A Retrospective Population-Based Analysis” and the Healthcare Dive article “MA patients' readmission rates [...]

iqtsupport2019-07-01T06:00:15-04:00July 1, 2019|Medicare|

MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year. The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation: inpatient- and outpatient drug- and device related payment proposals proposed changes in the hospital area wage index the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet the long-term hospital prospective payment system MedPAC is [...]

iqtsupport2019-06-26T06:00:55-04:00June 26, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, MedPAC, post-acute care|

MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress. Included in the report are sections on: Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties. Restructuring Medicare Part D for the era of specialty drugs. Medicare payment strategies to improve price competition and value for Part B drugs. MedPAC’s mandated report to Congress on clinician payments. Issues in Medicare beneficiaries’ access to primary care. Assessment of the Medicare Shared Savings Program’s effect on Medicare spending. Ensuring the accuracy and completeness of Medicare Advantage encounter data. Redesigning the Medicare Advantage quality bonus [...]

iqtsupport2019-06-19T11:57:26-04:00June 19, 2019|Alternative payment models, Centers for Medicare & Medicaid Services, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Surprise! Teaching Hospitals Cost Less Than Non-Teaching Hospitals

30-day and episode-of-care costs are lower for care provided by major teaching hospitals than they are for other teaching hospitals and non-teaching hospitals. Or so concludes a new study published by JAMA Open Network. According to the study: Major teaching hospitals’ initial hospitalization costs are higher. Major teaching hospital costs are less than other hospitals after 30 days of care and over entire episodes of care. Major teaching hospitals’ costs are similar to those of other teaching hospitals and non-teaching hospitals over a 90-day episode of care. Major teaching hospitals’ patients incurred lower costs for post-acute care. Major teaching hospitals [...]

iqtsupport2019-06-13T06:00:38-04:00June 13, 2019|hospitals, Medicare|

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services. In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve” reporting and documentation requirements coding and documentation requirements for Medicare or Medicaid payment prior authorization procedures policies and requirements for rural providers, clinicians, and beneficiaries policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries beneficiary enrollment and eligibility determination CMS processes for issuing regulations and policies Comments are [...]

iqtsupport2019-06-12T06:00:42-04:00June 12, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

PACE Regulation Updated

PACE programs will have new flexibility under a recent update of regulations governing Programs of All-Inclusive Care. As described by the National Association of Medicaid Directors, the new regulation Allows PACE team members to fulfill multiple roles on the care team; Allows certain non-physician providers to serve in the place of primary care physicians on the care team; Clarifies that PACE programs offering prescription drug benefits are subject to Medicare Part D regulations; Eliminates requirements for PACE organizations to seek waivers for several of the most commonly waived aspects of PACE regulation; and Updates CMS's enforcement actions to promote accountability [...]

iqtsupport2019-06-11T06:00:59-04:00June 11, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

ACA Tied to Reduced Disparities in Cancer Care

Improved access to health insurance has led to reduced racial disparities in the diagnosis and treatment of cancer. As reported by the Washington Post, According to researchers involved in the racial-disparity study, before the ACA went into effect, African Americans with advanced cancer were 4.8 percentage points less likely to start treatment for their disease within 30 days of being given a diagnosis. But today, black adults in states that expanded Medicaid under the law have almost entirely caught up with white patients in getting timely treatment, researchers said. Another study found that since the reform law’s implementation in Medicaid [...]

iqtsupport2019-06-10T06:00:04-04:00June 10, 2019|Affordable Care Act, Medicaid|