Policy Updates

Low-Income Patients More Likely to End Up in Low-Quality SNFs

Dually eligible individuals are more likely than others to find themselves in low-rated skilled nursing facilities, recent research has found. According to a study published in the Journal of Applied Gerontology, more than 50 percent of dually eligible individuals – those covered by both Medicare and Medicaid – who are admitted to skilled nursing facilities are served by facilities that have low (one or two stars) ratings under Medicare’s five-star quality rating system for nursing homes. Overall, the dually eligible are 9.7 percentage points more likely than patients not on Medicaid to be served by lower-rated facilities. The education of [...]

iqtsupport2019-04-19T06:00:35-04:00April 19, 2019|Medicaid, Medicare post-acute care, post-acute care|

Groups Seek Funding for Children’s Hospital Graduate Medical Education

Provide $400 million in funding for children’s hospital graduate medical education programs in the FY 2020 budget, 28 groups have asked congressional leaders in a recent letter. The letter, sent to the chairs and ranking members of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, and Related Agencies and the same subcommittee of the House Appropriations Committee, notes that Sustaining pediatric training programs at children’s hospitals to meet the need of children, now and in the future, requires bolstering our national commitment. Support for training pediatric providers through CHGME (children’s hospitals graduate medical education) lags behind the [...]

iqtsupport2019-04-18T06:00:17-04:00April 18, 2019|hospitals|

MACPAC Recommends Changes in Medicaid Shortfall Definition

Hospitals’ calculation of their Medicaid shortfall would change under a recommendation that MACPAC voted to make to Congress. That change, in turn, could affect hospitals’ future Medicaid disproportionate share payments. Last week the Medicaid and CHIP Payment and Access Commission voted overwhelmingly to change how hospitals calculate their Medicaid shortfall: the difference between what they spend caring for their Medicaid patients and what Medicaid pays them for that care. Under MACPAC’s proposal, hospitals would need to deduct from their shortfall total all third-party payments they receive for the care they provide to their Medicaid patients. If this proposal were to [...]

iqtsupport2019-04-17T06:00:13-04:00April 17, 2019|hospitals, MACPAC, Medicaid, 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 wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon. First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and [...]

iqtsupport2019-04-16T06:00:59-04:00April 16, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations|

Medicare Advantage Permitted to Address Non-medical Needs

Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members. As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020, MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it. In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an [...]

iqtsupport2019-04-16T06:00:54-04:00April 16, 2019|Medicare|

Feds Looking to Bundle Medicare Post-Acute Payments?

Bring us your ideas for bundling Medicare post-acute-care payments, the head of the Center for Medicare and Medicaid Innovation recently told a gathering of hospital officials in Washington, D.C. As reported by Fierce Healthcare, CMMI director Adam Boehler told hospital officials that Now is the time to bring us ideas. We’re really in listening mode…I think there’s been a lot of intrigue and interest we’ve heard from people. So we’re gathering stakeholder input there on that and it’s a great time to give us thoughts on where we can lower costs. Learn more from the Fierce Healthcare article "CMMI's Adam [...]

iqtsupport2019-04-15T06:00:16-04:00April 15, 2019|Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare post-acute care, post-acute care|

SNF Discharge May Affect Hospital Readmission Rates

Heart failure patients discharged from skilled nursing facilities after two days or less may be as much as four times more likely to be readmitted to a hospital than those who stay longer, according to a new analysis. The study also found that the hospital readmission rate falls by half for patients who remain in a skilled nursing facility for one to two weeks. The analysis evaluated Medicare data for heart failure patients at least 65 years old and did not adjust for their severity of illness. These findings suggest that the current emphasis on limiting patients’ time in post-acute-care [...]

iqtsupport2019-04-11T06:00:21-04:00April 11, 2019|Medicare, Medicare post-acute care, post-acute care|

Medicaid Expansion Helping FQHCs

Federally qualified health centers have benefited from Medicaid expansion, a new survey has found. According to a new Commonwealth Fund report, a survey comparing FQHCs in states that expanded their Medicaid programs to FQHCs in states that did not expand their Medicaid programs found that FQHCs in expansion states are: more financially stable more likely to provide behavioral health services, including medication-assisted treatment for opioid addiction, counseling, and coordination of care with social service providers more likely to engage in value-based care Because of Medicaid expansion, FQHCs now are paid for services they previously provided at no charge to low-income, [...]

iqtsupport2019-04-10T06:00:05-04:00April 10, 2019|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 April agenda were: Expanding the use of value-based payment in Medicare Medicare Shared Savings Program performance Redesigning the Medicare Advantage quality bonus program Increasing the accuracy and completeness of Medicare Advantage encounter data Evaluating patient functional assessment data reported by post-acute-care providers Options for slowing the growth of Medicare fee-for-service spending for emergency department services Options to increase the affordability of specialty drugs and biologics in Medicare Part D Improving payment for low-volume and isolated outpatient dialysis [...]

iqtsupport2019-04-09T06:00:04-04:00April 9, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Groups Work to Create New Codes for Social Determinants

Social determinants of health could have their own ICD-10 codes if a new initiative from the American Medical Association and United Healthcare succeeds. The two are working together to develop new ICD-10 codes that would take into consideration social determinants of health such as housing and food security, access to transportation, and ability to pay for medicine. The project launches at a time when research suggests that social determinants of health can affect nearly 80 percent of health care outcomes. Learn more in the Health Analytics IT article “AMA, UnitedHealth Partner for Social Determinants ICD-10 Project.”

iqtsupport2019-04-08T06:00:59-04:00April 8, 2019|Uncategorized|