Noteworthy News

Archive for May, 2016


A Look at Alternative Medicaid Expansion

While most states expanding their Medicaid programs in response to the opportunity presented by the Affordable Care Act simply expand their existing Medicaid programs, six states have taken a different approach, obtaining Medicaid demonstration waivers so they could tailor their programs in different ways. In addition, a number of states currently considering Medicaid expansion appear to be considering pursuing demonstration waivers, often referred to as section 1115 waivers, as well. One area in which these demonstration programs differ from traditional Medicaid expansion is in the degree of financial responsibility new Medicaid beneficiaries assume. Typically, new Medicaid participants must pay more [&hellip

Are States Gaming New Medicaid Requirement?

Some doctors think so. In a letter to the Centers for Medicare & Medicaid Services, the American Academy of Pediatrics, American College of Physicians, American Medical Association, and American Osteopathic Association suggest that two states have drastically cut their Medicaid rates, and others are contemplating doing so as well, in anticipation of implementation of a new Medicaid policy that requires states to track the impact of future rate reductions on access to care. That requirement is part of a new rule addressing access to care that CMS issued last year. By lowering rates now, the groups charge, states will establish [&hellip

New Report Highlights Benefits of 340B Program

A new report describes how the federal government’s 340B Drug Pricing Program works, how it serves low-income participants, what might happen if the program were curtailed, and why the program remains as important as ever despite the declining number of uninsured Americans. The program, created in the early 1990s, requires pharmaceutical companies to provide outpatient drugs to eligible health care providers at significantly reduced prices. Providers qualify based on the number of low-income and uninsured patients they serve and they must be non-profit organizations. Almost all private, non-profit urban safety-net hospitals participate in the program. Amid a considerable increase in [&hellip

Bill Proposes Modifying Ban on Higher Medicare Outpatient Payments

A new bill introduced in the House Ways and Means Committee would limit a recent prohibition on establishing new off-campus hospital outpatient facilities that can receive hospital-based Medicare outpatient payments. Under the Bipartisan Budget Act of 2015, new off-campus, hospital-based outpatient facilities would be paid for Medicare-covered outpatient services like regular physician offices and not like hospital outpatient departments. The Helping Hospitals Improve Patient Care Act of 2016, however, would permit new outpatient departments that were in “mid-build” at the time the 2015 law passed to be exempt from that law’s limits on outpatient payments. According to a Ways and [&hellip

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program. According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to … implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis [&hellip

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