Noteworthy News

Archive for March, 2014


Will “Private Option” Mean Reduced Medicaid Benefits?

While many states have chosen to take advantage of the Affordable Care Act’s expansion of Medicaid simply by expanding their existing Medicaid programs, a number of states are pursuing a different approach:  crafting programs that enable the newly eligible to select private insurance plans paid for by Medicaid. This so-called private option has already been approved for Arkansas and Iowa; Pennsylvania has asked the federal government for approval to take a similar approach; and private option alternatives are currently in the works in New Hampshire, Tennessee, Utah, and Virginia. A question has arisen, however, about whether private option Medicaid plans [&hellip

Congress Pursues Post-Acute Care Reform

Members of Congress are working to improve the manner in which Medicare pays for post-acute care for seniors. Pursuing an area that MedPAC, which advises Congress on Medicare payment issues, has cited as in need of improvement and reform, a bipartisan group of senators and representatives solicited input from stakeholders and has now published a “discussion draft” of legislation that focuses on policy changes and standardized assessment data. Among the post-acute-care providers addressed that could be affected by reform are home health agencies, long-term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. Many urban safety-net hospitals offer various post-acute-care [&hellip

CMS Finalizes 2015 Qualified Health Plan Criteria

The federal Centers for Medicare & Medicaid Services (CMS) has issued a letter to insurers describing the provider networks insurers will need to be certified as qualified health plans in the federally facilitated marketplace in 2015. The final criteria emphasize creating networks that include providers that can help insured members obtain mental health and substance abuse services.  Insurers also will be required to include at least 30 percent of the “essential community providers” located in their area within their provider networks.  Essential community providers include critical access hospitals, federally qualified health centers (FQHCs), children’s hospitals, and others. Among those essential [&hellip

NAUH Endorses SGR Bill, Way to Pay For It

In a letter to Ron Wyden (D-OR), chairman of the Senate Finance Committee, the National Association of Urban Hospitals endorsed S. 2110, the SGR Repeal and Medicare Provider Modernization Act of 2014. The bill calls for the repeal of the Medicare sustainable growth rate formula (SGR) used to determine Medicare payments to physicians. In the letter, NAUH also endorsed using proceeds from the federal Overseas Contingency Operations fund to pay for the SGR repeal. See NAUH’s letter here

MACPAC Recommends Steps to Ensure Continuity of Care

Citing income volatility among low-income Americans, the federal agency charged with analyzing Medicaid and the Children’s Health Insurance Program (CHIP) has recommended that Congress adopt measures to ensure that low-income Americans retain health insurance as their income fluctuates above and below the federal poverty level. In its March report to Congress, MACPAC (the Medicaid and CHIP Payment and Access Commission) recommends that Congress empower states to extend coverage to eligible adults for an entire year to ensure that as those adults become eligible for Medicaid, lose Medicaid eligibility as their income rises, and then become eligible again because of unemployment [&hellip

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