Noteworthy News

Archive for May, 2015

 

Senate Takes Testimony on Medicare Observation Status

The Senate Special Committee on Aging recently heard testimony about the challenges posed by the “observation status” designation conferred on some Medicare patients in hospitals. Among the concerns raised at the hearing were the financial vulnerability of some seniors hospitalized only under observation and not as inpatients; the possibility that some hospitals may be using observation status to avoid Medicare penalties for readmitting recently discharged payments; the punitive actions of Medicare recovery audit contractors (RAC auditors); and more. Intertwined with this is Medicare’s two-midnight rule and the challenges the program has faced attempting to implement this rule. Testifying before the [&hellip

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade. In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace. In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for [&hellip

Underinsurance Remains a Problem

Twenty-three percent of American adults are uninsured, according to a new survey by the Commonwealth Fund. Among them, 14 million had deductibles that exceeded five percent of their income while another 24 million had deductibles that fell below that threshold but had out-of-pocket health care costs – deductibles, co-insurance, co-payments, and out-of-network payments – that exceeded ten percent of their income. The figures are for 2012 and reflected no change since 2010 but were nearly twice those found in 2003. In addition, the survey found that the proportion of the insured with high-deductible plans has more than tripled, from three [&hellip

GAO Examines Medicaid Section 1115 Waivers

The U.S. Department of Health and Human Services (HHS) frequently exercises the authority granted to it under section 1115 of the Social Security Act to authorize Medicaid expenditures for uses not strictly permitted under that law if those uses extend Medicaid coverage to populations not already served by Medicaid or promote Medicaid objectives. At the request of the chairmen of the Senate Finance Committee and the House Energy and Commerce Committee, the U.S. Government Accountability Office (GAO) examined recently approved section 1115 waivers to evaluate whether those waivers met the criteria for the exemptions and whether the documents HHS issues [&hellip

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments. That two-year Medicaid primary care fee bump ended on December 31, 2014. Sixteen states and [&hellip

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