Archive for May, 2012


Medicaid Primary Care Rates to Rise

Rates for primary care services covered by Medicaid will rise upon implementation of a new regulation recently published in draft form by the Centers for Medicare & Medicaid Services (CMS).

Under the proposed regulation, states will pay Medicare-level rates for Medicaid-covered primary care services in 2013 and 2014.  Medicare rates generally are higher for such services, and under the proposed regulation the federal government, not the states, will pay for the difference between Medicare and Medicaid rates.

This new policy was mandated by the Affordable Care Act.  In addition to raising fee-for-service rates, states will be expected to revise agreements with Medicaid managed care plans to ensure that they, too, pay the better rates.

Proponents of the higher rates believe they will improve access to primary care services for the Medicaid population and possibly reduce future Medicaid costs by helping recipients get more timely care and thereby avoid more serious illnesses.

Learn more about the proposed Medicaid rate increase in a Commonwealth Fund blog entry and find the entire proposed regulation here.  Interested parties have until June 11 to submit written comments to CMS.…

Focus on Dual Eligibles Continue

Dual eligibles – people whose health care benefits are covered by both Medicare and Medicaid – constitute the poorest and sickest of publicly insured people.  These nine million people also are among the most expensive to care for, so the federal government and state governments are investing significant effort and resources to find better, more effective, and more economical ways to serve this challenging population.

The prevalence of dual eligibility varies widely from state to state, depending on the nature of individual states’ populations and their particular Medicaid eligibility requirements.  Dual eligibility even differs significantly from county to county in many states.

The Kaiser Commission on Medicaid and the Uninsured has released a new analysis on the dual eligible population, including state-by-state and county-by-county data and whether individual states have submitted proposals to the federal government to pursue a demonstration program to integrate Medicaid and Medicare financing and services for their dual eligible population.  You can find that analysis here.…

States Struggle to Return Nursing Home Residents to the Community

Five years after it was launched, a federal program to help residents of long-term-care facilities return to the community has fallen far below its goals.

The Money Follows the Person Rebalancing Demonstration Program, launched in 2007, was created to move low-income elderly and disabled Medicaid recipients from long-term-care facilities back into the community if they were interested in such a move and capable of living with greater independence.

The program’s initial goal was to move than 35,000 people back into the community during the program’s first five years.  To date, 22,500 have made this transition – 36 percent short of the goal that the states themselves set.  Some states are doing better than others; some are struggling despite considerable additional investment in the program by Congress.

Read more about the Money Follows the Person Rebalancing Demonstration Program, the obstacles it has encountered, and the results the program has produced so far in this Kaiser Health News report.…

Hospitals Work to Reduce Costs

Hospitals are focusing more than ever on reducing their costs, pushed to do so by insurers, employers, and the health care reform law.

In the process, they are doing everything from reminding physicians how much a single pint of blood costs to removing fried foods from their cafeterias’ menus.

Read more about why hospitals across the country are working to cut their costs, and how they are doing so, in this New York Times article.…

Comparative Effectiveness Research Funding Available

The Patient-Centered Outcomes Research Institute (PCORI) has announced that it will fund $120 million in new comparative effectiveness research.

The agency, created by the Affordable Care Act, will award research grants in five areas:  assessment of prevention, diagnosis, and treatment options; improving health care systems; communication and dissemination; addressing disparities; and patient-centered and methodological research.

Grants will be awarded on a competitive basis.  The competitive process starts with a letter of intent and the different program areas have their own deadlines for submitting letters and complete applications.

To learn more about the funding opportunities and find links to complete descriptions of the programs, read the PCORI announcement here.…