In the January 18, 2012 Federal Register (77 Fed. Reg. 2500), the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would implement a service-specific basis to define the uninsured for purposes of determining the hospital-specific limitation on Disproportionate Share Hospital (DSH) payments. Section 1923(g) of the SSA limits DSH payments to hospitals to the uncompensated costs of furnishing 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". If the proposed rule is finally adopted, it would reverse the final rule issued in December 2008 (73 Fed. Reg. 77904) that defined the uninsured for purposes of the DSH limitation as those individuals without "creditable coverage," consistent with the definitions under 45 C.F.R. pt. 144 and 45 C.F.R. pt. 146. [More]

On December 29, 2011, U. S District Court Judge Christina Snyder ruled that "California can't cut reimbursements hospitals receive for the skilled-nursing services they provide to low-income people." Both state and federal officials had approved the cuts based on the reasoning that patients could utilize free-standing skilled nursing facilities. But Judge Snyder concluded that state and federal officials "likely relied on unreasonable projections and faulty reasoning about how the cuts would affect frail patients". The case is California Hospital Association v. Douglas, 11-09078, US District Court, Central District of California (Los Angeles). [More]

On December 28, 2011, the U.S. Department of Health and Human Services (DHHS) awarded 23 states $296 million in bonus payments for exceeding enrollment targets in the CHIP program. As an example, Maryland is getting $28.3 million because the state "has streamlined the children's health coverage enrollment process...and uses electronic databases to verify family information." [More]

Ohio Governor John Kasich's office recently submitted a draft proposal to the Centers for Medicare & Medicaid Services (CMS) to create Medicaid "health homes", which are designed to better coordinate physical and behavioral health care for people with severe and persistent mental illness. If approved, the plan "would allow the federal government to cover 90% of the cost of care coordination (with a 10% state match) for those individuals." [More]

On November 21, the President signed into law a “bipartisan” provision that is intended to rectify a portion of the Affordable Care Act (ACA) that would have allowed certain individuals who elect to receive early Social Security benefits to gain eligibility for Medicaid and/or insurance subsidies without counting the full amount of the Social Security benefits. [More]

The Center for Medicare and Medicaid Innovation, created under the ACA, will award grants, beginning in March, to doctors, community groups, local governments, and others who propose ways to improve care to beneficiaries of Medicare, Medicaid, and CHIP. [More]

On Monday, 11/14/11, the U.S. Supreme Court agreed to take on the legal issues concerning the Affordable Care Act (ACA) by considering the split decisions of various Courts of Appeal. The significance afforded by the Justices to the issues to be decided is reflected by the Court’s announcement that it would allot 5 and 1/2 hours for oral argument rather than the usual 1. [More]

On October 27, 2011, the California Department of Health Care Services announced that the Centers for Medicare and Medicaid Services (CMS) has approved a number of provider reimbursement cuts in the state’s Medicaid program. The specific proposals approved by CMS are a 10 percent provider payment reduction on a number of outpatient services, including physicians, clinics, optometrists, therapists, laboratories, dental, durable medical equipment, and pharmacy; a 10 percent payment reduction for freestanding nursing and adult subacute facilities; and a 10 percent provider payment reduction and rate freeze for distinct part/nursing facility-B services. [More]

On November 8, 2011, a panel of the U.S. Court of Appeals in Washington, D.C., on a split vote, upheld the constitutionality of the mandate provision in the Affordable Care Act. The dissenting judge found that there was a lack of timeliness, since the mandate does not go into effect until 2014. Media reports indicated that the U.S. Supreme Court may have met in secret on November 9 to consider whether to take up any or all of the appellate decisions dealing with the Act. [More]

On October 27, 2011, DHHS Secretary Kathleen Sebelius issued a statement that “she lacked the statutory authority to use my demonstration authorities” to reimburse states for an estimated $4.3 billion they paid for Medicaid services for almost 280,000 beneficiaries who should have been enrolled and compensated for under the Medicare program. The erroneous payments resulted from an error by the Social Security Administration that classified some disabled enrollees as eligible for Supplemental Security Income, when actually they were eligible for Title II Social Security Disability Insurance (SSDI) payments. Eligibility for the SSDI program would, in turn, have resulted in compensation under the Medicare program, thereby saving the states from payouts under their Medicaid programs. [More]