Congress takes steps to reauthorize CHIP

On October 4, 2017, the U.S. Senate Finance Committee approved a bill that would reauthorize federal funding through FFY 2022 for the Children’s Health Insurance Program (CHIP), a program that currently serves over nine million low-income children. New funding authorization for CHIP expired on September 30, 2017. For now, states are operating CHIP on federal allotments left over from prior years. Those reserves vary widely from state to state. [More]

Massachusetts Supreme Judicial Court holds that the retention of the right to live in a home transferred to an irrevocable trust does not render the home an “asset” for Medicaid purposes

On May 31, 2017, the Supreme Judicial Court of Massachusetts reversed and remanded two cases involving determinations of eligibility for long-term care assistance under the Massachusetts Medicaid program (MassHealth). Nadeau v. Director of the Office of Medicaid and Daley v. Secretary of the Executive Office of Health and Human Services, SJC 12200 and 12205, May 31, 2017. [More]

CMS proposes changes in Medicare home health programs

On June 27, 2016, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Medicare home health prospective payment system (HH-PPS), the home health quality reporting program (HH-QRP), and the home health value-based purchasing program (HH-VBP). The net effect of the proposed changes on home health agencies in 2017 would be to reduce aggregate Medicare payments on behalf of 3.4 million Medicare beneficiaries to 11,400 HHAs by about $180 million, about one percent of Medicare HHA expenditures. [More]

NEJM examines Medicare physician reimbursement system

On April 7, 2016, the New England Journal of Medicine (NEJM) published an article entitled, “Finding Value in Unexpected Places – Fixing the Medicare Physician Fee Schedule.” The NEJM article notes that the Medicare physician fee schedule (MPFS) may: affect how physicians spend time with patients, drive unneeded tests and procedures, influence physicians’ specialty choices, and worsen shortages of much-needed primary care physicians and geriatricians. [More]

CMS finalizes mental health parity rules

On March 30, 2016, the Centers for Medicare and Medicaid Services (CMS) published final rules on mental health/substance use disorder parity requirements applicable to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP). The final Medicaid/CHIP rules are based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which generally prohibits more restrictive cost-sharing (e.g., co-payments and deductibles), quantitative limitations (e.g., visit limits), and non-quantitative limitations in mental health/substance use disorder benefits under a health plan than in medical/surgical coverage under the same plan. [More]

CMS proposes changes to Medicare ACO rules

On February 3, 2016, the Centers for Medicare and Medicaid Services (CMS) proposed regulations in the Federal Register on Medicare payments to accountable care organizations (ACOs) under the Medicare “shared savings” program (MSSP), which currently includes 434 ACOs, serving 7.7 million Medicare beneficiaries nationwide. Under the MSSP, Medicare Part A and Part B fiscal intermediaries and carriers pay ACOs on a traditional, fee-for-service basis. An ACO may qualify for a “shared savings” bonus if the ACO achieves CMS-specified Medicare savings targets while meeting CMS-specified quality of care performance metrics. [More]

CMS finalizes new Medicaid drug reimbursement rules

On February 1, 2016, the Centers for Medicare and Medicaid Services (CMS) published final regulations in the Federal Register on Medicaid upper payment limits (UPLs) for covered outpatient drugs, as well as rebates that drug manufacturers must provide to states. State Medicaid agencies must take into account “average manufacturers’ prices” (AMPs) and other factors in calculating state Medicaid payments for covered outpatient drugs and dispensing fees to pharmacies that purchase medications, usually from wholesalers. Based on data in reports generated by state Medicaid agencies, drug manufacturers must calculate rebates to states under methods specified in the rule. [More]