Noteworthy News

Archive for January, 2014


States Using Medicaid Expansion to Pursue Innovation

While many of the states that have chosen to expand their Medicaid programs under the terms of the Affordable Care Act did so by embracing those terms, others are viewing Medicaid expansion as an opportunity to pursue wholesale changes in how they serve their low-income residents. Arkansas and Iowa have already received federal waivers to expand their Medicaid programs – exemptions from selected aspects of existing Medicaid law.  Under these waivers, the states operate demonstration programs to test the effectiveness of their variations on ordinary Medicaid practices. In addition to Arkansas’s and Iowa’s successful waiver applications, Pennsylvania, Virginia, New Hampshire, [&hellip

CMS Offers Advice on Managing Expected Upsurge in ER Visits

With Medicaid enrollment rising because of eligibility changes introduced through the Affordable Care Act, hospital emergency rooms expect to see an increase in the number of emergency room visits as new Medicaid enrollees seek care for long-neglected health problems. In anticipation of this rise in ER visits, the Centers for Medicare & Medicaid Services (CMS) has issued an informational bulletin with suggestions for hospitals on how to manage the expected increase in ER utilization. Among CMS’s suggestions are for hospitals to broaden access to primary care services (because much of the increased utilization will be because the newly insured still [&hellip

MedPAC Endorses Site-Neutral Payments

MedPAC has recommended to Congress that Medicare equalize the rates paid to hospital outpatient departments and private physicians’ offices for many outpatient services. Currently, hospital outpatient departments are paid more than physician offices for many Medicare-covered services. MedPAC, which advises Congress on Medicare payment issues, called for reducing or eliminating current fee differentials. While MedPAC’s recommendations are not binding, those recommendations frequently form the basis for future Medicare policies. Learn more about this and other MedPAC recommendations in this Becker’s Hospital Review article

MedPAC Recommends Raise for Hospitals

The independent agency that advises Congress on Medicare payment issues has recommended a 3.25 percent increase in Medicare payments to hospitals for inpatient and outpatient services in FY 2015. The Medicare Payment Advisory Commission (MedPAC) also recommended an increase of 5.25 percent if the two percent Medicare sequestration cut is still in effect when the new federal fiscal year begins. While MedPAC’s recommendations are not binding, they are respected and often establish the parameters for future policy deliberations in both Congress and the administration. Learn more about MedPAC’s hospital payment recommendations in this Becker’s Hospital Review article

Medicare Appeals Go on Back Burner

Faced with a backlog of more than 350,000 appeals of claims decisions, Medicare has announced that that it will suspend acting on new requests for appeals hearings made by hospitals, doctors, nursing homes, and other providers for approximately two years. During that time, the federal Office of Medicare Hearings and Appeals will continue to hear appeals from beneficiaries and will work to reduce its enormous case backlog. Two years ago, Medicare was fielding approximately 1200 appeals a week.  By November of 2013, that figure had risen to 15,000. Learn more about the appeals backlog, how and why it grew, and [&hellip

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