Policy Updates

CMS Authorizes Waiving of Some Medicare Coronavirus Fees

Medicare Advantage organizations, Medicare Part D plans, and Medicare-Medicaid managed care plans have been directed by the Centers for Medicare & Medicaid Services to waive cost-sharing for testing and treatment of the novel coronavirus. This news was transmitted to those payers in a March 10 letter from CMS. The directive also authorizes Medicare Advantage plans to waive coronavirus-related telehealth fees and authorizes Part D plans to relax refill-too-soon limits, provide maximum expended day supplies of prescription drugs, reimburse enrollees for prescription drugs obtained from out-of-network pharmacies, ease prior authorization limits on drugs prescribed to treat patients with the disease, and [...]

iqtsupport2020-03-12T06:00:10-04:00March 12, 2020|Medicare, Medicare reimbursement policy|

Block Grants Could Hurt Medicaid, Study Finds

A switch to block grants to fund state Medicaid programs “…would require states to cut coverage, reduce benefits, increase cost-sharing, lower provider payment rates, or otherwise reduce Medicaid expenditures as compared to current law spending levels” according to a new Commonwealth Fund study. The study, conducted in the wake of the Trump administration’s new guidance on how states can transform their Medicaid programs into block grants and its encouragement that they do so, suggests that such efforts could result in considerable harm to Medicaid beneficiaries, providers of Medicaid-covered services, and state government finances. Meanwhile, the federal government’s share of state [...]

iqtsupport2020-03-11T11:34:50-04:00March 11, 2020|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 March agenda were: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Realigning incentives in Medicare Part D Redesigning the Medicare Advantage quality bonus program Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees Improving Medicare’s end-stage renal disease prospective payment system Separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency that advises [...]

iqtsupport2020-03-09T09:40:54-04:00March 9, 2020|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

U.S. May Pick Up Tab for Coronavirus Care for the Uninsured

Care for the uninsured who contract the coronavirus may be paid for by the federal government under the National Disaster Medical System program. That program, activated during national disasters, pays hospitals, doctors, and other medical facilities approximately 110 percent of Medicare rates for hospital and doctor care, home health services, primary care, and rehabilitation services. The possibility of using the program for this purpose is being discussed within the Trump administration and was raised during a congressional hearing earlier this week by the Department of Health and Human Services’ assistant secretary for preparedness. Learn more about the National Disaster Medical [...]

iqtsupport2020-03-06T06:00:28-05:00March 6, 2020|Uncategorized|

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 February 2020 MACPAC meeting opened with a continuation of MACPAC’s examination of Medicaid’s role in maternal health, when Medicaid officials from Michigan, New Jersey, and North Carolina joined the Commission to discuss how their states are addressing maternal morbidity and mortality.* The Commission plans to include a chapter on maternal health in its June 2020 report to Congress. Commissioners later turned their attention to policy options for improving enrollment in the Medicare Savings Program. [...]

iqtsupport2020-03-06T06:00:04-05:00March 6, 2020|hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare|

Comfort, Not Quality, Woos Patients

People are more likely to recommend a hospital based on the comfort they felt when hospitalized rather than on the quality of the care they received, a new study has found. Good food, rooms with a view, friendly nurses, peace and quiet, more television channels, and other amenities impress patients more than higher survival rates and lower hospital-acquired conditions rates. These are among the findings from an analysis of patient satisfaction data from 3000 hospitals between 2007 and 2010. Learn more about how inpatients view their hospital experiences and how those experiences shape how they rate hospitals in Oxford Academic’s [...]

iqtsupport2020-03-04T06:00:37-05:00March 4, 2020|hospitals|

Number of Medicare-Dependent Hospitals Declines

The number of Medicare-dependent hospitals in the U.S. fell 28 percent between 2011 and 2017, the U.S. Government Accountability Office reports. Medicare-dependent hospitals receive additional payments from Medicare if at least 60 percent of their discharges or inpatient days are associated with Medicare patients, if they have 100 or fewer beds, and if their historic costs in one of three base years are greater than what they would have been paid through Medicare’s inpatient prospective payment system. The Medicare-dependent program was created in 1989 to protect vulnerable small, mostly rural hospitals, and in any given year not all eligible hospitals [...]

iqtsupport2020-03-03T06:00:53-05:00March 3, 2020|Medicare, Medicare reimbursement policy|

MFAR Backlash Continues

Diverse health care and government interests are rallying around their opposition to the proposed Medicaid fiscal accountability rule. The regulation, proposed by the Centers for Medicare & Medicaid Services in November, would impose new limits on the ability of states to finance their share of their Medicaid spending, potentially jeopardizing provider payments and the ability of high-volume Medicaid providers to operate without suffering great losses. In all, CMS received more than 4200 written comments in response to the proposed regulation, most of them expressing opposition. Among those doing so were state governments, the National Governors Association, hospitals and hospital associations, [...]

iqtsupport2020-03-02T06:00:22-05:00March 2, 2020|Medicaid, Medicaid DSH, Medicaid regulations|

Azar: Budget Proposes Reducing Medicaid Matching $

The federal government would reduce its financial commitment to state Medicaid programs under the FY 2021 budget the Trump administration proposed earlier this month. While testifying before the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services and Education, Health and Human Services Secretary Alex Azar acknowledged that the administration’s proposed FY 2021 would eliminate the enhanced rate at which the federal government matches state funds used to serve individuals who enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion provision. That enhanced rate calls for the federal government to pay 100 percent of the costs associated with [...]

iqtsupport2020-02-28T09:33:40-05:00February 28, 2020|Affordable Care Act, Medicaid|

CMS to Look at Accrediting Agencies

Health care accrediting organizations will be the subject of scrutiny and possible action by the federal government in the coming months. At a recent conference, Centers for Medicare & Medicaid Services administrator Seem Verma said that Receiving CMS’s authorization to inspect and deem healthcare providers compliant with Medicare’s quality standards is nothing short of assuming a sacred public trust…But an increasing amount of evidence indicates that accrediting organizations are not living up to that high bar. According to Verma, CMS’s interest is motivated by a number of recent incidents of “serious deficiencies” among hospitals that had been found compliant with [...]

iqtsupport2020-02-27T06:00:36-05:00February 27, 2020|Centers for Medicare & Medicaid Services|