Archive for November, 2014


Could New Regulation Slow Movement Away from Nursing Homes for Seniors?

A new federal regulation that calls for alternatives to nursing homes to develop specific care plans for individual Medicaid-covered residents could slow the decades-long movement away from institutionalization in nursing homes and toward greater use of home- and community-based services for seniors in need of assistance.

Under a new Medicaid regulation to take effect next year, operators of alternatives to nursing homes like adult day care programs, group homes, assisted living facilities, and continuing care retirement communities will be required develop plans that address both the services participating seniors need and the preferences they have for the settings in which they live.

While most observers believe the regulation is well-intended, some fear that it may place an onerous burden on program and facility operators and, if not causing them to cease operating, could discourage others from entering a field that is viewed as a productive approach to meeting the needs of many seniors without the high cost of nursing home care.

Some also believe the regulation is geared more toward the disabled who participate in such programs than the elderly.

Under the regulation, states have five years to complete a transition toward compliance with the new requirements.  That transition includes …

Administration Delays Major 340B Program Regulation

The U.S. Department of Health and Human Services has decided against releasing a long-awaited regulation that was expected to bring sweeping changes to the federal government’s 340B Drug Pricing Program.

The 340B program requires drug manufacturers to sell drugs at a discount to hospitals and other providers that serve especially large proportions of low-income patients.  While providers believe the program enables them to serve more vulnerable patients at a reasonable cost, drug companies have argued that the federal government has expanded the program to include more providers and more drugs than the program originally envisioned.

A spokesman for the federal Health Resources and Services administration told Bloomberg BNA that the release has been delayed until next year and that the agency

…plans to issue a proposed guidance for notice and comment that will address key policy issues raised by various stakeholders committed to the integrity of the 340B program. HRSA is also planning to issue proposed regulations where the statute provides explicit rulemaking authority, pertaining to civil monetary penalties for manufacturers, calculation of the 340B ceiling price, and administrative dispute resolution.

To learn more about the delay in the anticipated 340B regulation, see this Bloomberg BNA article.…

OIG Sets 2015 Medicare, Medicaid Investigations

The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has outlined the areas where it anticipates focusing its investigative energies in 2015.

Among the Medicare issues it plans to address next year are:

  • new hospital inpatient admission criteria
  • oversight of provider-based status
  • the appropriateness of indirect medical education (IME) payments
  • evaluation and management (E&M) coding practices
  • hospital controls over wage data used in the calculation of hospital Medicare area wage indexes

Among the Medicaid issues the OIG will examine are:

  • the accuracy of state eligibility determinations
  • quality of care, including access to preventive screenings for children
  • managed care organization practices, including claims for services delivered after patients’ deaths and payments made on behalf of beneficiaries who are not eligible for Medicaid

For an overview of the OIG 2015 plan, see this National Law Review article.  To see the plan itself go here, to the OIG’s web site.…

States Face Medicaid Challenges

Fifty American states have 50 different Medicaid programs.  While no two state Medicaid programs are alike, the people who run those programs often share common concerns, problems, and priorities.

The National Association of Medicaid Directors has surveyed its members on the challenges they face, their priorities, and the matters they see occupying most of their time in the coming years.  Among the areas the survey explored are:

  • budgets
  • Affordable Care Act implementation
  • relationships with others in their state government, federal agencies, and regulators
  • program integrity
  • innovations like bundled payments, accountable care organizations, demonstration projects, delivery system reform and improvements, and challenges in the area of long-term services and supports

Find out how the country’s 50 Medicaid directors view the challenges they face in the coming year in State Medicaid Operations Survey:  Third Annual Survey of Medicaid Directors, which you can find here.…

Medicaid Directors Look to the Future

The directors of state Medicaid programs met recently outside Washington, D.C. to compare notes and take a closer look at the challenges they face in the future.

During the conference, sponsored by the National Association of Medicaid Directors, more than 800 participants heard nearly 40 presentation on a variety of subjects, including community health integration, behavior health services, Medicaid services for children, care coordination programs, Medicaid managed care, programs for serving the dually eligible, the opioid epidemic, delivering care to special populations, rising Medicaid costs, and more.

Copies of these presentations are available here, on the web site of the National Association of Medicaid Directors.…