Archive for June, 2014


Keep Medicaid Pay Boost, Docs Ask Congress

Physician groups and other health care organizations are asking Congress to continue the increase in Medicaid payments that primary care providers have been receiving for nearly two years.

The pay raise, mandated by the Affordable Care Act, was instituted to help induce more primary care providers to serve Medicaid patients in anticipation of the reform law’s significant expansion of Medicaid eligibility.  That pay raise, which brings Medicaid rates up to the level of Medicare rates and is paid for entirely by the federal government, expires at the end of 2014.

Now, primary care physicians have written to the leaders of the Senate Finance Committee and the House Energy and Commerce Committee asking them to extend the raises and add ob/gyns to providers eligible for the enhanced payments.

See their letter here.…

States Must Do More to Track Medicaid Managed Care Expenditures, GAO Says

Even though states are constantly increasing their use of managed care to serve their Medicaid populations, most of their program integrity efforts focus on monitoring fee-for-service payments, resulting in a lack of oversight of managed care spending.

This is the conclusion of a recent report by the federal Government Accountability Office (GAO).

The report, Medicaid Program Integrity:  Increased Oversight Needed to Ensure Integrity of Growing Managed Care Expenditures, noted that the federal government has delegated most of this oversight responsibility to the states and has not updated its own program integrity guidance since 2000.  As a result, the states are not adequately monitoring their own payments to Medicaid managed care organizations nor the payments those organizations make to participating health care providers.

In response to these and other problems, the GAO recommended

…that CMS increase its oversight of program integrity efforts by requiring states to audit payments to and by MCOs; updating its guidance on Medicaid managed care program integrity; and providing states additional support for managed care oversight, such as audit assistance from existing contractors.

The complete report can be found here, on the GAO web site.…

340B Program Under the Microscope

Federal officials continue to cast a wary eye on a program that gives discounts on prescription drugs to hospitals that care for large numbers of low-income patients.

The federal 340B Prescription Drug Program requires drug manufacturers to give discounts to eligible providers for the prescriptions they provide patients on an outpatient basis; the hospitals then provide their low-income patients with their prescriptions at a discount or free of charge.  The program has grown a great deal in recent years and now, critics argue that some hospitals that currently receive the discounts should not qualify for them and others are not reinvesting the savings the program generates in care for low-income patients.

Hospitals, meanwhile, note that program savings enable them to fund clinics and otherwise unaffordable programs and services and help them absorb the cost of uncompensated care.

The controversy has drawn congressional interest, and the federal agency that administers the program, the Health Resources and Services Administration, was expected to produce new guidelines governing eligibility and the use of prescription drug discounts.  Those guidelines have been delayed in the wake of a federal court ruling involving orphan drug sales that has called into question the agency’s regulation-issuing authority.

Learn more …

MedPAC Again Calls for Site-Neutral Payments

Medicare should pay for certain medical services on a site-neutral basis and not pay different rates for the same services to inpatient rehabilitation hospitals and skilled nursing facilities.

Or so says MedPAC, the independent federal agency charged with advising Congress on Medicare payment policy.

MedPAC has offered this recommendation in the past and presents it again in its June 2014 report to Congress.

In researching this recommendation, MedPAC looked at three medical conditions in which patients recover at either rehab hospitals or skilled nursing facilities:  major joint replacement, selected hip and femur procedures, and strokes.  It found that for the two forms of orthopedic care, there were few if any differences in patient recovery between the two types of facilities.  As a result, MedPAC recommends that both facilities should be paid at the (lesser) skilled nursing facility rates for such care – that is, on a site-neutral basis.

MedPAC found that stroke recovery care is more complex and requires further research.

Learn more about MedPAC’s June 2014 recommendations, including this one involving Medicare site-neutral payments, in this MedPAC fact sheet.  Find the entire MedPAC June 2014 report to Congress here.…

One State Sees Major Drop in Uninsured

Are Affordable Care Act reforms putting a dent in the number of uninsured Americans?

They certainly are in Minnesota.

According to a study by the University of Minnesota’s State Health Access Data Assistance Center, the number of uninsured residents in the state fell more than 40 percent in the six months after September 30, 2013.

Minnesota chose to expand its Medicaid program, as provided for in the Affordable Care Act, and also operated its own health insurance exchange.

See the numbers and learn more about how and why the state experienced such a major change in the report Early Impacts of the Affordable Care Act on Health Insurance Coverage in Minnesota, which can be found here.…