Archive for August, 2018

 

CMS Reinforces Need for Budget Neutrality in Medicaid Waivers

States that seek federal waivers for permission to employ new approaches to serving their Medicaid population will have to pass more rigorous tests to ensure that those new approaches are budget-neutral, the Centers for Medicare & Medicaid Services has announced.

In a detailed letter to state Medicaid directors, CMS outlines some of the current methodologies employed by states to demonstrate the budget neutrality of their waiver requests and details instances in which it will judge those methodologies differently in the future.  A news release accompanying the letter explains that

….this letter marks the first time that CMS has formally outlined how states must calculate budget neutrality for demonstration projects, in order to strengthen fiscal accountability. The guidance also comes a day after Administrator Seema Verma testified before the Senate Homeland Security and Government Accountability Committee on improper payments in the Medicaid program, which often result in higher federal spending.

The news release also states that

“CMS welcomes smart new approaches to coverage and delivering care through Medicaid demonstration projects, but we won’t approve them without a careful analysis of their impact on taxpayers. Federal spending on the program has increased, growing by over $100 billion between 2013 and 2016,” said

Growing Number of Hospitals on the Critical List

Eight percent of American hospitals – 450 of them – are at risk of closing in the coming years and another 10 percent, or 600 hospitals, are considered “weak” according to a new analysis performed by Morgan Stanley.  The signs of these problems include sinking margins, declining occupancy and revenue, and government and insurer policies that enable patients to receive certain services at facilities other than hospitals, as they did in the past.

The largest concentrations of at-risk hospitals can be found in Texas, Oklahoma, Louisiana, Kansas, Tennessee, and Pennsylvania.

Learn more about the Morgan Stanley analysis in this Bloomberg News report or here, from Becker’s Hospital Review.…

Large Number of Hospitals on the Critical List

Eight percent of American hospitals – 450 of them – are at risk of closing in the coming years and another 10 percent, or 600 hospitals, are considered “weak” according to a new analysis performed by Morgan Stanley.  The signs of these problems include sinking margins, declining occupancy and revenue, and government and insurer policies that enable patients to receive certain services at facilities other than hospitals, as they did in the past.

The largest concentrations of at-risk hospitals can be found in Texas, Oklahoma, Louisiana, Kansas, Tennessee, and Pennsylvania.

Learn more about the Morgan Stanley analysis in this Bloomberg News report or here, from Becker’s Hospital Review.…

HHS Seeks Feedback on Anti-Kickback Challenges

The Office of the Inspector General of the U.S. Department of Health and Human Services has issued a request for information from health care stakeholders on how the federal government might modify current safe-harbor and anti-kickback laws and regulations in ways that might promote the provision of better health care at lower costs.

The RFI explains that

The Office of Inspector General (OIG) seeks to identify ways in which it might modify or add new safe harbors to the anti-kickback statute and exceptions to the beneficiary inducements civil monetary penalty (CMP) definition of “remuneration” in order to foster arrangements that would promote care coordination and advance the delivery of value-based care, while also protecting against harms caused by fraud and abuse. Through internal discussion and with the benefit of facts and information received from external stakeholders, OIG has identified the broad reach of the anti-kickback statute and beneficiary inducements CMP as a potential impediment to beneficial arrangements that would advance coordinated care. To inform our efforts, we welcome public comment on the safe harbors to the anti-kickback statute and the exceptions to the beneficiary inducements CMP definition of “remuneration” as they relate to the goals of the Regulatory Sprint outlined

Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs.

Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs.

This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings of $6394 a year, mostly because of fewer hospitalizations.

Learn more about how Medicaid expansion is improving the health of low-income people with diabetes and lowering health care spending in this California Healthline report or go here to see the Health Affairs study “Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medications” on which that report is based.…