Noteworthy News

Archive for August, 2016


Medicare Readmissions Penalties Rise

Medicare will impose more than $500 million in penalties in FY 2017 on hospitals that readmit too many Medicare patients within 30 days of their discharge from the hospital. The penalties, part of Medicare’s hospital readmissions reduction program, represent a 20 percent increase over the penalties the program levied in FY 2016. Under the program, most (but not all) hospitals are evaluated on their performance with patients with six medical conditions: heart attacks, heart failure, chronic lung disease, hip and knee replacement, and the need for coronary bypass surgery. The maximum penalty is three percent of hospitals’ Medicare payments and [&hellip

CMS Urges Improvements in Care for Physically, Mentally Disabled

New guidance issued by the Centers for Medicaid Services outlines how states can make better use of home care in serving physically and mentally disabled Medicaid beneficiaries. Those steps include establishing open registries of home care workers; establishing qualifications for such workers; and paying wages that will help foster continuity of care for the clients of those home care workers. In making these recommendations, CMS seeks to make greater use of managed long-term services and supports and home- and community-based services when serving individuals who might otherwise need costly nursing home care. Learn more about CMS’s recommendations and why it [&hellip

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations.   Such payments are often used to distribute the proceeds from state hospital taxes. The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely. In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care [&hellip

Access to Primary Care Better for Medicaid Patients in Private Plans

Medicaid beneficiaries enrolled in commercial, marketplace health plans have better access to appointments for primary care services than those enrolled in traditional state Medicaid programs. Or so concludes a study conducted by the Leonard Davis Institute of Health Economics. According to surveys conducted by “secret shoppers,” appointment rates with primary care providers for callers with plans to which they were assigned on the federal insurance marketplace were 27.7 percentage points higher than when they called providers enrolled in their state Medicaid program in Arkansas and 12 percentage points higher in Iowa. There was no different in waiting times for appointments. [&hellip

Report: Uncompensated Care Payments Insufficiently Aligned With Uncompensated Costs

Some of the payments Medicare makes to hospitals to help them with their uncompensated care costs are not well-aligned with actual hospital uncompensated care costs, the U.S. Government Accountability Office has concluded. In a new report based on FY 2013 and FY 2014 data, the GAO found that Medicare UC [uncompensated care] payments are not well aligned with hospital uncompensated care costs for two reasons. First, payments are largely based on hospitals’ Medicaid workload rather than actual hospital uncompensated care costs…Second, CMS [the Centers for Medicare & Medicaid Services] does not account for hospitals’ Medicaid payments that offset uncompensated care [&hellip

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