Noteworthy News

Archive for February, 2014


CMS Offers Additional Guidance on “Two-Midnight Rule”

The Centers for Medicare & Medicaid Services (CMS) has issued additional information about its plans for implementing the so-called Medicare two-midnight rule. The rule, which officially took effect last August, has been the subject of controversy, questions, and clarifications ever since, with CMS issuing addiitonal guidance last September and again this last month. Among other things, CMS’s latest guidance explains that CMS is requesting that the Medicare Administrative Contractors (MACs) re-review all claim denials under the Probe & Educate process to ensure the claim decision and subsequent education is consistent with the most recent clarifications.  The MAC may reverse their [&hellip

States Face Challenges in Outside-the-Box Medicaid Expansion

For most states expanding their Medicaid program in response to the opportunity afforded by the Affordable Care Act, expansion has been fairly straightforward:  they simply let more people into their existing Medicaid programs. But several states – Arkansas, Iowa, and Michigan – have tried something different:  pursuing fundamental changes in their Medicaid programs. Among the nearly half of the states still holding out against Medicaid expansion, the “something different” approach appears likely to be more common in the future, and in particular, those that do pursue expansion appear likely to seek to do so through greater use of private health [&hellip

Enthusiasm Waning for Permanent Medicare Doc Fix

While most health care interests and members of Congress want to see a permanent end to the annual Medicare “doc fix” problem, it appears increasingly likely that the next “fix” will be yet another short-term patch. The obstacle?  How to pay for a permanent solution. With the price tag for a permanent solution of around $150 billion, members of Congress have found themselves hard-pressed to find offsets that do not engender swift, angry response from health care interest groups.  Those groups want a permanent solution to the problem but also want others to pay for it. The result, many suspect, [&hellip

New Approaches to Serving Dual Eligibles Set to Launch

Provisions in the Affordable Care Act that encourage states to take new approaches to serving their dually eligible residents – low-income seniors eligible for both Medicare and Medicaid – will soon translate into new state programs. Massachusetts has already launched such an initiative, a new California program will begin in May, and 17 additional states are scheduled to begin new efforts later this year and next. New federal policies encourage state Medicaid programs to work with Medicare in service to their dually eligible population, with the states and Medicare sharing in the savings they produce.  Currently, dually eligible patients constitute [&hellip

Some Hospitals Stand to Lose Medicaid Expansion, DSH Money

When the Supreme Court made Medicaid expansion optional rather than mandatory for states, its decision affected the delicate balance of one aspect of the Affordable Care Act. Hospitals that serve large numbers of low-income and uninsured patients receive special supplemental payments from Medicare and Medicaid to help subsidize the care they provide to these patients:  disproportionate share payments, or DSH payments. And because Medicaid expansion was expected to reduce the number of uninsured patients such hospitals serve, the Affordable Care Act calls for reducing over a period of years both the Medicare DSH and Medicaid DSH payments hospitals receive. But [&hellip

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