Noteworthy News

Archive for January, 2018

 

A New Use for Section 1115 Medicaid Waivers?

Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility. But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations. According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid.  In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of [&hellip

Administration Lays Groundwork for Medicaid Work Requirements

The Centers for Medicare & Medicaid Services has issued guidelines for states interested in adding a work requirement component to their Medicaid programs. With nearly a dozen states applying to implement controversial Medicaid work requirements, CMS has issued a guidance letter to state Medicaid directors outlining the criteria it will use when considering such applications. The new policy does not mandate work requirements in state Medicaid programs; it only presents the parameters CMS will use when considering the applications of states wishing to impose such requirements. For  more information about the new policy, see the following resources: CMS’s news release [&hellip

NAUH Seeks Action on Medicaid DSH, 340B

The National Association of Urban Hospitals has written to leaders of the House and Senate asking them to reverse implementation of Affordable Care Act-mandated cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to state and to block implementation of a federal regulation that would reduce Medicare payments to qualified participants in the section 340B prescription drug discount program by 28 percent.  See NAUH’s letter here

CMS Unveils New Bundled Payment Program

The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.”  Under this new program – participation in which will be voluntary – participants can, as CMS explains …earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. The following are a few highlights of BPCI Advanced. It encompasses 32 types of clinical episodes (29 inpatient and three outpatient).  These episodes, of 90 days, may change in the future. Participating providers can waive the Medicare requirement [&hellip

E&C Calls for Action on 340B

The section 340B prescription drug program has flaws and needs change, a report by the House Energy and Commerce Committee has concluded. The program, which requires pharmaceutical companies to provide discounts on prescription drugs to be dispensed on an outpatient basis to qualified providers that serve large numbers of low-income patients, has been controversial in recent years.  As the number of providers eligible for the program has grown, pharmaceutical companies have claimed that the program is expensive, is being abused, and is responsible for driving up prescription drug costs while providers insist that 340B is a vital tool in helping [&hellip

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