U.S. Supreme Court Hears Oral Arguments on Whether Medicaid Providers Can Challenge a State’s Reimbursement Rates

 

On January 20, 2015, the U.S. Supreme Court heard oral arguments on whether the Supremacy Clause of the U.S. Constitution granted a state’s Medicaid providers a private right of action to challenge a state’s reimbursement rates. The Supremacy Clause generally is invoked when a federal law and a state law on the same subject collide with the federal law prevailing. [More]

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Categories:Health and Human Services

 

Indiana Wins State Health Plan Approval

 

The Centers for Medicare and Medicaid Services (CMS) notified the Indiana Family and Social Services Administration (FSSA) on January 27, 2015 that CMS has approved FSSA’s “Healthy Indiana Plan 2.0”. Indiana’s plan is designed to improve access to preventive care, encourage healthy behaviors, and promote greater efficiency in the health care delivery system. The CMS approval includes waivers of federal Medicaid requirements in eight major areas, including waivers related to charging enrollment premiums and enrollee co-payments on covered services. [More]

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Federal District Court Judge Rules FL Medicaid Program Violates Federal Laws

 

On December 31, 2014, Judge Adalberto Jordan of the U.S. District Court for the Southern District of Florida ruled that Florida’s Medicaid program violated federal laws, including those pertaining to the EPSDT program and the requirement in 42 U.S.C. section 1396a(30)(A) that providers be sufficiently compensated to ensure access by Medicaid recipients to services equal to others in the same geographical area. [More]

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CMS Withdraws Its Free Care Policy

 

In a December 15, 2014 letter to state Medicaid directors, the Centers for Medicare and Medicaid Services (CMS) issued new guidance withdrawing its long-standing free care policy. Historically, with the exception of IEP/IFSP services, CMS refused Medicaid payments to school districts for covered services provided to Medicaid-enrolled students if the school district provided the services free to other students (called the “free care policy”). [More]

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Categories:Education

 

CMS Issues Final Rule Re: Hospital-Specific Limitation

 

In the December 3, 2014 Federal Register (79 Fed. Reg. 71679), the Centers for Medicare & Medicaid Services (CMS) issued a final rule authorizing a service-specific basis for defining the uninsured, for the purpose of determining the hospital-specific limitation on disproportionate share hospital (DSH) payments. Under section 1923(g) of the Social Security Act, DSH payments to hospitals are limited to the uncompensated costs of providing hospital services to individuals who are Medicaid eligible or have no health insurance (or other source of third party coverage) for the services furnished during the year. [More]

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CMS Proposes Changes in Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the December 8, 2014 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Under the MSSP, Medicare providers and suppliers that participate in a qualifying ACO receive traditional Medicare Part A and Part B fee-for-service payments, the ACO drives collaboration, and the ACO has an opportunity to earn “shared savings” bonus payments for each ACO “performance period” if it achieves MSSP savings targets and performance standards under quality measures for that period. [More]

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GAO Issues Report on Transparency of CMS Websites for Consumers

 

The U.S. Government Accountability Office (GAO) released a report on November 18, 2014 entitled, “Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers.” GAO found that five Centers for Medicare and Medicaid Services (CMS) websites launched over 12 years – Nursing Home Compare (1998), Dialysis Compare (2001), Home Health Compare (2005), Hospital Compare (2005), and Physician Compare (2010) – do not use language consumers understand, do not present data in ways meaningful to consumers, and do not help consumers collect information they need to make informed, value-based decisions about their care. While the CMS websites can motivate providers to improve quality of care, research shows that providers and consumers look at data differently. [More]

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HHS OIG Releases Work Plan for Federal Fiscal Year 2015

 

As the new Federal Fiscal Year began on October 1, 2014, a work plan was released that outlines the engagements planned throughout the year. The Office of Inspector General (OIG) was created was created “to protect the integrity of US Department of Health and Human Services (HHS) programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal health care laws.” [More]

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CMS Launches $840 Million Quality Improvement Initiative

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued two funding opportunity announcements on the Transforming Clinical Practices Initiative (TCPI) on October 23, 2014. The two announcements describe opportunities for applicants to compete for up to $840 million in federal funding under cooperative agreements with CMS over a May 1, 2015 - April 30, 2019 performance period. Applicants may seek funding under cooperative agreements as Practice Transformation Networks (PTNs) or as Support and Alignment Networks (SANs). [More]

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CMS Issues Proposed Notice to Establish Methodology to Determine Federal Payments Under BHP in 2016

 

The Centers for Medicare & Medicaid Services (CMS) published in the October 23, 2014 Federal Register a proposed Notice (79 Fed. Reg. 63363) which would establish the methodology the agency intends to utilize to determine federal payments under the Basic Health Program (BHP) in 2016. Pursuant to Section 1331 of the Affordable Care Act (ACA), states can elect to operate a BHP, which would provide affordable health coverage to individuals under age 65 with household incomes between 133% and 200% of the federal poverty level who are not otherwise eligible for Medicaid, CHIP, or affordable employer-sponsored coverage. [More]

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