Federal Medicaid issues Archives - Page 8 of 12 - Safety-Net Association of Pennsylvania

New Bill Would Address Social Determinants of Health

The federal government would provide funding to help address social determinants of health within Medicaid populations under a new bill introduced in the House of Representatives last week.

According to a legislative summary prepared by one of the bipartisan bill’s sponsors,

Economic and social conditions have a powerful impact on our health and wellness. Stable housing, reliable transportation and access to healthy foods are all factors that can make a difference in the prevention and management of many health conditions like diabetes, asthma and heart disease. Known as social determinants of health, a focus on these non-medical factors can improve health outcomes and wellbeing. States are increasingly looking to deploy social determinants of health interventions to manage costs and improve health outcomes within their Medicaid programs. However, one of the greatest challenges to high-impact interventions is the difficulty in navigating and coordinating fragmented and complex programs aimed at addressing healthcare needs, food insecurity, housing instability, workforce supports, and transportation reliability, among others.

To address these challenges, the bill would

… help states and communities devise strategies to better leverage existing programs and authorities to improve the health and well-being of those participating in Medicaid. The legislation will provide planning grants and technical assistance to state, local and Tribal governments to help them devise innovative, evidence-based approaches to coordinate services and improve outcomes and cost-effectiveness.

Such legislation could be especially beneficial to the communities served by Pennsylvania safety-net hospitals, which generally can be found in low-income communities whose residents’ health is often shaped in large part by social determinants of health.

Learn more about the Social Determinants Accelerator Act by reading a summary of the bill’s key provisions and an FAQ on the bill.

PA Safety Net Admin2019-07-30T06:00:58+00:00July 30th, 2019|Federal Medicaid issues, social determinants of health|Comments Off

CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals. Now, CMS proposes rescinding this requirement, writing in a news release that

This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries. CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that the current requirement applies only to Medicaid fee-for-service payments even though most Medicaid beneficiaries now receive care through managed care plans, the payments for which are not subject to the same process.

The agency adds that it intends to

…replace the ongoing access reviews required by current regulations with a more comprehensive and outcomes-driven approach to monitoring access across delivery systems, developed through workgroups and technical expert panels that include key State and federal stakeholders.

Because they care for so many Medicaid patients, the adequacy of the rates states pay for Medicaid services is especially important to Pennsylvania safety-net hospitals.

Learn more about CMS’s proposal in its news release on the subject or see the proposed regulation itself. Learn about the process CMS intends to employ to replace its current approach to monitoring access to Medicaid services in this CMS informational bulletin.

PA Safety Net Admin2019-07-18T06:00:42+00:00July 18th, 2019|Federal Medicaid issues|Comments Off

Medicaid DSH Delay Advances in Energy and Commerce Committee

Medicaid disproportionate share cuts would be delayed for two years under a proposal advanced last week by the Health Subcommittee of the House Energy and Commerce Committee.

The Medicaid DSH cuts, mandated by the Affordable Care Act, have already been delayed three times by Congress and could be on their way to a fourth delay if the proposal advanced by the Health Subcommittee is endorsed by the Energy and Commerce Committee and works its way to the full House of Representatives, where such a proposal is thought to enjoy wide support.

The Safety-Net Association of Pennsylvania supports this delay of Medicaid DSH cuts. Earlier this year, SNAP asked members of the state’s congressional delegation to join a campaign in the House of Representatives to delay this cut.

Learn more about the possibility of another delay of Medicaid DSH cuts in the HealthLeaders article “House Panel Advances Surprise Bill Package.”

PA Safety Net Admin2019-07-16T06:00:31+00:00July 16th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

The Role of Medicaid in Addressing Social Determinants of Health

Medicaid can play a major role in addressing the social determinants of health.

Or so argues a recent post on the Health Affairs Blog.

According to the post, social determinants of health – income, education, decent housing, access to food, and more – significantly influence the health and well-being of individuals – including low-income individuals who have adequate access to quality health care. Medicaid, the post maintains, can play a major role in addressing social determinants of health.

The post outlines the role state Medicaid programs can play in addressing social determinants of health; describes tools for such action such as section 1115 Medicaid demonstration waivers; offers examples of efforts currently under way in some states; and presents suggestions for steps the federal government can take to facilitate such efforts.

Addressing social determinants of health is an especially important issue for Pennsylvania safety-net hospitals because they care for so many more Medicaid-covered low-income patients than the typical hospital in the state.

Learn more from the Health Affairs Blog post “For An Option To Address Social Determinants Of Health, Look To Medicaid.”

PA Safety Net Admin2019-07-12T09:43:03+00:00July 12th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals, social determinants of health|Comments Off

CMS Outlines New Medicaid Program Integrity Activities

The federal government will introduce a number of initiatives to combat Medicaid waste, fraud, and abuse in the coming months.

In an article on the Centers for Medicare & Medicaid Services’ blog, CMS administrator Seema Verma outlined her agency’s major Medicaid program integrity efforts of the past year, including:

Oversight of state Medicaid claiming and program integrity
Disallowing unallowable claims of federal funding
Increased audits and oversight
Data sharing and partnerships
Education, technical assistance, and collaboration
Reducing improper payments

Initiatives to be introduced in the coming months include (as described in the blog post):

A proposed comprehensive update to Medicaid’s fiscal accountability regulations, to increase states’ accountability for supplemental payments. The update includes additional state reporting, clearer financial definitions, and stronger federal guidance to ensure that states use supplemental payments properly.
A proposed regulation to further strengthen the integrity of the Medicaid eligibility determination process, including enhanced requirements around verification, monitoring changes in beneficiary circumstances, and eligibility redetermination.
Additional guidance on the Medicaid Managed Care Final Rule from 2016 to further state implementation and compliance with program integrity safeguards, such as reporting overpayments and possible fraud.
Release of improvements to the Medicaid and CHIP Scorecard—a dashboard of program measures that increases public transparency about the programs’ administration and outcomes. The improvements include two program integrity measures to enhance transparency and continue to provide states with performance measures related to their Medicaid programs. Examples of such program integrity measures may include measures based on state initiation of collaborative investigations with their UPIC, state participation in the HFPP at any level, and performance data derived from improper payment drivers.
Conduct provider screening on behalf of states for Medicaid-only providers to improve efficiency and coordination across Medicare and Medicaid, reduce state and provider burden, and address one of the biggest sources of error as measured by PERM.
Medicaid provider education through Targeted Probe and Educate—which identifies providers who have high error rates and educates them on billing requirements—to reduce aberrant billing, as well as education provided through Comparative Billing Reports—which show providers their billing patterns compared to their peers.
Audit state claiming of federal matching dollars to address areas that have been identified as high-risk by GAO and OIG, as well as other behavior previously found detrimental to the Medicaid program.

Learn more in the CMS blog article “Medicaid Program Integrity: A Shared and Urgent Responsibility.”

PA Safety Net Admin2019-07-03T10:21:53+00:00July 3rd, 2019|Federal Medicaid issues|Comments Off

Administration Ramps Up Scrutiny of Immigrants’ Use of Public Benefits

Immigrants’ sponsors could be more likely to be held financially responsible for the cost of public benefits those immigrants receive under a new memorandum issued by the White House.

The requirement itself is not new; the purpose of the memorandum is to encourage federal agencies to enforce existing laws that state that, according to the memorandum,

…when an alien applies for certain means-tested public benefits, the financial resources of the alien’s sponsor must be counted as part of the alien’s financial resources in determining both eligibility for the benefits and the amount of benefits that may be awarded. Financial sponsors who pledge to financially support the sponsored alien in the event the alien applies for or receives public benefits will be expected to fulfill their commitment under law.

Among the means-tested public benefits programs at which this new directive is aimed are Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), and Temporary Assistance for Needy Families (TANF).

While the law already requires agencies to enforce immigrants sponsors’ legal financial responsibilities, the White House memorandum notes that it is not being enforced and directs the federal agencies involved to review and update their enforcement procedures.

Enforcement of this directive could result in fewer people applying for and being found eligible to receive Medicaid. If this occurs, it could be especially harmful to Pennsylvania safety-net hospitals that serve large immigrant communities, potentially leaving them unpaid for care they provide to such patients.

Learn more from the administration’s “Memorandum on Enforcing the Legal Responsibilities of Sponsors of Aliens.”

PA Safety Net Admin2019-06-06T06:00:12+00:00June 6th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Medicaid DSH Delay Wins Bipartisan Support

More than 300 members of the U.S. House have joined a letter to House leadership urging a delay in Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH).

The bipartisan letter notes that hospitals that receive Medicaid DSH funds cannot absorb the loss of revenue such a cut would bring. That cut, scheduled to begin in FY 2020, would amount to a $4 billion reduction in nation-wide Medicaid DSH spending in FY 2020 and an $8 billion reduction in each of FY 2021, FY 2022, FY 2023, FY 2024, and FY 2025.

SNAP was actively involved in urging Pennsylvania House members to join the letter. If implemented, the Medicaid DSH cuts would be especially harmful to SNAP members and all Pennsylvania safety-net hospitals – and to the low-income residents of the communities they serve.

See the bipartisan letter seeking a delay of Medicaid DSH cuts here.

PA Safety Net Admin2019-05-24T06:00:46+00:00May 24th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

Tackling Social Determinants of Health

Two states are working to address social determinants of health through their Medicaid programs.

In California and Oregon, the state Medicaid programs are using care coordination and funding from multiple sources, including traditional Medicaid funding, alternative payment approaches, and savings from care coordination to provide services such as housing, food, and legal assistance while also building the capacity of health care and community groups to support such efforts. Both states obtained federal Medicaid waivers to enable them to expend Medicaid resources on non-Medicaid-covered services.

Learn more about how California and Oregon are using their Medicaid programs to address social determinants of health in the Health Affairs report “Medicaid Investments To Address Social Needs In Oregon And California.”

PA Safety Net Admin2019-05-15T06:00:53+00:00May 15th, 2019|Federal Medicaid issues, social determinants of health|Comments Off

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs.

Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests.

According to a recent post on the CMS blog (in CMS’s own words),

Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note: state plan amendments].
Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016.
Between calendar year 2016 and 2018, median approval times for 1915(b) waivers decreased by 11 percent, 1915(c) renewal approval times decreased by 38 percent, and 1915(c) amendment approval times decreased by 28 percent.
The backlog of pending SPA and 1915 waiver actions pending additional information from the states was reduced 80 percent from previous years.

Learn more in the CMS blog entry “CMS Streamlines Medicaid Review Process and Reduces Approval Times so States Can More Effectively Manage Their Programs.”

PA Safety Net Admin2019-05-13T06:00:33+00:00May 13th, 2019|Federal Medicaid issues|Comments Off

New Poverty Level Standards to Jeopardize Medicaid Eligibility?

The Trump administration is considering changing how the federal government measures inflation for the purpose of calculating the federal poverty level.

Such a change, if implemented, could potentially reduce inflation-related increases in the federal poverty level, which in turn could limit the ability of some individuals and families to qualify, or continue to qualify, for a variety of public safety-net services – including, potentially, Medicaid.

Among the possible alternatives to the current methodology for calculating inflation is the Chained Consumer Price Index for All Urban Consumers. The Obama administration also explored substituting this index for the current inflation factor.

Any change that makes it more difficult for people to qualify for Medicaid could be particularly damaging to Pennsylvania safety-net hospitals, which are generally located in communities with especially large numbers of low-income residents. If patients lose their Medicaid eligibility because the criteria for participating in the program change, that could leave such hospitals serving even more uninsured patients and providing even more uncompensated care than they already do.

The federal Office of Management and Budget has issued a request for comment about various inflation factor calculation alternatives. Go here to see OMB notice Request for Comment on the Consumer Inflation Measures Produced by Federal Statistical Agencies. Comments are due in late June. Learn more from the New York Times article “Trump Administration Seeks to Redefine Formula for Calculating Poverty.”

PA Safety Net Admin2019-05-10T06:00:54+00:00May 10th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

SNAPShots

SNAPShots

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us