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Archive for Federal Medicaid issues

Medicaid to Help Pay for Food, Heat, Rent?

Maybe. At least that is what Department of Health and Human Services Secretary Alex Azar hinted during a recent symposium held in Salt Lake City. During the event, Azar said that HHS’s Center for Medicare and Medicaid Innovation seeks …solutions for the whole person, including addressing housing, nutrition, and other social needs. Azar hinted at future CMMI action, saying that What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to. CMMI currently operates one major program that … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

HHS Gives States New Options for Medicaid-Covered Behavioral Health Treatment

The U.S. Department of Health and Human Services has informed state Medicaid programs that it is giving them new opportunities to pay for hospitalization to care for recipients with behavioral health problems. For years Medicaid has greatly limited the ability of state Medicaid programs to pay for inpatient care for many behavioral health problems – a limit commonly known as the IMD (institution of mental disease) exclusion.  Earlier this year the Centers for Medicare & Medicaid Services eased this long-time limit, announcing that it would make it easier for states to secure waivers from it.  CMS has announced in a formal guidance letter to state Medicaid directors that it is extending this policy, according to a CMS news release, which … Read More

Posted in Federal Medicaid issues

Medicaid Birthing Model Improves Outcomes

A federal program to improve birth outcomes among Medicaid-covered women has produced positive results:  lower rates of pre-term births, fewer low birthweight babies, fewer C-sections, lower delivery costs, and lower first-year health care spending. The “Strong Start for Mothers and Newborns” program was a four-year initiative established by the Affordable Care Act and developed by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Innovation to employ patient education, nutrition, exercise, preparation for childbirth, breast-feeding, and family planning rather than strictly medical interventions and was delivered through three evidence-based prenatal care models:  Birth Centers, Group Prenatal Care, and Maternity Care Homes. The program, operated in 219 separate sites in 32 states (with one in Pennsylvania), served … Read More

Posted in Affordable Care Act, Federal Medicaid issues

CMS Proposes New Medicaid Managed Care Regulation

Just two years after a major overhaul of Medicaid managed care regulations, the Centers for Medicare & Medicaid Services is again proposing changes in how the federal government regulates the delivery of managed care services to Medicaid beneficiaries. Under the newly proposed regulation, states would: be free to implement more changes in their managed care programs without seeking federal permission; have slightly more flexibility in how supplemental payments are made to hospitals through managed care plans and implement some such changes without federal approval; be permitted to redefine what constitutes an adequate provider network for managed care plans; and not be required to publicize beneficiary grievance and appeals processes as prominently as they currently do. Overall, the proposed regulation appears … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

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. The October 2018 MACPAC meeting covered a range of front-line issues in Medicaid, leading off with an analysis of disproportionate share hospital (DSH) allotments on Thursday morning. Following the analysis, the Commission discussed options for March recommendations on how to structure DSH allotment reductions that are scheduled to begin in fiscal year 2020. The Commission later resumed the discussion it began in September on work and community engagement requirements, presenting new data from Arkansas on compliance and disenrollments, as well as information gathered since that meeting about Arkansas’s approach to implementation. On Thursday afternoon, … Read More

Posted in DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

Proposed “Public Charge” Regulation Could Hit Medicaid, Hospitals

If a regulation proposed by the Department of Homeland Security to redefine what constitutes a “public charge” is adopted, millions of people currently enrolled in the Medicaid and Children’s Health Insurance Program might choose to disenroll from those programs rather than risk losing their opportunity to obtain legal permanent resident status in the U.S. The proposed regulation seeks to filter out of possible residency status individuals who might become public charges, or dependent on government programs, over time. A new analysis published by the Kaiser Family Foundation concluded that Under the proposed rule, individuals with lower incomes, a health condition, less education, and/or who are enrolled or likely to enroll in certain health, nutrition, and housing programs would face increased … Read More

Posted in Federal Medicaid issues

CMS Promises Enhanced Use of Medicaid Data to Improve Program Results

Centers for Medicare & Medicaid Services administrator Seema Verma intends to increase federal use of data reported by the states to improve the performance of state Medicaid programs. In an article published on the CMS blog, Verma wrote that Through strong data and systems, CMS and states can drive toward better health outcomes and improve program integrity, performance, and financial management in Medicaid and CHIP. Verma pointed to two core sets of data she considers vital:  Medicaid and CHIP child and adult core sets, which are reported only voluntarily by states, and administrative data submitted through the relatively new Transformed-MIS system.  The latter, according to Verma. …modernizes and enhances the way states submit operational data about beneficiaries, providers, claims and … Read More

Posted in Federal Medicaid issues

Verma Speaks at Medicaid Managed Care Summit

Centers for Medicare & Medicaid Services administrator Seema Verma recently addressed the Medicaid Managed Care Summit, which was held in Washington, D.C. Ms. Verma’s speech focused on four major areas: Empowering states to function as laboratories for innovation by giving them the flexibility to introduce changes that work best for their own citizens. Developing Medicaid and CHIP scorecards that present data on health outcomes, quality metrics, and CMS’s administrative performance. Improving Medicaid program integrity, including through “…targeted audits to ensure that provider claims for actual health care spending match what the [Medicaid managed care] health plans are reporting financially.” Strengthening CMS’s use of data in Medicaid oversight. See Ms. Verma’s complete remarks here.

Posted in Federal Medicaid issues

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. to review a number of Medicaid- and CHIP-related issues. MACPAC members heard presentations on and discussed the following issues: Multistate Collaboration: Panel on State Perspectives Themes from Interviews on the Development of Hospital Payment Policies DSH Payments: Policy Changes and Policy Options Operational Considerations for Work and Community Engagement Requirements Medicaid Coverage of New and High Cost Drugs Managed Care Oversight Oversight of UPL Payments: Additional Analyses and Policy Options Mandated Report: Therapeutic Foster Care Find outlines of these subjects and additional materials by clicking the links above and go here for a transcript of the two days of public meetings. MACPAC is a non-partisan legislative branch … Read More

Posted in Federal Medicaid issues

Battle Over Medicaid Work Requirements Not Over

The Secretary of Health and Human Services is not accepting a recent federal court ruling as the final word on Medicaid work requirements. Although the court ruled against a federally approved plan to permit the state of Kentucky to implement a work requirement for some able-bodied Medicaid recipients, HHS Secretary Alex Azar insists that his department will continue to support work requirements for Medicaid beneficiaries. Azar told a Heritage Foundation audience that We suffered one blow in district court in litigation, but we are undeterred.  We’re proceeding forward…We’re fully committed to work requirements and community participation in the Medicaid program…we will continue to litigate, we will continue to approve plans, we will continue to work with states.  We are moving … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid
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