Policy Updates

Some Readmissions From Nursing Homes to Hospitals Hard to Avoid

Improvements in the delivery of care cannot prevent some skilled nursing facility patients from being readmitted to hospitals, a new study has concluded. According to the study, when advanced practice nurses brought best practices to 16 nursing homes participating in a Medicare pilot program, they enjoyed considerable success reducing hospital readmissions but found themselves unable to stop some, including readmissions caused by residents or their families calling ambulances on their own; patients refusing treatment and then demanding hospitalization because of the effects of the denied treatment; and patients in hospice deciding they want surgery. These were among the findings in [...]

iqtsupport2019-06-07T06:00:44-04:00June 7, 2019|Medicare post-acute care|

Administration Ramps Up Scrutiny of Immigrants’ Use of Public Benefits

Immigrants’ sponsors could be more likely to be held financially responsible for the cost of public benefits those immigrants receive under a new memorandum issued by the White House. The requirement itself is not new; the purpose of the memorandum is to encourage federal agencies to enforce existing laws that state that, according to the memorandum, …when an alien applies for certain means-tested public benefits, the financial resources of the alien’s sponsor must be counted as part of the alien’s financial resources in determining both eligibility for the benefits and the amount of benefits that may be awarded. Financial sponsors [...]

iqtsupport2019-06-06T06:00:08-04:00June 6, 2019|Medicaid, Medicaid regulations|

Proposed Immigration Rule Discourages Medicaid Enrollment

A proposal by the U.S. Department of Homeland Security is discouraging participation in Medicaid and other government safety-net programs. A proposed Homeland Security regulation would establish new criteria for determining whether individuals seeking admission into the U.S. might eventually become “public charges”: people who would depend on public resources to meet their needs rather than the resources of friends, family, sponsors, or private organizations or be able to provide for themselves or their families. Among those criteria are past use of government aid programs and current income and health status. Since the regulation was proposed last October, many legal immigrants, [...]

iqtsupport2019-06-03T15:21:21-04:00June 3, 2019|Medicaid|

Medicaid Waiver Process Often Lacks Transparency, GAO Finds

States’ applications for federal Medicaid waivers often lack transparency, according to a new report by the U.S. Government Accountability Office. According to the GAO, the chief problem with the transparency of state applications for Medicaid waivers arises when states either seek to amend waivers they have already obtained or amend waiver applications currently under review by the Centers for Medicare & Medicaid Services. Too often, the GAO found, states neither subject such amendments to public review and comment nor adequately explain to stakeholders the implications of the amendments they are proposing. To address this problem, the GAO recommends that CMS [...]

iqtsupport2019-05-23T09:52:40-04:00May 23, 2019|Medicaid|

More Medicaid Matching Funds for Only Partial Medicaid Expansion?

The federal government is considering providing an unusual amount of federal Medicaid matching funding for only partial state Medicaid expansion. At least that’s what Centers for Medicare & Medicaid Services administrator Seema Verma told a health care conference in Georgia last week. The state of Georgia has proposes partially expanding its Medicaid population. Under the Affordable Care Act, states that fully expand their Medicaid programs under the terms established by the 2010 health care law receive nine dollars in federal matching funds for every one dollar they spend on their Medicaid expansion population. States that only partially expand their Medicaid [...]

iqtsupport2019-05-15T06:00:11-04:00May 15, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid|

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs. Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests. According to a recent post on the CMS blog (in CMS’s own words), Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note: state plan amendments]. Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016. Between calendar year 2016 [...]

iqtsupport2019-05-14T06:00:36-04:00May 14, 2019|Centers for Medicare & Medicaid Services, Medicaid|

New Poverty Level Standards to Jeopardize Medicaid Eligibility?

The Trump administration is considering changing how the federal government measures inflation for the purpose of calculating the federal poverty level. Such a change, if implemented, could potentially reduce inflation-related increases in the federal poverty level, which in turn could limit the ability of some individuals and families to qualify, or continue to qualify, for a variety of public safety-net services – including, potentially, Medicaid. Among the possible alternatives to the current methodology for calculating inflation is the Chained Consumer Price Index for All Urban Consumers. The Obama administration also explored substituting this index for the current inflation factor. The [...]

iqtsupport2019-05-13T06:00:02-04:00May 13, 2019|Medicaid|

MACPAC Seeks Input on IMDs

A 2018 law calls for the Medicaid and CHIP Payment and Access Commission to report to Congress on institutions for mental diseases, or IMDs, receiving Medicaid payments. The law specifies that MACPAC solicit input from a variety of sources, including the Centers for Medicare & Medicaid Services, state Medicaid and mental health agencies and authorities, Medicaid insurers, Medicaid advocates, and others. To help fulfill this requirement, MACPAC is now soliciting views from stakeholders. Among the many subjects on which MACPAC seeks input are (in MACPAC’s words), state requirements, including certification, licensure and accreditation applied to IMDs seeking Medicaid payment and [...]

iqtsupport2019-05-10T06:00:59-04:00May 10, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

CMS Outlines Improvements in RAC Audit Processes

In the face of complaints from hospitals about backlogs, time-consuming procedures, and lengthy appeals processes involving Medicare Recovery Audit Contractor audits, the Centers for Medicare & Medicaid Services recently outlined changes it has implemented in the RAC audit process to address these and other concerns. They are (in CMS's own words): Better Oversight of RACs We are holding RACs accountable for performance by requiring them to maintain a 95% accuracy score. RACs that fail to maintain this rate will receive a progressive reduction in the number of claims they are allowed to review. We also require RACs to maintain an [...]

iqtsupport2019-05-09T06:00:15-04:00May 9, 2019|Centers for Medicare & Medicaid Services, Medicare|

Are Savings Baked Into Medicare Advantage?

Medicare Advantage plans spend less for their members’ care than traditional Medicare – even when beneficiaries switch from traditional Medicare to a Medicare Advantage plan. This spending trend, moreover, applies to all types of Medicare beneficiaries, even after risk adjustment, regardless of age, gender, or dual-eligibility. It even applies to beneficiaries with chronic medical conditions, according to a recent study. Why the difference? The study’s authors suggest “favorable self-selection.” Past studies have suggested that Medicare Advantage plans’ care management components are responsible for reduced costs but this study casts that theory in doubt. Another theory is that the provider networks [...]

iqtsupport2019-05-08T13:00:45-04:00May 8, 2019|Medicare|