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Bill Would Overhaul Medicaid DSH

A new Senate proposal would change how the federal government allocates Medicaid disproportionate share money (Medicaid DSH) to the states. The State Accountability, Flexibility, and Equity (SAFE) for Hospitals Act, introduced by Senator Marco Rubio (R-FL), seeks to …create equity for all states by updating a metric used to determine how much each state is allotted, which has not been reformed since the early 1990s. A news release issued by Senator Rubio explains that the bill Gradually changes the DSH allocation formula so states’ allocations are based on the number of low-income earners living in the state, as a percentage, of the total U.S. population earning less than 100% of the Federal Poverty Level (FPL). Prioritizes DSH funding to hospitals … Read More

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

MACPAC Looks at Medicaid DSH

Last week the federal Medicaid and CHIP Payment and Access Commission met in Washington, D.C. and one of the subjects on its agenda was Medicaid DSH. The Affordable Care Act mandated major reductions of Medicaid disproportionate share (Medicaid DSH) allotments to states and those reductions have been delayed by Congress several times but are now scheduled to begin in FY 2020. At the MACPAC meeting the commission’s staff presented three proposed recommendations that address Medicaid DSH allotments; these recommendations were based on a consensus reached by MACPAC commissioners at their October meeting.  Those recommendations are: Phase in Medicaid DSH reductions more gradually over a longer period of time. Apply reductions to unspent DSH funds first. Distribute reductions in a way … Read More

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

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP issues, met publicly in Washington, D.C. last week. The following is MACPAC’s own summary of its two days of meetings. The April 2018 meeting began with session on social determinants of health. Panelists Jocelyn Guyer of Manatt Health Solutions, Arlene Ash of the University of Massachusetts Medical School, and Kevin Moore of UnitedHealthcare Community & State discussed state approaches to financing social interventions through Medicaid. In its second morning session, the Commission reviewed a draft chapter of the June 2018 Report to Congress on Medicaid and CHIP on the adequacy of the care delivery system … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments

Court Rebuffs CMS on Medicaid DSH

A federal court has rejected the manner in which the Centers for Medicare & Medicaid Services collects certain Medicaid data from states in a ruling that has potential implications for eligible hospitals’ Medicaid disproportionate share hospital payments (Medicaid DSH). In a case that challenged how CMS told hospitals to report third-party payments for Medicaid patients, the court ruled against CMS in two different ways:  first, it found that CMS had not interpreted a 2003 law in a manner consistent with congressional intent; and second, it ruled that CMS could not clarify its interpretation through a published FAQ rather than through regulations. As a result of the ruling, some hospitals may get extra room under their hospital-specific Medicaid DSH limit.  For … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients. Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs. Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH.  The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients. The Affordable Care Act calls for reducing Medicaid DSH payments … Read More

Posted in Affordable Care Act, Federal Medicaid issues, Medicaid supplemental payments

SNAP Writes to House Ways and Means Committee About Medicaid DSH Audits

The federal government should give states the option of monitoring Medicaid disproportionate share payments (Medicaid DSH) to hospitals through prospective DSH limit calculations rather than through retroactive DSH audits. SNAP recently shared this view with the House Ways and Means Committee’s Health Subcommittee in response to that subcommittee’s request for suggestions from stakeholders on ways to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery.  According to SNAP, retroactive DSH audits are cumbersome, burdensome, and expensive, give rise to many disputes and appeals, and in the end yield results very similar to much simpler prospective DSH limit calculations performed by the very state governments that distribute Medicaid DSH funds.  See SNAP’s comments … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized

New MACPAC Study Evaluates Medicaid, Medicare Payments

Medicaid payments to hospitals are comparable to or even higher than Medicare payments. Or at least they are once supplemental Medicaid payments are included. So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues. In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is … Read More

Posted in Medicaid supplemental payments, Pennsylvania Medicaid policy, Uncategorized

CMS Clarifies Medicaid DSH Rule

Last week the Centers for Medicare & Medicaid Services announced a final rule addressing the treatment of third-party payers in calculating Medicaid uncompensated care costs.  This calculation affects individual hospitals’ Medicaid disproportionate share (Medicaid DSH) limit. According to CMS, This rule clarifies federal requirements regarding the treatment of third party payers in determining the hospital-specific Medicaid DSH payment limit, which is set by statute as a hospital’s “uncompensated costs” incurred in providing hospital services to Medicaid and uninsured patients. The final rule makes clearer our existing policy that uncompensated costs include only those costs for Medicaid eligible individuals that remain after accounting for all payments received by or on behalf of Medicaid eligible individuals, including Medicare and other third party … Read More

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

MACPAC Looks at Medicaid DSH

Hospitals that serve especially large numbers of Medicaid and low-income patients still need Medicaid disproportionate share hospital payments (Medicaid DSH) to avoid red ink despite the expansion of Medicaid and the increase in the number of uninsured people fostered by the Affordable Care Act. So concludes the Medicaid and CHIP Payment and Access Commission (MACPAC) the non-partisan legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program issues. In its March 2017 report to Congress, MACPAC writes that In both expansion and non-expansion states, deemed DSH hospitals, which are statutorily required to receive DSH payments because they serve a high share of Medicaid-enrolled … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments
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