CMS has paid out about $1.3 billion to settle Medicare appeals claims

 

On June 11, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that the agency has settled Medicare appeals claims with more than 1900 hospitals. CMS paid out approximately $1.3 billion pursuant to a settlement policy announced in August 2014 to help reduce a backlog of patient status claim denials pending in the appeals process. [More]

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Florida legislature reaches agreement on hospital funding for one year

 

Florida legislators agreed to end a conflict about funding for hospitals for one year by increasing Medicaid reimbursement rates for hospitals. The Low Income Pool program (LIP) funded by a section 1115 project was scheduled to end June 30, but the Center for Medicare and Medicaid Services (CMS) did agree to continue the program at a reduced funding level from $2.2 billion to $1 billion for one year and $600 million thereafter. [More]

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CMS Finalizes New Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the June 9, 2015 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Medicare providers and suppliers that participate in a qualifying ACO under the MSSP receive traditional Medicare Part A and Part B fee-for-service payments but the ACO has an opportunity to earn “shared savings” bonus payments if it achieves MSSP savings targets and quality benchmarks. [More]

 

White House Releases Report on Benefits of Medicaid Expansion

 

The White House has released a report entitled, “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.” The report estimates that if the 22 states that have not yet expanded Medicaid chose to do so, some 4,299,000 persons in those states would gain coverage; 1,021,000 more persons would report a usual source of care; 491,000 more persons would receive all needed care; hundreds of thousands more persons would receive recommended preventive screenings (626,400 more persons would receive cholesterol screenings, 163,400 more women would receive mammograms, etc.); [More]

 

U.S. Supreme Court rejects Maine’s attempt to end Medicaid coverage for young adults

 

On Monday, June 8, 2015, the U.S. Supreme Court refused to review a decision by the First Circuit Court of Appeals, which upheld a decision by the Centers for Medicare & Medicaid Services (CMS) rejecting a plan by Mary Mayhew, Maine’s top health official, to cease Medicaid coverage for 6000 19- and 20-year-olds. [More]

 

HHS Proposes New Medicaid/CHIP Quality Improvement Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued proposed rules on May 26, 2015 which would require state Medicaid agencies to draft and implement comprehensive strategies for assessing and improving quality of care for Medicaid beneficiaries. [More]

 

CMS proposes hospital funding offer to assist Florida budget conflict

 

In a May 21, 2015 letter to the Florida Agency for Health Care Administration regarding Low Income Pool (LIP) funding, the Centers for Medicare & Medicaid Services (CMS) stated, “We have preliminarily concluded that 2015-16 funding should be at approximately $1 billion, consistent with the funding level for LIP prior to 2014, to maintain stability while the system transitions. Funding in subsequent years at a more sustainable and appropriate level to cover the state’s remaining uncompensated care costs would be approximately $600 million.” [More]

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GAO Evaluates Federal HCBS Programs

 

The U.S. Government Accountability Office (GAO) released a report on May 20, 2015 entitled, “Federal Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services and Supports.” The report evaluates a wide range of programs within the U.S. Department of Health and Human Services (HHS), including the Administration on Aging (AOA), Administration for Community Living (ACL), and the Centers for Medicare and Medicaid Services (CMS), as well as programs within the U.S. Department of Housing and Urban Development (HUD), Transportation (DOT), and Agriculture (USDA). [More]

 

RWJF Report Estimates 20 States Could Lose $720 Billion in Federal Health Funds Over Ten Years

 

The Robert Wood Johnson Foundation (RWJF) issued a report on May 18, 2015 estimating that 5,623,000 persons in 20 states that have declined to implement state-based health insurance Exchanges under the Affordable Care Act (ACA) may become uninsured in 2016 if the U.S. Supreme Court rules that advance premium tax credits (APTCs) and cost-sharing reductions (CSRs) are only available through state-based Exchanges, not federally-facilitated Exchanges. A ruling in King v. Burwell on that question is expected by June 30, 2015. [More]

 

GAO Report Finds HHS 1115 Waiver Program Lacks Transparency

 

On Wednesday, May 13, 2015, the Government Accountability Office (GAO) issued a report which concluded that the waiver process for Section 1115 of the Social Security Act, which gives the U.S. Department of Health and Human Services (HHS) authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs, “lacks transparency.” [More]

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