Archive for June, 2015


Report on Public Health and Health Care

The Institute of Medicine (IOM) has published a report summarizing its February workshop that explored the relationship between public health and health care.

According to the IOM, the workshop

… was designed to discuss and describe the elements of successful collaboration between health care and public health organizations and professionals; reflect on the five principles of primary care–public health integration (which can be applied more broadly to the health care–public health relationship): shared goals, community engagement, aligned leadership, sustainability, and data and analysis; and explore the “elephants in the room” when public health and health care interact: what are the key challenges and obstacles and what are some potential solutions, including strengths both sides bring to the table. The workshop presentations reflected on collaboration in four contexts: payment reform, the Million Hearts initiative, hospital – public health collaboration, and asthma control.

Find the IOM report Collaboration between Health Care and Public Health: Workshop Summary here.…

Costs Mount for Non-Medicaid Expansion States

States that chose not to expand their Medicaid programs as permitted under the Affordable Care Act are shouldering greater costs to support hospital uncompensated care than states that did expand.

And taxpayers in those states continue to pay taxes to support public hospitals and uncompensated care programs while also paying taxes to help underwrite the cost of Medicaid services in states that have expanded their Medicaid programs.

These are among the conclusions presented in the article “Not expanding Medicaid can cost local taxpayers,” which was published on the Stateline web site.

The article uses Texas as a case study, detailing the uncompensated care provided by hospitals to the uninsured and the taxes Texans pay to underwrite that care. Despite those costs, and despite the Obama administration’s expressed desire not to continue providing supplemental funds to support uncompensated care payments, Texas appears unlikely to expand its Medicaid program for the foreseeable future.

Learn more about the cost to states and taxpayers of not expanding state Medicaid programs in this Stateline article.…

CMS Issues Guidance on Medicaid Managed Care Rate-Setting

The federal government has provided new guidance to states concerning how to ensure that the rates they pay Medicaid managed care organizations are adequate.

While federal law has long required that such rates be “actuarially sound,” the Centers for Medicare & Medicaid Services (CMS), which issued the draft guidance, has released new guidance to advise states about the information it seeks to ensure that proposed rates are truly actuarially sound.

The guidance notes that CMS will follow three principles when evaluating proposed rates to be paid to Medicaid managed care organizations.

  • The capitation rates are reasonable and comply with all applicable laws (statutes and regulations) for Medicaid managed care;
  • the rate development process complies with all applicable laws (statutes and regulations) for the Medicaid program, including but not limited to eligibility, benefits, financing, any applicable waiver or demonstration requirements, and program integrity; and
  • the documentation is sufficient to demonstrate that the rate development process meets generally accepted actuarial practices and principles.

See the CMS document “Draft 2016 Medicaid Managed Care Rate Development Guide” here. The National Association of Medicaid Directors has conveyed its concerns about some aspects of the proposed guidance to CMS; find its letter here.


Medicare ACO Demonstration Shows Promise

A federal demonstration program to test the ability of an accountable care organization (ACO) to serve chronically ill Medicare patients more effectively while saving money has shown promise, according to the Centers for Medicare & Medicaid Services (CMS).

Seventeen medical practices participating in the Independence at Home Demonstration, which serves chronically ill Medicare patients in their homes, saved a combined $25 million, or an average of $3070 for each beneficiary served.

All 17 participating practices improved in at least three of the program’s six quality measures; four of those practices improved in all six measures. Together, the 17 practices reduces hospital readmissions and used hospital inpatient services less frequently for chronic medical problems. Nine of the participating practices will share nearly $12 million in incentive payments for their efforts.

Learn more about the Independence at Home ACO demonstration model here and find out more about the program’s first-year performance here.…

MACPAC Reports to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its second of two 2015 reports to Congress on Medicaid and the Children’s Health Insurance Program (CHIP).

In the report, the agency looks at the role of Medicaid in providing behavioral health services; examines Medicaid coverage of dental services for adults; contemplates the intersection between Medicaid and child welfare; and considers whether Delivery System Reform Incentive Payment (DSRIP) programs are a legitimate means of fostering health care delivery reform or have become just a means of states’ supplementing the Medicaid payments they make to providers.

Find a summary of the MACPAC report and a link to the complete report here.…