Archive for September, 2013


“Two-Midnight Rule” Put on Hold

Medicare has delayed implementation of its most recent attempt to help providers determine whether to bill the federal government for inpatient or observation care for hospitalized patients.

Under the new rule, which was to have taken effect on October 1, patients who were expected to remain in the hospital for at least two midnights were to be considered admissions while those expected to stay for less time were to be classified as observation patients.

The rule was issued in an attempt to clarify a situation that had been scrutinized based on less objective measures, often leaving hospitals feeling under-reimbursed for their services and seniors angry because Medicare would not cover some of their post-discharge care.

But advocates for patients complained that the new rule still leaves seniors too vulnerable to unexpected health care costs and hospitals maintain the rule is confusing.

Consequently, while the rule officially takes effect on October 1, Medicare has indicated that it will not enforce it at least until next year.

To learn more about the issue and this temporary measure, see this Kaiser Health News report.…

CMS Proposes Basic Health Program

The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposal to establish what it is calling a “Basic Health Program” that gives states “the option to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace.”

The program, established in the Affordable Care Act, is designed for people who do not qualify for Medicaid or CHIP and whose incomes are between 133 percent and 200 percent of the federal poverty level.  Legal residents who are non-citizens whose incomes are below 133 percent of the federal poverty level also qualify.  The federal government is picking up 95 percent of the cost of this program.

A new proposed regulation addresses who is eligible, how enrollment works, enrollee financial responsibilities, the program’s basic benefits, and more.

Read about the new Basic Health Program in this CMS fact sheet, which also includes a link to the entire proposed regulation.…

CMS Proposes New Approach to Paying FQHCs

Federally Qualified Health Centers, or FQHCs, would receive an approximately 30 percent increase in Medicare payments under a new regulation proposed by the Centers for Medicare & Medicaid Services (CMS).

Currently, FQHCs, which serve more than 21 million low-income people nation-wide, typically in medically underserved areas, are paid on a “reasonable cost”  basis by Medicare when they treat eligible seniors.  Under the proposed Medicare regulation, FQHCs would be paid under a new prospective payment system.

FQHCs are expected to be important providers of care to low-income people who obtain health insurance through Affordable Care Act insurance expansion reforms.  The new payment system would take effect in FY 2015.

Read more about the proposed regulation and its expected impact on FQHCs in this CMS news release.…

Could ACA Increase ER Use?

While the Affordable Care Act seeks to bring health insurance to more people, the reform law also may drive up use of hospital emergency rooms.

According to a new study of emergency room utilization in California, a recent increase in Medicaid coverage in that state brought with it an increase in emergency room use as patients with insurance but limited access to primary care services sought medical attention at hospital emergency rooms.

According to an article published recently in the Journal of the American Medical Association, a 35 percent increase in the number of Medicaid-insured Californians between 2005 and 2010 helped lead to a 13.2 percent increase in emergency room utilization during the same period.

The increase, the study’s authors believe, came because while many more people had health insurance, they could not find primary care providers ready to serve them in a timely manner and turned instead to hospital emergency rooms for care.

The article questions whether other states will experience similar surges in emergency room use when they expand their Medicaid programs as provided for in the Affordable Care Act.

Read more about the study and its findings’ possible implications in this MedPage Today article or find …

Number, Proportion of Uninsured Falls

For the second consecutive year, the number and proportion of uninsured Americans has fallen.

In 2012, 15.4 percent of the people in the U.S. were uninsured, or about 48 million people.

The previous year, 15.7 percent, or 48.6 million, were uninsured.

Much of the decline can be attributed to government programs.

Different groups within the U.S. population are insured at different rates.  Read about those differences, and some of numbers underlying these figures, in this New York Times report.…