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House to Set Sights on Medicare, Medicaid Cuts in 2018

The House of Representatives will pursue entitlement spending cuts next year, House Speaker Paul Ryan recently explained on a radio program.
That means Medicare, Medicaid, and possibly even Social Security.
Ryan said that

We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.

Medicare and Medicaid cuts would be very harmful to Pennsylvania safety-net hospitals.
Learn more about Ryan’s remarks, the administration’s priorities, and what other members of Congress are saying about entitlement cuts in this Washington Post story.

2017-12-14T06:00:33+00:00December 14th, 2017|Federal Medicaid issues, Medicare|Comments Off on House to Set Sights on Medicare, Medicaid Cuts in 2018

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance.  Medicaid, in particular, has not been a financial participant in such efforts.
But that may be changing.
The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios.  The updated regulation also encourages greater coordination of care for Medicaid patients and coverage for long-term services and supports in the home and community for medically qualified patients.
Because they serve so many low-income patients, Pennsylvania safety-net hospitals are especially interested in policy changes that might enable them to serve such patients more effectively.
The Commonwealth Fund has taken a closer look at how the 2016 Medicaid managed care regulation may facilitate addressing the psycho-social needs of Medicaid beneficiaries.  Go here to see its report “Addressing the Social Determinants of Health Through Medicaid Managed Care.”

2017-12-05T06:00:32+00:00December 5th, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off on New Help With Addressing Low-Income Patients’ Social Services Needs?

CMS Shares Vision for Medicaid

Medicaid is about to undergo major changes, CMS administrator Seema Verma outlined in a news release yesterday and in a speech to state Medicaid directors.
According to the news release, those changes include:

  • re-establishing a state-federal partnership that Verma believes has become too much federal and not enough state
  • giving states greater freedom to innovate
  • offering new guidelines for how states can align their individual programs with federal Medicaid objectives
  • new guidance on section 1115 waivers
  • longer section 1115 waivers with simpler review processes
  • CMS willingness to consider proposals to impose work requirements on Medicaid beneficiaries
  • Medicaid and CHIP “scorecards” that track and publish state and federal Medicaid and CHIP outcomes

Pennsylvania safety-net hospitals serve more Medicaid patients than the typical hospital and would therefore be affected more by any major changes in how Medicaid operates.
Go here to see CMS administrator Verma’s full new release and to find links to relevant documents, web sites, and Ms. Verma’s speech about the changes.  Go here to read a Washington Post report on Ms. Verma’s speech and here to see a Kaiser Health News report.

2017-11-08T06:00:43+00:00November 8th, 2017|Federal Medicaid issues|Comments Off on CMS Shares Vision for Medicaid

House Members Seek Delay of DSH Cuts

221 members of the House of Representatives have written to House leaders asking them to delay cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to begin on October 1.
The cuts, mandated by the Affordable Care Act, have already twice been delayed by Congress, both times for two years, and now, a majority of House members have written to House speaker Paul Ryan and minority leader Nancy Pelosi asking them to advance legislation to delay Medicaid DSH cuts once again.
The purpose of Medicaid DSH payments is to help hospitals that serve especially large numbers of low-income patients to absorb some of the losses they incur serving uninsured and underinsured people.  Pennsylvania safety-net hospitals receive, and greatly benefit from, Medicaid DSH payments.
See the letter to House leaders here and see NAUH’s letter to House members here.

2017-10-04T14:33:14+00:00October 4th, 2017|Federal Medicaid issues|Comments Off on House Members Seek Delay of DSH Cuts

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.
Among the issues MACPAC commissioners discussed during their two-day meeting were:

  • delivery system reform incentive payment programs
  • Medicaid enrollment and renewal processes
  • managed care oversight
  • monitoring and evaluating section 11115 demonstration waivers
  • Medicaid coverage of telemedicine services

MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues.  It is a non-partisan agency of the legislative branch of government.
Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during the meetings.

2017-09-21T06:00:10+00:00September 21st, 2017|Federal Medicaid issues|Comments Off on MACPAC Meets

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.

Safety-Net Association of Pennsylvania logoSNAP 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 to the Ways and Means Committee here.

2017-08-29T17:00:02+00:00August 29th, 2017|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off on SNAP Writes to House Ways and Means Committee About Medicaid DSH Audits

SNAP Joins Others in Letter to PA Senators

SNAP was among 27 Pennsylvania health care organizations to send a joint letter to senators Bob Casey and Pat Toomey pointing out aspects of the House-passed American Health Care Act that could jeopardize access to care for medically vulnerable Pennsylvanians.
Safety-Net Association of Pennsylvania logoAmong the issues addressed in the letter are how the House-passed proposal would detract from the role of Medicaid in fighting the state’s opioid crisis; the proposed reduction in tax credits to help purchase health insurance; the challenge posed by a per capita approach to Medicaid financing; the potential loss of health care jobs; the likelihood of large numbers of Pennsylvanians losing their health insurance and state Medicaid costs rising significantly; and the erosion of consumer protections.
See the complete letter here.

The Prospect of a Medicaid Work Requirement

Over the past three years a dozen states have proposed establishing a work requirement for eligibility for their Medicaid programs and in its proposed FY 2018, the Trump administration has called for extending the ability to impose such a requirement to all states.
But how would a Medicaid work requirement work?  To whom would it apply and what kinds of work might satisfy such a requirement for the approximately 22 million Medicaid recipients (out of 76 million total recipients) to whom it might apply?
Work requirements would have significant implications for the patients and communities that Pennsylvania safety-net hospitals serve, and possibly for the hospitals as well.
A new Commonwealth Fund report looks at these and other issues.  Go here to find the article “What Might a Medicaid Work Requirement Mean?”

2017-06-01T06:00:06+00:00June 1st, 2017|Federal Medicaid issues|Comments Off on The Prospect of a Medicaid Work Requirement

MACPAC Meets

Last week the Medicaid and CHIP Payment and Access Commission met in Washington, D.C.  The agency performs policy and data analysis and offers recommendations to Congress, the Department of Health and Human Services, and the states.
During two days of meetings, MACPAC commissioners received the following presentations:

  • Federal CHIP Funding Update: When Will States Exhaust Their Allotments?
  • Review of June Report Chapter: Program Integrity in Medicaid Managed Care
  • Review of June Report Chapter: Medicaid and the Opioid Epidemic
  • Medicare Savings Program: Eligible But Not Enrolled
  • Medicaid Reform: Implications of Proposed Legislation
  • Preliminary Findings From Evaluations of Medicaid Expansions Under Section 1115 Waivers
  • Potential Effects of Medicaid Financing Reforms on Other Health and Social Programs
  • Review of June Report Chapter: Analysis of Mandatory and Optional Populations and Benefits
  • Managed Long-Term Services and Supports: Network Adequacy for Home and Community-Based Services
  • Update on MACPAC Work on Value-Based Payment and Delivery System Reform

For links to all of these publications and a transcript of the two-day meeting go here, to the MACPAC web site.

2017-05-05T06:00:59+00:00May 5th, 2017|Federal Medicaid issues|Comments Off on MACPAC Meets

Medicaid Work Requirements

Both Congress and a number of states have discussed introducing work requirements into their Medicaid programs.  Such a proposal was part of the American Health Care Act, a number of governors and state legislators have discussed work requirements as a condition of Medicaid eligibility, and some states are reportedly considering including such requirements in section 1115 Medicaid waiver applications.
In a new report, the Congressional Research Service examines the U.S. Department of Health and Human Services’ authority to grant such waivers and how courts might look at such requirements if they were be contested.
Go here to see the Congressional Research Service report “Judicial Review of Medicaid Work Requirements Under Section 1115 Demonstrations.”

2017-04-21T06:00:50+00:00April 21st, 2017|Federal Medicaid issues|Comments Off on Medicaid Work Requirements
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