Senators Push IRS on Non-Profit Compliance

Two prominent senators have written to the Internal Revenue Service seeking information about what the agency is doing to ensure that non-profit hospitals comply with the requirements for providing sufficient community benefits to justify their tax-exempt status.

 Senators Orrin Hatch (R-UT), chairman of the Senate Finance Committee, and Chuck Grassley (R-IA), a senior member of that committee, have asked the IRS to provide their committee with specific information about how the IRS evaluates non-profit hospitals’ Form 990 Schedule H; about guidance the IRS provides regarding how hospitals define their communities and their communities’ needs; about the performance and outcome of IRS reviews of individual non-profit hospitals’ compliance with legal tax-exemption requirements; and about the status of the IRS’s anticipated report to Congress on tax-exempt and public hospitals.

Go here to see the senators’ news release about their letter and the letter itself.…

Physician-Owned Hospitals Returning?

In testimony before the House Ways and Means Committee, new Health and Human Services Secretary Alex Azar indicated that he may be receptive to easing restrictions on physician-owned hospitals.

The Affordable Care Act made it difficult for doctors either to launch new hospitals of their own or to expand physician-owned hospitals already in operation, and many existing physician-owned facilities stopped serving Medicare patients.  In response to a question from a committee member, Azar expressed his interest in working to enable physician-owned hospitals to operate.

Learn more from this Fierce Healthcare article.…

Lowering Prescription Drug Costs

Shifting Medicare Part B drug coverage into Medicare Part D.

Reducing Medicare Part D co-pays for generic drugs.

Increasing the number of pharmacy benefit managers.

Establishing expedited review for new versions of brand-name drugs.

Tying U.S. drug prices to prices paid for the same drugs in other countries.

Using U.S. trade policies to compel other countries to pay more for American pharmaceutical products.

These are among the ideas presented in a new report by the White House Council of Economic Advisers detailing steps that might be taken to reduce prescription drug prices in the U.S.

To learn more about these and other ideas, go here to see the White House Council of Economic Advisers report Reforming Biopharmaceutical Pricing at Home and Abroad.…

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well.

Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including:

  • establishing time limits on how many months or years individuals may be enrolled in Medicaid;
  • locking out for a specified period of time Medicaid recipients who have not gone through annual eligibility redetermination or have failed to pay Medicaid premiums;
  • prohibiting hospitals from making presumptive eligibility determinations when they encounter new, low-income patients who are not enrolled in Medicaid at the time;
  • tightening their eligibility requirements;
  • excluding family planning providers like Planned Parenthood; and
  • establishing closed drug formularies for their Medicaid population.

Learn more about how the foundation has been laid for such changes if states are so inclined to pursue them and the implications of such changes if they are implemented in the article “State Waivers as a …

A New Wave of Medicaid Expansion?

Spurred by the Trump administration’s invitation to states to apply for approval to make work requirements a part of their Medicaid program, a number of states that spurned the opportunity created for expansion under the Affordable Care Act may consider pursuing Medicaid expansion in the near future.

Currently, some elected officials in Idaho, Kansas, North Carolina, Utah, Virginia, and Wyoming appear to be considering what they once considered unthinkable:  making more of their residents eligible for Medicaid.

For the most part, expansion talk is coming from moderate Republican legislators who believe a work requirement may help soften the staunch opposition to Medicaid expansion among their more conservative Republican colleagues – and at this point it is all still just talk.

Ten states have already sought federal approval to establish a work requirement as part of their Medicaid programs and one state, Kentucky, has already had such a request approved.

Learn more about how a federal move to reduce the number of people on the nation’s Medicaid rolls may actually result in an increase in nation-wide Medicaid enrollment in this Washington Post story.…