Health and Human Services Research

New York Medicaid Integrity PlanThe New York State Office of the Medicaid Inspector General issued its SFY '09 audit work plan on April 22. This is the first annual audit work plan of new IG office created by the State of New York in order to address concerns raised by earlier USDHHS OIG audits.

Public Provider Reimbursement RuleA federal judge in U.S. District Court, Washington, D.C., has accepted arguments by nine plaintiffs that the CMS publication of a final Medicaid rule on reimbursement of public providers immediately after Congress passed (but before the President signed) a moratorium bill was improper. The legal implications of this are not yet known.

SCHIP ExpansionCMS issued revised guidelines on April 28 on statistical criteria that States must meet in order to expand SCHIP eligibility to children in families with income over 250 percent of the Federal poverty level. Massachusetts, Connecticut, and New Jersey have been in litigation against CMS over an 8/17/07 version of the guidelines.

Medicare/Medicaid Payments for Institutional FacilitiesCMS published an interim final rule on May 6 on '09 payments for Long Term Care Hospitals. The rule would increase rates by 2.7 percent, a $110 million increase in Medicare payments to 400 LTCHs that will receive $4.47 billion from Medicare in '09.

CMS Medicaid RegulationsUS Senate began on April 28 to consider a bill approved by the House last week imposing a moratorium through April 1, 2009 on seven CMS Medicaid regulations.

Medicare rehabilitation hospital paymentsCMS published proposed rules on April 25 on Medicare payments for inpatient rehabilitation facilities (IRFs). These rules affect 1,000 IRFs in general hospitals and 200 free standing IRFs that Medicare pays $5.6 billion annually through case mix group (CMG) prospective amounts per discharge and outlier adjustments.

Medicaid and SCHIP RulesThe U.S. House of Representatives voted 349-62 on April 23 to impose a moratorium until April ’09 on CMS restrictions on case management, reimbursement of public providers, outpatient hospital and clinic services, school-based administration and transportation, rehabilitative services, hospital-based graduate medical expenditures, and provider-related taxes.

Medicare Rules Linking Payments to QualityCMS proposed rules on April 14 which expand on its FY ’07 initiatives to link Medicare payments to quality of care.