Medicaid disproportionate share Archives - Page 4 of 7 - Safety-Net Association of Pennsylvania

MACPAC Recommends Changes in Medicaid Shortfall Definition

Hospitals’ calculation of their Medicaid shortfall would change under a recommendation that MACPAC voted to make to Congress. That change, in turn, could affect hospitals’ future Medicaid disproportionate share payments.

Last week the Medicaid and CHIP Payment and Access Commission voted overwhelmingly to change how hospitals calculate their Medicaid shortfall: the difference between what they spend caring for their Medicaid patients and what Medicaid pays them for that care. Under MACPAC’s proposal, hospitals would need to deduct from their shortfall total all third-party payments they receive for the care they provide to their Medicaid patients.

If this proposal were to be adopted, it has the potential of changing Medicaid DSH allocations among the states and change the distribution of Medicaid DSH funds within individual states, although the Congressional Budget Office estimates that it would have little impact on either measure.

Complicating the MACPAC recommendation is last year’s federal court ruling that third-party payments could not be deducted from hospitals’ Medicaid shortfall totals because the Centers for Medicare & Medicaid Services lacks the authority to implement such a policy. Making such a change therefore would require action by Congress.

Learn more about the MACPAC recommendation and its potential implications for hospitals and their Medicaid DSH payments in the Fierce Healthcare article “’Medicaid shortfall’ definition should change when tallying DSH payments, MACPAC says.”

PA Safety Net Admin2019-04-19T06:00:38+00:00April 19th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

MACPAC: Slow Medicaid DSH Cuts

Slow the pace of scheduled cuts in Medicaid disproportionate share hospital payments (Medicaid DSH), the non-partisan agency that advises Congress and the administration will tell Congress in its next report of policy recommendations.

The Medicaid and CHIP Payment and Access Commission voted 16-1 recently to recommend to Congress that Medicaid DSH cuts, mandated by the Affordable Care Act but delayed three times by Congress, be reduced in size and spread out over a longer period of time.

Currently, Medicaid DSH allotments to the states are scheduled to be reduced $4 billion in FY 2020 and then $8 billion a year in FY 2021 through FY 2025. MACPAC recommends that the cuts be reduced to $2 billion in FY 2020, $4 billion in FY 2021, $6 billion in FY 2022, and $8 billion a year from FY 2023 through FY 2029.

MACPAC commissioners also voted to urge Congress to restructure the manner in which Medicaid DSH allotments to the states are calculated based on the number of low-income individuals who reside in the states.

Most Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider them a vital resource in helping to underwrite the uncompensated care they provide to uninsured patients.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program.

Learn more about MACPAC’s actions on Medicaid DSH in the Fierce Healthcare article “MACPAC calls for Congress to delay cuts to safety-net hospitals.”

PA Safety Net Admin2019-02-04T06:00:11+00:00February 4th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP.

Later that morning, the Commission discussed a study on performance and return on investment for state program integrity strategies. This session was originally scheduled for the December meeting. Following a break for lunch, the Commission was briefed on a new report by Mathematica Policy Research, under contract to MACPAC, regarding beneficiary enrollment in the Financial Alignment Initiative, which is testing new approaches to integrating care for people who are dually eligible for Medicaid and Medicare. Later, staff presented an analysis of the factors affecting physician decisions to accept new Medicaid patients.

Friday’s sessions opened with a panel of experts discussing how utilization management policies are applied to medication-assisted treatment (MAT). Under the SUPPORT for Patients and Communities Act (P.L. 115-271), MACPAC is required to study utilization management policies related to MAT and report on these by late October 2019. The meeting concluded with its third and final session on hospital payment: how to account for third-party payments in the DSH definition of Medicaid shortfall.

Supporting the commissioners’ deliberations were the following presentations prepared by MACPAC staff.

Because SNAP members serve so many Medicaid patients, MACPAC’s deliberations are especially relevant to them because its recommendations often find their way into future Medicaid and CHIP policies.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program.

PA Safety Net Admin2019-01-29T06:00:09+00:00January 29th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients.
Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs.
Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH. The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients.
The Affordable Care Act calls for reducing Medicaid DSH payments to hospitals. Many hospitals and hospital groups oppose this cut and are asking Congress to block its implementation. Pennsylvania’s safety-net hospitals benefit considerably from Medicaid DSH payments.
The Commonwealth Fund recently published a commentary calling for delaying scheduled Medicaid DSH cuts. Go here to see the article “Keep Harmful Cuts in Federal Medicaid Disproportionate Share Hospital Payments at Bay.”

PA Safety Net Admin2017-12-27T06:00:23+00:00December 27th, 2017|Affordable Care Act, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C.
The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting.

The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s vice president for Medicaid drug rebate management; and John Coster, director of the Center for Medicaid and CHIP Services Division of Pharmacy at the Centers for Medicare & Medicaid Services. At the final morning session, Commissioners reviewed a draft March 2018 report chapter on streamlining Medicaid managed care authorities. The Commission voted to approve recommendations to Congress, but deferred action on a third recommendation for further discussion at its upcoming January 2018 meeting.

In the afternoon, MACPAC staff previewed highlights from the December 2017 MACStats: Medicaid and CHIP Data Book. MACStats pulls together Medicaid and CHIP data from multiple sources that often can be difficult to find. The collection is published annually and individual tables are updated throughout the year. The Commission then reviewed the draft March report chapter on telemedicine in Medicaid, and later in the day the Commission returned to the topic of prescription drugs, to explore potential recommendations on the Medicaid drug rebate program.

The final December sessions covered MACPAC’s annual analysis of disproportionate share hospital payments (a required element of its March reports), and findings from interviews with four states to better understand how they are implementing Section 1115 Medicaid-expansion waivers.

The following presentations, many with supporting documents, were offered during the MACPAC meeting:

PA Safety Net Admin2017-12-19T06:00:26+00:00December 19th, 2017|Federal Medicaid issues|Comments Off

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.

PA Safety Net Admin2017-10-04T14:33:14+00:00October 4th, 2017|Federal Medicaid issues|Comments Off

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.

SNAP 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.

PA Safety Net Admin2017-08-29T17:00:02+00:00August 29th, 2017|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

New MACPAC Reports

The Medicaid and CHIP Payment and Access Commission has released several new reports, including:

a look at how states exercise flexibility in their individual Medicaid programs;
methodologies for setting Medicaid per capita caps;
a review of how states are addressing high-cost hepatitis C drugs in their Medicaid programs;
an analysis of Medicaid disproportionate share hospital payment (Medicaid DSH) allotments and payments; and
an analysis of when states will exhaust their CHIP allotments.

MACPAC is a non-partisan legislative branch agency that advises Congress, the states, and the administration on Medicaid and CHIP payment and access issues.
Find links to these and other MACPAC reports here, on the MACPAC web site.

PA Safety Net Admin2017-04-18T06:00:00+00:00April 18th, 2017|Federal Medicaid issues|Comments Off

CMS Clarifies Medicaid DSH Rule

Last week the Centers for Medicare & Medicaid Services announced a final rule addressing the treatment of third-party payers in calculating Medicaid uncompensated care costs. This calculation affects individual hospitals’ Medicaid disproportionate share (Medicaid DSH) limit.
According to CMS,

This rule clarifies federal requirements regarding the treatment of third party payers in determining the hospital-specific Medicaid DSH payment limit, which is set by statute as a hospital’s “uncompensated costs” incurred in providing hospital services to Medicaid and uninsured patients.

The final rule makes clearer our existing policy that uncompensated costs include only those costs for Medicaid eligible individuals that remain after accounting for all payments received by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments. This is consistent with the statutory requirements governing Medicaid DSH and applicable limits.

All Pennsylvania safety-net hospitals receive Medicaid DSH payments.
See the full rule here.

PA Safety Net Admin2017-04-04T06:00:05+00:00April 4th, 2017|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

MACPAC Looks at Medicaid DSH

With Medicaid disproportionate share payments (Medicaid DSH) facing future reductions, the agency charged with advising Congress on Medicaid and Children’s Health Insurance payment and access matters is considering what changes the federal supplemental Medicaid payment program might need.
At a recent meeting in Washington, D.C., the Medicaid and CHIP Payment and Access Commission discussed the changing role and purpose of Medicaid DSH as more Americans obtain health insurance through private or public sources. MACPAC commissioners noted that hospital uncompensated care is falling, especially in states that have taken advantage of the Affordable Care Act to expand their Medicaid programs.
A new Medicaid DSH formula set to be used for FY 2018, based more heavily than the current formula on the number of uninsured people in individual states, is expected to result in larger-than-average reductions for hospitals in Medicaid expansion states.
Among the steps commissioners discussed were examining how hospitals use their Medicaid DSH funds; considering how any changes in the distribution of Medicaid DSH funds might affect other parts of states’ health care systems; and the role states should play in determining the allocation of Medicaid DSH funds.
Medicaid DSH funds are a vital source of support to help Pennsylvania safety-net hospitals care for their many uninsured patients.
For a closer look at the issue and MACPAC’s deliberations, see this CQ Roll Call article presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-26T06:00:26+00:00September 26th, 2016|Affordable Care Act, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

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