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Providers Can’t Sue Over Low Medicaid Payments

Health care providers may not turn to the courts when they believe their state Medicaid program is not paying them enough for the services they deliver, the Supreme Court has decided.
Instead, they must seek help from the federal government, which makes the rules that govern Medicaid provider payments.
The Supreme Court decision overturns a lower court ruling in response to a suit by facilities in Idaho that provide residential services to the disabled claiming that the state was paying them less than it had agreed to pay.  As a result, providers must now turn to the Centers for Medicare & Medicaid Services (CMS) if they believe they are not being paid fairly.
Learn more about the Supreme Court’s decision in this news story in The Hill.
 

2015-04-01T06:00:50+00:00April 1st, 2015|Uncategorized|Comments Off on Providers Can’t Sue Over Low Medicaid Payments

Hospitals Worry About Underpayments as Medicaid Expands in PA

The Healthy Pennsylvania Medicaid expansion will bring Medicaid payments that often fall below hospital costs, potentially causing problems for hospitals that serve especially large numbers of new Medicaid beneficiaries.
While hospitals acknowledge that in some cases they will, under the program, start receiving payments for care they otherwise might have provided without any reimbursement at all, they note that the payments they expect from Healthy PA private insurers will fail to cover the cost of the care they provide in many cases.
Doctor listening to patientThe problem is especially acute when it comes to payment for outpatient services, which may cover only about 30 percent of the cost of outpatient care.
Because they serve so many Medicaid patients, this situation is likely to pose an especially great challenge for Pennsylvania’s safety-net hospitals.
For a look at the challenges hospitals expect under the Healthy PA Medicaid expansion and  the effect it may have on their bottom line, see this Pittsburgh Tribune-Review story.

2014-12-11T06:00:55+00:00December 11th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off on Hospitals Worry About Underpayments as Medicaid Expands in PA
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