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Archive for January 2019

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them. At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission. According to a presentation delivered at a MACPAC meeting last week: Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists. Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than physicians as a whole. Physicians in states with high managed care penetration rates are less likely (66.7 percent) to accept … Read More

Posted in Uncategorized

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP. Later that morning, the Commission discussed a study on performance and return on investment for state program integrity strategies. This session was originally scheduled for the December meeting. Following … Read More

Posted in DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments

Chatter About Medicaid Block Grants Grows

A week after a published report suggested that the Trump administration might be working on a plan to introduce Medicaid block grants, the Washington Post reports that those efforts are under way in earnest. According to the Post, A small group of people within the Centers for Medicare and Medicaid Services is working on a plan to allow states to ask permission for their federal Medicaid dollars to be provided in a single lump sum instead of the way they are currently awarded as a percentage of states’ total costs. While many, including members of Congress, insist that the administration cannot move forward with such a proposal without legislation, others suggest that the administration may offer states the opportunity to participate in Medicaid block … Read More

Posted in Federal Medicaid issues

SNAP Comments on Proposed Federal Managed Care Reg

The Safety-Net Association of Pennsylvania has submitted formal comments to the Centers for Medicare & Medicaid Services in response to CMS’s proposed changes in federal Medicaid managed care regulations. SNAP’s letter addressed three aspects of the proposed regulation:  payment rate ranges, directed Medicaid payments, and Medicaid pass-through payments.  The overall theme underlying SNAP’s comments was that the proposed changes represent positive steps but could be taken further to provide additional flexibility for Pennsylvania’s Medicaid program to take stronger steps to ensure the ability of Pennsylvania safety-net hospitals to serve their communities. SNAP expressed support for CMS’s restoration of the use of actuarial rate ranges in setting Medicaid managed care rates but urged CMS to make those rate ranges even broader … Read More

Posted in Uncategorized

Court Rejects 340B Cuts

A federal court has ruled that the Centers for Medicare & Medicaid Services overstepped its authority in reducing Medicare payments for prescription drugs covered by the section 340B prescription drug discount program. While the court conceded that CMS has the authority to address 340B payments, it found that CMS’s drastic payment cuts, introduced in FY 2018, “…fundamentally altered the statutory scheme established by Congress…” for determining 340B payment rates. The court suggested that CMS either change its methodology for determining 340B payments to justify the specific cuts it proposes or raise its objections with Congress, which created the program and has the authority to change it. According to documents submitted to the court by the parties that filed the suit, … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report. According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially. The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices. Because they serve so many more Medicaid patients than the typical hospital, Pennsylvania safety-net hospitals, their patients, and the communities they serve can be greatly affected by such practices. Learn more in the Kaiser Health … Read More

Posted in Pennsylvania Medicaid, Pennsylvania safety-net hospitals
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