Noteworthy News

Archive for May, 2012


In Search of a Permanent Medicare Doc Fix

With the most recent Medicare doc fix set to expire at the end of the year, lawmakers again are looking for a permanent cure for what has become a chronic condition. The sustainable growth rate (SGR) formula adopted in 1997 has continually called for reductions in Medicare payments to physicians, which in turn has led to fears that reducing those payments will jeopardize seniors’ access to care.  As a result, Congress has repeatedly overridden the formula-driven payment cuts, pumping new money into Medicare to prevent the cuts and to increase those payments in some years. Now, with payments again scheduled [&hellip

Medicaid Primary Care Rates to Rise

Rates for primary care services covered by Medicaid will rise upon implementation of a new regulation recently published in draft form by the Centers for Medicare & Medicaid Services (CMS). Under the proposed regulation, states will pay Medicare-level rates for Medicaid-covered primary care services in 2013 and 2014.  Medicare rates generally are higher for such services, and under the proposed regulation the federal government, not the states, will pay for the difference between Medicare and Medicaid rates. This new policy was mandated by the Affordable Care Act.  In addition to raising fee-for-service rates, states will be expected to revise agreements [&hellip

Focus on Dual Eligibles Continues

Dual eligibles – people whose health care benefits are covered by both Medicare and Medicaid – constitute the poorest and sickest of publicly insured people.  These nine million people also are among the most expensive to care for, so the federal government and state governments are investing significant effort and resources to find better, more effective, and more economical ways to serve this challenging population. The prevalence of dual eligibility varies widely from state to state, depending on the nature of individual states’ populations and their particular Medicaid eligibility requirements.  Dual eligibility even differs significantly from county to county in [&hellip

Report Tracks State Efforts to Prepare for ACA Medicaid Expansion

The Affordable Care Act calls for a significant expansion of Medicaid eligibility.  The federal government offers states various opportunities to prepare for the implementation of this eligibility expansion in 2014, and now, the Kaiser Commission on Medicaid and the Uninsured has issued a new report tracking state efforts so far. The Kaiser report, “How is the Affordable Care Act Leading to Changes in Medicaid Today?  State Adoption of Five New Options,” focuses on five different aspects of Medicaid expansion:  1) getting an early start on Medicaid expansion; 2) increased federal funding to upgrade Medicaid eligibility systems; 3) new federal Medicaid [&hellip

California Hospitals Facing Medicaid Cuts?

California Governor Jerry Brown has proposed reducing state Medi-Cal (Medicaid) payments to hospitals by $150 million during the state’s 2012-2013 fiscal year. And the governor’s proposal calls for shifting another $75 million in supplemental payment funds into the state’s general revenue fund in FY 2013-2014. These proposals come at a time when the state’s hospitals have agreed to be taxed to help support the Medi-Cal program and raise federal Medicaid matching funds. Read more about this latest proposal and the hospital industry’s reaction to it in this Sacramento Business Journal article

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