Medicaid and CHIP

HHS releases two rules to streamline regulations for hospitals and providers

Posted on May 10, 2012

Today, the Centers for Medicare & Medicaid Services (CMS) released two final rules. The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year. The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.

Among other changes, the final rules will…

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CMS releases proposed rule to increase Medicaid payments

Posted on May 9, 2012

Today the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS), released a proposed rule on Medicaid payments. The proposed rule would implement Medicaid payment for primary care services furnished by certain physicians in years 2013 and 2014 at rates not less than Medicare rates in effect in that time period. The rule would apply to physicians who practice family medicine, general internal medicine, or pediatric medicine, and to services paid through Medicaid managed plans. The proposal also permits providers to charge higher rates for vaccinations under the federally backed Vaccines for Children program. CMS estimated the provision will cost the government $5.5 billion the first year, and $5.6 billion in the second.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments, Medicaid and CHIP

CMS releases final rule addressing Medicare fraud

Posted on April 24, 2012

The Centers for Medicare & Medicaid Services (CMS) published a final rule today addressing three provisions under the Affordable Care Act (ACA): 1) Medicare and Medicaid Programs; 2) Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and 3) Changes in Provider Agreements. This final rule follows up on the May 5, 2010 interim final rule with comment period. It requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. In addition, it requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare. Finally, it mandates document retention and provision requirements on providers and supplier that order and certify items and services for Medicare beneficiaries.

The final rule intends to prevent fraud in Medicare…

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Fraud and Abuse, Key Developments, Medicaid and CHIP, Medicare

Georgetown University Health Policy Institute releases paper on state revenues and Medicaid

Posted on March 29, 2012

The Georgetown University Health Policy Institute published a report which examines the decline in state revenues and changes in Medicaid spending during the last two recessions to look more closely at what has been driving state budget deficits. As states have faced large budget deficits, some politicians have blamed Medicaid, claiming that rising program costs are crowding out other priorities. While spending in Medicaid has grown as a result of increased enrollment due to the recession, most of this added spending has been shouldered by the federal government. Although less frequently discussed, a greater challenge to state budgets during these difficult economic times has been the steep declines in revenues.

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Categories: Library, Medicaid and CHIP, Third Party Resources

Update: Highlights from the Final ACA Medicaid Eligibility Regulations

Posted on March 23, 2012

On March 16, 2012 the Centers for Medicare and Medicaid Services (CMS) released a final rule regarding Medicaid eligibility under the Affordable Care Act. A summary of the final rule was previously posted on healthreformgps.org. This Update summarizes the key provisions of the final regulation, which also contains certain interim final rules on which further comment is sought.

The Final Rule, which takes effect January 1, 2014, addresses a wide array of issues raised in the 2011 proposed rule.

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Categories: Health Insurance, Implementation Briefs, Implementation Update, Medicaid and CHIP

NAMD releases paper with recommendations regarding Medicaid program integrity improvements

Posted on March 20, 2012

The National Association of Medicaid Directors (NAMD) issued a position paper today calling on federal policymakers to ensure that federal and state resources go to effective, high-value initiatives to strengthen the integrity of the Medicaid program. In addition to describing the landscape for Medicaid program integrity activities, the paper offers states’ perspective on the duplication and inefficiencies that currently exist.

The report, “Rethinking Medicaid Program Integrity: Eliminating Duplication and Investing in Effective, High-Value Tools,” makes four overarching recommendations:

1) Clarify the roles of the state and federal governments in Medicaid program integrity efforts;

2) Improve collaboration and communication between Medicare and Medicaid;

3) Invest in resources tailored to individual state Medicaid programs; and

4) Evaluate the return on investment and utility of existing program integrity initiatives.

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Categories: Fraud and Abuse, Library, Medicaid and CHIP, Third Party Resources

HHS releases final rule on Medicaid eligibility

Posted on March 16, 2012

Today the U.S. Department of Health and Human Services released the final rule for Medicaid program eligibility changes under the Affordable Care Act (ACA). Similar to the exchange final rule, certain provisions of the Medicaid final rule were issued as interim final, with a 45 day comment period. Under the ACA, individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level (currently $14,856 for an individual and $30,656 for a family of four) are eligible for Medicaid coverage. Medicaid expansion will become effective in 2014 when the Exchanges begin operation. The federal government will pay 100 percent of the association expansion cost for the first three years and at least 90 percent after that.

The final rule announced today deviates from the August 2011 proposed rule enrollment rules. The proposed rule would have given the Exchanges the responsibility of determining who is eligible for Medicaid in order to facilitate “one-stop shopping” for coverage options. Under the final rule, however, states will now be able to choose whether the Exchange will enroll people in Medicaid or whether the state Medicaid agency alone will have that power.

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Categories: Department of Health and Human Services, Key Developments, Medicaid and CHIP

The Center for Medicare and Medicaid Innovation: A Year’s Progress

Posted on January 26, 2012

Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.

To foster the development of more collaborative and…

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Categories: Health Care Quality and Delivery System Reform, Implementation Briefs, Implementation Update, Medicaid and CHIP, Medicare

ACAP releases article on dual eligibles

Posted on January 12, 2012

Jane Hyatt Thorpe and Katherine Jett Hayes recently released an article funded by the Association for Communication Affiliated Plans (ACAP), “A New State Plan Option to Integrate Care and Financing for Persons Dually Eligible for Medicare and Medicaid,” which reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and introduces a state plan option as a new model for consideration by federal and state policymakers. This new model draws on experience from existing programs and waivers to provide a permanent state plan option for a fully integrated, capitated care model that could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.

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Categories: Library, Medicaid and CHIP, Medicare, Third Party Resources

RWJF and National Academy of Social Insurance release report on Medicaid, Exchanges, and the individual insurance market

Posted on January 11, 2012

The Robert Wood Johnson Foundation and the National Academy of Social Insurance recently released “Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market,” which examines the practical and conceptual factors that underlie the federal/state relationship in dealing with the alignment of Medicaid and the State Health Insurance Exchange policy. The report lays out dimensions of collaboration between states and the federal government that could help establish a seamless continuum of coverage for those who may move between eligibility for Medicaid and for tax subsidies in the Exchange.

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Categories: Library, Medicaid and CHIP, Third Party Resources