Archive: October 2012

New KCMU report finds most states will aim to cover dual eligibles in demonstration projects

Posted on October 30, 2012

The Centers for Medicare and Medicaid Services (CMS) has proposed two models to align financing for beneficiaries eligible for both Medicare and Medicaid benefits, or dual eligibles. One is a capitated model and one a managed fee-for-service model. In the spring of 2012, 26 states submitted proposals to CMS seeking to test one or both of these models. CMS is presently reviewing the states’ proposals to determine which will be implemented.

According to a report released by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU), 21 of the 26 states that have submitted demonstration project proposals include a plan to insure all dual eligibles in their proposal. CMS has said that it will include as many as 2 million (out of the 9.1 million people eligible for both Medicare and Medicaid nationally) dual eligible beneficiairies in the demonstration project. The remaining 5 states have issued restrictions based on age, diagnosis, and/or service in their proposals. 23 of the 26 states plan to use a passive enrollment system to cover dual eligibles. In other words, the duals would be covered unless they actively chose to opt out of the program.

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KFF report finds Medicaid spending growth slows

Posted on October 25, 2012

According to a survey released this morning by the Kaiser Family Foundation, the slowly improving economy helped Medicaid spending growth slow to one of its lowest rates in the last fiscal year (FY). The survey found that total Medicaid spending across states increased only 2 percent in fiscal year 2012. The relatively slow spending and enrollment growth are expected to continue in FY 2013.

Cost pressure and cost containment were dominant themes in the slowed spending growth, but states were also able to consider program changes, payment and delivery system reforms and continue efforts to re-orient long-term care programs to community-based care models. Eligibility rules for Medicaid remained stable due to the maintenance of eligibility (MOE) protections under the Affordable Care Act (ACA), and a number of states adopted targeted eligibility expansions or simplified enrollment procedures.

States are also preparing for the new role for Medicaid in the implementation of the ACA. Under the June 2012 Supreme Court ruling, state policy makers can decide whether and when to implement the Medicaid expansion.

The report’s findings are drawn from the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA) budget survey of Medicaid officials in all 50 states and the District of Columbia. The survey collects data regarding trends in Medicaid spending, enrollment and policy initiatives.

Click here for the executive summary.

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Update: Legal Challenges to the Affordable Care Act — Liberty v. Geithner Petition for Rehearing

Posted on October 25, 2012

One of a number of lawsuits filed in opposition to the ACA was Liberty University, Inc., et al. v. Geithner et al. Under this lawsuit in 2010, a private Christian university and a number of individual petitioners sued the government to block enforcement of the ACA’s employer requirement to provide health insurance coverage to employees, as well as the individual requirement to maintain health insurance coverage. The district court in the Western District of Virginia rejected all the plaintiffs’ claims, which included challenges based on the Commerce Clause, the Necessary and Proper Clause, the Tenth Amendment, the First Amendment, the Fifth Amendment, and the Religious Freedom Restoration Act (RFRA). On appeal, the Fourth Circuit held that the Anti-Injunction Act (AIA) barred federal courts…

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Courts block defunding of Planned Parenthood

Posted on October 23, 2012

Federal judges Friday and today ruled that Arizona and Indiana, respectively, cannot halt public funding to Planned Parenthood for general healthcare services that don’t include abortion.

In Arizona, the preliminary injunction by U.S. District Judge Neil Wake bars the state from applying a new state anti-abortion law to Planned Parenthood Arizona. The state already prohibits public funding for most abortions. The new law, passed earlier this year but not yet implemented, would go so far as to bar public funding for general health care services provided by entities that also provide abortions. Supporters of the new law said that public funding for agencies like Planned Parenthood indirectly subsidizes abortions. Judge Wake ruled that the subsidies could in no way fund abortions because Medicaid reimbursements to Planned Parenthood Arizona cover only about half of the costs and thus, the Judge ruled that, ”there is no excess funding that could be used to subsidize abortions.” The Judge found that it is in the best interest of Arizona to block the law’s implementation to prevent some 3,000 patients from being denied health care delivery from their chosen health care providers.

In Indiana, a federal appeals court similarly ruled that the state cannot cut off funding for Planned Parenthood just because they provide abortions, amongst many other health care services. The 7th U.S. Circuit Court of Appeals in Chicago upheld a lower court decision that found that Indiana cannot enforce a state law that barred abortion providers from collecting Medicaid reimbursements for any health care services provided.

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Representative Issa subpoenas Obama administration for Medicare Advantage documents

Posted on October 23, 2012

Darrell Issa, House Oversight and Government Reform Committee Chairman, subpoenaed the Obama administration on Monday for documents that he believes will reveal illegal actions taken by the Department of Health and Human Services (HHS) with respect to Medicare. Issa threatened to issue the subpoena in a letter he wrote last week. In response, the HHS delivered 1,300 pages to Issa before the Thursday 5:00 p.m. deadline. Arguing that the information delivered by HHS did not address his request, Issa went forward with the subpoena on Monday. Issa requested information regarding the size of demonstration programs, a rationale for the Medicare Advantage bonus payments, and information regarding the requirement that all demonstration projects receive a statistical evaluation.

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Consulting group releases report on bending the Medicare cost curve

Posted on October 18, 2012

According to a study released last week by Dobson DaVanzo and Associates, the Medicare program could save as much as $100 billion over the next decade and the Part A trust fund could be extended by two-and-a-half years if post-discharge patients were served in a more clinically appropriate post-acute care setting. Experts have estimated that the Medicare trust fund will go bankrupt by 2024 without reform. The consulting group’s report offers ideas regarding how the Medicare system could improve the efficiency and quality of care delivered to effectively bend the cost curve and thus extend the solvency of the program. The report found that Medicare savings can be achieved by identifying the patient pathways to the receipt of care, targeting ways to avert readmissions, and placing patients in the most clinically appropriate and cost-effective setting.

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Health Affairs and RWJF examine pay-for-performance model in new report

Posted on October 18, 2012

A report recently published by Health Affairs and the Robert Wood Johnson Foundation (RWJF) centers on the “pay-for-performance” model of health care payment. Pay-for-performance  is an umbrella term that encompasses payment initiatives aimed at improving the quality, efficiency, and overall value of health care. This payment model contrasts with the traditional payment for medical services, which is predominatly fee-for-service or based on the volume of care provided. Providers are traditionally paid based on the complexity of services they provide, as opposed to the quality. The pay-for-performance arrangements, on the other hand, provide financial incentives to hospitals, physicians, and other health care providers to carry out such improvements and achieve optimal outcomes for patients. The Affordable Care Act (ACA) expands the use of pay-for-performance approaches in Medicare in particular. The Health Affairs / RWJF policy brief reviews the background and current state of public and private pay-for-performance initiatives and explores options to make these programs more effective in the future.

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RWJF releases report on employer-sponsored coverage in Massachusetts

Posted on October 18, 2012

The Robert Wood Johnson Foundation published a report by grantee Mark A. Hall, J.D., entitled “Employers’ Use of Health Insurance Exchanges: Lessons from Massachusetts.” Hall, a professor of law and public health in the Division of Public Health Sciences at Wake Forest University Medical School, is completing a qualitative investigation of employers’ use of the Massachusetts Connector in order to inform states and the federal government about best strategies for the design and operation of the Affordable Care Act’s (ACA’s) small-group health insurance exchanges and market regulations.

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CRS report examines the ACA’s role in fiscal issues

Posted on October 17, 2012

The Affordable Care Act’s provisions to increase federal revenue through taxes on high-income workers are among the many proposals that policymakers will face next year, according to a new report released by the Congressional Research Service (CRS). The report provides an overview of the tax and spending policy changes set forth by the Act. Collectively referred to as the “fiscal cliff,” these policies would extend current revenue policies (e.g., extending the Bush tax cuts) and change current spending policies (e.g., not allowing the Budget Control Act sequester to take effect) to increase the projected budget deficit relative to current law. The Congressional Budget Office (CBO) estimates that if current law remains in place, the budget deficit will fall by $502 billion between FY2012 and FY2013.

In making these fiscal policy choices, Congress will have to weigh the benefits of deficit reduction against the potential implications of fiscal policy choices for the ongoing economic recovery. Maintaining current revenue and spending policies will add to the deficit, while increasing revenues and reducing spending, as under current law, could slow economic growth. Thus, deficit reduction measures must be balanced against concerns that spending cuts or tax increases could dampen an already weak economic recovery. CBO has concluded that allowing current law fiscal policies to take effect will dampen short-term economic growth, but accelerate long-term economic growth. Conversely, CBO has concluded that postponing the fiscal restraint would accelerate short-term economic growth, but dampen long-term economic growth. In that context, several policy observers have recommended implementing a credible medium-term plan that balances economic considerations with deficit reduction.

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GAO releases report on Prevention and Public Health Fund

Posted on October 17, 2012

The Affordable Care Act (ACA) established the Prevention and Public Health Fund (PPHF) to provide expanded and sustained national investment in prevention and public health programs, including prevention research, health screenings, and immunization programs. The ACA appropriated $500 million for fiscal year 2010, $750 million for fiscal year 2011, and additional amounts for future fiscal years to operationalize the PPHF.

The Government Accountability Office (GAO) was asked to provide information on how PPHF funds were allocated for fiscal years 2010 and 2011. The GAO report describes (1) the HHS agencies and activities for which PPHF allocations were made, (2) the process and criteria HHS used to allocate PPHF funds, and (3) HHS reporting of the outcomes of activities receiving PPHF funding.

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