CMS Issues Guidance on Medicaid DSH Auditing and Reporting Requirements

 

The Centers for Medicare & Medicaid Services (CMS) issued guidance on auditing and reporting requirements for Medicaid Disproportionate Share Hospital (DSH) payments, which are intended to bring transparency to the use of DSH funds. The guidance, issued on April 4, 2014, is entitled, “Additional Information of the DSH Reporting and Audit Requirements-Part 2.” In the December 19, 2008 Federal Register, CMS issued a final rule establishing new requirements to implement a provision of the Medicare Prescription Drug, Improvement, and Modernization Act. That final rule included a transition period related to audit findings for Medicaid state plan rate years (SPRYs) 2005 through 2010. CMS has stated that this new additional guidance “is designed to ensure proper implementation, consistent practice, and protection for states and hospitals as we approach the end of the regulatory transition period”. [More]

 

New York Wins CMS Approval of Medicaid Redesign Plans

 

The Centers for Medicare and Medicaid Services (CMS) notified the New York Department of Health on April 14, 2014 that CMS has approved New York’s plans to redesign its Medicaid program under section 1115 demonstration waivers. New York’s plans include completing work begun by Governor Andrew Cuomo’s Medicaid Redesign Team (MRT), which developed 79 recommendations after extensive state-wide stakeholder input. The CMS letter officially approves amendments to a current section 1115 demonstration running through December 31, 2014 and establishes parameters for a subsequent, five year renewal period. The CMS letter authorizes $8 billion in Federal Medicaid funding for innovative programs, within a global Medicaid cap, in three major categories. [More]

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Covered California Reports QHP Enrollment Surge in March

 

Covered California, the nation’s largest health insurance Exchange, released enrollment data on April 3, 2014 showing that enrollments in qualified health plans (QHPs) offered through the Exchange surged to 1,221,727 on March 31, 2014, the last day of the six month open enrollment period (versus 868,936 that had been reported through February 28); on the last day, a record number of 117,421 application accounts were set up on the Exchange. [More]

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CMS Report Shows February Growth in Medicaid/CHIP Enrollment

 

The Centers for Medicare and Medicaid Services (CMS) released on April 4, 2014 a report showing that 25 states which implemented Medicaid expansion under the Affordable Care Act (ACA) by February 2014 saw on average an 8.3 percent increase in Medicaid/CHIP enrollment for February 2014, as compared to those states’ average monthly enrollments in a July – September 2013 baseline period. The largest percentage increases were in Oregon (34.8 percent), West Virginia (33.5 percent), Vermont (32.3 percent), Nevada (21.7 percent), and Maryland (20.8 percent). The ACA created as of January 1, 2014 a new Medicaid eligibility category of non-disabled, childless adults with incomes up to 133 percent of the Federal poverty level, but exact data are not yet available from CMS on how many January – February 2014 enrollees are in that new ACA category. [More]

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President Obama Signs H.R. 4302

 

On April 2, President Obama signed into law H.R. 4302, the “Protecting Access to Medicare Act of 2014,” which averts a 24 percent reduction in Medicare Part B physician payment rates until at least March 31, 2015. As in many prior years, Congress set aside Medicare payment reform proposals that would have repealed the “sustainable growth rate” (SGR) formula (in Medicare law since 1997) but postponed for another year the payment reductions that the SGR formula would have imposed. Instead, physician payment rates will increase 0.5 percent as a result of the new legislation. H.R. 4302 also postpones from October 1, 2014 to October 1, 2015 the date upon which the Centers for Medicare and Medicaid Services (CMS) can require health care providers and health plans to transition from ICD-9-CM to ICD-10-CM coding on claims, a five-fold increase in diagnostic coding specificity. [More]

 

New Hampshire Agrees to Medicaid Expansion Plan under ACA

 

On March 26, 2014, New Hampshire Governor Maggie Hassan signed Senate Bill 413 into law, joining 25 other states in expanding Medicaid eligibility under the Affordable Care Act (ACA). The New Hampshire law will provide health insurance to 50,000 low-income adults in a 2 ½-year pilot program paid for with federal Medicaid funding. [More]

 

HHS Finalizes Exchange Rules for 2015

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the March 11, 2014 Federal Register as part of the HHS Notice of Benefit and Payment Parameters for 2015 related to the risk adjustment, reinsurance, and risk corridors programs under the Affordable Care Act (ACA). The Notice of Benefit and Payment Parameters for 2015 deals mainly with health insurance issuer contributions into risk pools and disbursements from risk pools to health insurance issuers to maintain stability in the health insurance marketplace as coverage expands as a result of the ACA. [More]

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HHS Proposes Revisions to Health Insurance Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the March 21, 2014 Federal Register to update and clarify a wide range of health insurance rules under the Affordable Care Act (ACA). The proposed rules would adjust requirements for health insurance in the individual and group health insurance markets; standards for health insurance Exchanges; standards for health insurance issuers offering qualified health plans (QHPs) through Exchanges; reporting requirements for health insurance issuers on health care quality, medical loss ratios (MLRs), and rebates to consumers from issuers that do not meet MLR requirements; and standards under the ACA reinsurance, risk corridor, and risk adjustment programs. The proposed rules require Exchanges to display prominently on their web sites QHP quality rating and enrollee satisfaction survey results, and that QHPs participate in quality improvement strategies. The proposed rules also set forth revised procedures applicable to Navigators and other consumer assistance entities, privacy and security of personally identifiable information, program integrity, non-discrimination among consumers, investigation of complaints, and potentially severe civil monetary penalties (CMPs) that can be imposed as a result of improper use or disclosure of information, fraudulent practices, and other violations of Exchange standards. Under a new exception to Exchange non-discrimination standards, an organization receiving Federal funds to provide services to a defined population (e.g., the Ryan White HIV/AIDS program or an Indian health provider) may limit its provision of certified application counselor services to that population as long as it agrees to offer referral services to others seeking assistance. The proposed rules would circumscribe State requirements that might unduly restrict Exchange functions, such as requirements that Navigators carry errors and omissions insurance or hold agent or brokers licenses, and would explicitly prohibit improper activities such as charging applicants for application assistance or accepting remuneration from applicants or kickbacks from insurers. The proposed rules make clear that State-based Exchanges may, and Federal Exchanges will, require consumers to make payment of the first month’s premium in order to effectuate the consumer’s enrollment in a QHP. Comments on the proposed rules are due April 21, 2014. [More]

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CMS Issues Letter on Requirements for Increased Provider Offerings by Health Plans in 2015

 

On March 14, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a Letter, entitled, “2015 Letter to Issuers in the Federally-facilitated Marketplaces.” Among its provisions, the Letter states that health plans selling on the federal marketplaces in 2015 must include 30 percent of area “essential community providers,” which are usually health centers and other hospitals serving mostly low-income patients. [More]

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Child Care and Development Block Grant Act of 1990 Legislation Debated

 

The reauthorization of the Child Care and Development Block Grant (CCDBG) continues to be delayed through committee, as well as multiple amendments addressing a wide array of issues. On March 12, 2014 more than 30 amendments were introduced on the Senate floor in an effort to refine, redefine, and improve the requirements of the legislation. Often the amendments involved striking a word here and there, but some amendments called for substantive changes such as the elimination of duplicative programs. Those programs identified for elimination included. [More]

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