Noteworthy News

Archive for regulations

 

CMS Unveils New Medicaid Managed Care Regulation

For the first time in more than 20 years, the federal government is introducing major changes in how it regulates Medicaid managed care. The Centers for Medicare & Medicaid Services describes the 1425-page rule as aligning Medicaid managed care with other health insurance programs, updating how states purchase managed care services, and improving beneficiaries’ experience with Medicaid managed care. To learn more about what CMS has proposed, go here to see the rule itself. Go here to see CMS’s news release accompanying the new regulation. Go here to (under the link “final rule”) to find nine fact sheets summarizing key aspects of the new regulation. And [&hellip

Feds Seek to Regulate Narrow Networks

Amid concerns that low-cost health plans are reducing their provider networks to contain costs at the expense of access to care for their members, the Centers for Medicare & Medicaid Services (CMS) is proposing new guidelines to limit how much those provider networks can be narrowed. According to a CMS fact sheet, To protect consumer access to health care providers and delivery organizations, the proposal asks states to establish a provider network adequacy standard for health plans in the federal Marketplace, subject to minimum criteria that CMS will establish at a later date, with a default time and distance standard [&hellip

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid services. According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services. State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers. Interested parties have 60 days to [&hellip

IRS Finalizes Standards for Non-Profit Hospitals

The Internal Revenue Service has issued guidance for non-profit hospitals on selected issues that could jeopardize their non-profit status. As described in a commentary by the U.S. Treasury Department, non-profit hospitals must: Limit charges.  Hospitals may not charge individuals eligible for financial assistance more for emergency or other medically necessary care than the amounts generally billed to patients with insurance (including Medicare, Medicaid, or private commercial insurance).  Establish and disclose financial assistance policies.  Each hospital must establish and widely publicize a financial assistance policy that clearly describes to patients the eligibility criteria for obtaining financial assistance and the method for [&hellip

Feds Release Medicaid DSH “Uninsured” Definition

The Centers for Medicare & Medicaid Services (CMS) has published a new regulation that defines “uninsured” for the purpose of calculating the limit for how much individual hospitals may receive in Medicaid disproportionate share hospital payments (Medicaid DSH). Under federal law, Medicaid DSH payments to hospitals cannot exceed the uncompensated costs of the services those hospitals provide to Medicaid recipients and the uninsured.  In calculating hospital-specific limits, according to the new regulation, … the calculation of uncompensated care for purposes of the hospital-specific DSH limit will include the cost of each service furnished to an individual by that hospital for [&hellip

Search for
Noteworthy News

Related posts

    [exec] boposts_show(); [/exec]