A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Tag: Medicare

IRS issues two ACA rules

Posted by Nikki Hurt on November 29, 2013

The Internal Revenue Service (IRS) published two final rules concerning the implementation of the Affordable Care Act (ACA). The first rule outlines the health insurance provider fees firms in the insurance industry are expected to provide annually, beginning in 2014. These fees are anticipated to raise nearly $60 billion in revenue over the next several years, most of which will be used as subsidies for qualifying individuals to purchase insurance through health insurance marketplaces. The fee applies to insurance companies with annual revenues exceeding $25 million. Nonprofit insurers receiving more than 80% of their funds from the government, self-insured corporations, and government entities are all excluded from the fee.

The second rule addresses the Additional Medicare Tax provision of the ACA, which requires an additional hospital insurance tax on individuals with incomes above the specified threshold. The rule concerns the implementation and integration of the Additional Medicare Tax, specifically highlighting certain wages and compensation to which the tax does not apply, filing a tax return, and employer processes for adjusting payments and filing claims under the Additional Medicare Tax.

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CMS releases interim final rule in response to AHA

Posted by Nikki Hurt on October 2, 2013

The Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on disproportionate share hospital (DSH) payments. The rule alters when certain hospitals, specifically those with reporting periods that do not align with the fiscal year, will receive Medicare DSH payments. The discrepancy was causing administrative and financial issues for these hospitals, which CMS ultimately determined were not in the best interest of the patient population of these hospitals. The new rule was issued with significant encouragement from the American Hospital Association and Association of Medical Colleges.

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Will Uninsured People Who Lack Bank Accounts be Able to Participate in the Health Insurance Marketplace? CMS’ Proposed Rules

Posted by Nikki Hurt on June 20, 2013

A report issued in May 2013 by Jackson Hewitt Tax Service found that 27% of the uninsured, non-elderly population with household incomes in premium tax credit eligibility range are “unbanked” (that is, they lack either credit cards or bank accounts). Because many insurance companies require that premiums be paid with a credit card, by check, or by other electronic means, the unbanked uninsured effectively would be barred from coverage as well as from the premium tax credits whose purpose is to make coverage affordable. The problem is expected to fall most heavily on people already at risk for disparities in health and health care: African American and Latino families, families headed by unmarried adults and adults with low education levels, unemployed persons, and the poor…

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Medicare and Medicaid Disproportionate Share Hospital Payments: Proposed Rules

Posted by Nikki Hurt on June 13, 2013

For thirty years, the Medicare and Medicaid programs have furnished additional payments to hospitals that furnish a disproportionate share of services to low income populations. Despite the fact that the two disproportionate share hospital (DSH) programs share a common mission, they function differently in terms of how the funds actually move to hospitals and in the formulas used to make DSH payments. The Affordable Care Act makes significant adjustments in both DSH programs beginning in 2014 in anticipation of a significant expansion in the proportion of people who have health insurance coverage. With the United States Supreme Court’s decision in 2012 in NFIB v Sebelius, which permits states to opt out of the Medicaid expansion without risking the loss of federal funding for their existing Medicaid programs, the downward DSH payment adjustments become an even more significant matter for hospitals that treat large volumes of low income patients…

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CBO report addresses characteristics, spending and policies for duals

Posted by Nikki Hurt on June 7, 2013

The Congressional Budget Office (CBO) published a report describing the characteristics and costs associated with dual-eligible beneficiaries. A dual-eligible beneficiary, or dual, is someone that is eligible to receive benefits from both Medicare and Medicaid. Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies uses data from 2009 to examine the different payment systems used in both Medicare and Medicaid to pay for dual benefits, as well as methods by federal and state governments to integrate the payments systems and better coordinate care for this growing population.

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CMS releases additional hospital spending data

Posted by Nikki Hurt on June 3, 2013

In an expansion to the hospital charges data released last month, the Centers for Medicare and Medicaid Services (CMS) provided data describing charges for 30 different outpatient procedures. The data include charge estimates for Ambulatory Payment Classification Groups, which are paid under the Medicare Outpatient Prospective Payment System. Presented data are hospital-specific and report charge values collected during calendar year 2011.

CMS also released data on geographic variations in Medicare public use and Medicare utilization by those with chronic conditions.

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CBO releases new report describing budgetary impact of the ACA

Posted by Nikki Hurt on May 15, 2013

The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…

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CMS releases data on hospital charges

Posted by Nikki Hurt on May 8, 2013

In an effort to increase health care affordability and transparency, the Centers for Medicare and Medicaid Services (CMS) published data pertaining to hospital charges for the 100 most common services provided during Medicare inpatient stays. With more than 163,000 entries, the data released by CMS indicated wide variation in costs, both across the country and within similar regions. For instance, a joint replacement procedure can cost $5,300 in Ada, Oklahoma, while a similar procedure may cost upwards of $223,000 in Monterey Park, California. Similarly, heart failure treatments can cost anywhere between $9,000 and $51,000 in Jackson, Mississippi. To further promote the spirit of the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) will also be offering grants for entities to collect and analyze medical pricing and reimbursement data to aid consumers in their health care decision-making and promoting cost-effective care.

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Brookings proposes reforms to save hundreds of billions in health care

Posted by Nikki Hurt on April 30, 2013

The Brookings Institution recently released a study that indicates how value-based payments and small, conscientious quality improvements to both the private and public insurance sectors can significantly reduce health care costs in the future. Bending the Cure: Person-Centered Health Care Reform, describes how such changes could save the federal government $300 billion over the next 10 years and more than $1 trillion over the next 20 years. Brookings finds that moving to patient-centered care is the ultimate means by which future cost savings can be achieved. For a specific example, the study proposes that Medicare should move away from the fee-for-service model and embrace comprehensive payment organizations.

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CMS releases annual hospital IPPS rule

Posted by Nikki Hurt on April 29, 2013

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule of more than 1400 pages describing the new Medicare payment schedule for 2014. The annual Acute Care Hospital Inpatient Prospective Payment System (IPPS) rule proposes that general acute-care hospitals will see a payment increase of 0.8% and long-term care hospitals will see their payments rise by 1.1%. Pursuant to the Affordable Care Act (ACA), the NRPM also details the new penalty program for hospitals that do not reduce nosocomial infections, adding hip and knee implants and chronic obstructive pulmonary disorder to the 30 day readmission penalty program. Another component of the proposed rule alters Medicare disproportionate share hospital (DSH) payments. Additional payments to each hospital will be made based upon its percentage of the total uncompensated care rendered at all DSH hospitals at a given time, ultimately reducing overall DSH payments by 0.9%. Furthermore, hospitals that do not participate in the Hospital Inpatient Quality Reporting (IQR) Program will be subject to additional penalties.

Comments will be due by June 25th, 2013.

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