Archive for November, 2018


Number of Uninsured Children Rises

For the first time since 2008, the number of uninsured children in the U.S. increased in 2017, according to a new report from the Georgetown University Health Policy Institute.

While the total increase in the number of uninsured children is small – just 276,000 – 2017 marked the first time in nearly a decade that the number of uninsured children has risen.  For the year, 3.9 million were uninsured, up from 3.6 million in 2016.

Passage of the Affordable Care Act and extension of the Children’s Health Insurance Program (CHIP) have contributed to declines in the number of uninsured children.

In 2017, however, the number of uninsured children rose even as the overall uninsured rate in the U.S. remained the same:  8.8 percent.  States with the biggest increases in the number of uninsured children were South Dakota, Utah, and Texas.  More than 20 percent of all uninsured children in the U.S. live in Texas.

Learn more about the increase in the number of uninsured children and why these numbers have risen in the report Nation’s Progress on Children’s Health Coverage Reverses Course, which can be found here, on the web site of the Georgetown University Health Policy Institute.…

OIG Cites “Vulnerabilities” in Medicare Wage Index System

The Office of the Inspector General of the U.S. Department of Health and Human Services has “…observed significant vulnerabilities in the [Medicare area] wage index system…”  As a result of these vulnerabilities, Medicare has overpaid 272 hospitals by more than $140 million over the past 13 years.

The vulnerabilities the OIG identified that contributed to these overpayments are:

  • absent misrepresentation or falsification, CMS lacks the authority to penalize hospitals that submit inaccurate or incomplete wage data;
  • Medicare Administrative Contractors’ limited reviews do not always identify inaccurate wage data;
  • the rural floor decreases wage index accuracy; and
  • hold-harmless provisions in federal law and CMS policy pertaining to geographically reclassified hospitals’ wage data decrease wage index accuracy.

To address these problems, the OIG recommended that CMS and the Secretary of Health and Human Services revisit the possibility of comprehensive wage index system reform, including the option of a commuting-based wage index.  In 2012 CMS proposed establishing such a system but Congress chose not to mandate its implementation.

Without comprehensive reform, the OIG recommended that CMS:

  • seek legislative authority to penalize hospitals that submit inaccurate or incomplete wage data in the absence of misrepresentation or falsification;
  • seek legislation to repeal the law creating

Administration Seeks Industry Guidance on Rollback of Anti-Kickback Laws

Characterizing its objective as a “regulatory sprint to coordinated care,” the Department of Health and Human Services’ Office of the Inspector General this summer asked stakeholders for their input on how it might ease federal anti-kickback laws in ways that promote better coordination of care and cooperation between different types of caregivers while not encouraging fraud that costs consumers and taxpayers.

At the heart of this effort are laws that limit the ability of doctors and hospitals to work together.  Hospitals, for example, currently have limited tools with which to influence the behavior of doctors serving Medicare and Medicaid patients while insurers are limited in their efforts to encourage certain desired behaviors among those they insure.  Meanwhile, as this effort continues, the Justice Department continues to prosecute cases of alleged fraud that involves kickbacks.

The entire subject is exceedingly complex and the administration invited stakeholders to offer suggestions for how to loosen the laws without loosing new forms of inappropriate kickbacks.  Hundreds of interested parties submitted suggestions to the Department of Health and Human Services.

Learn more about the administration’s efforts to address anti-kickback laws in this New York Times article.


CMS to Congress: You’re the Impediment to Greater Use of Telehealth

The primary obstacle to Medicare making greater use of telehealth is current laws, the Centers for Medicare & Medicaid Services has told Congress in a new report.

The report, mandated by the 21st Century Cures Act, outlines the extent of telehealth utilization today, describes its benefits, and suggests potential new and expanded uses for telehelath, but it also notes that

Current restrictions on eligible telehealth originating sites appear to be the greatest barrier to preventing the expansion of Medicare telehealth services.  The two most significant Medicare restrictions are:  1) requiring the originating site to be located in certain types of rural areas; and 2) not allowing the beneficiary’s home to be an eligible originating site.

Congress’s mandate did not include a request for recommendations and CMS did not offer any.

Learn more about how Medicare uses telehealth today, how it could use telehealth more extensively if the opportunity presented itself, and what the barriers are to greater use of telehealth in the CMS report to Congress Information on Telehealth, which can be found here.…

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries.

As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City,

These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too.  If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to good outcomes and low cost as well. If a senior can be accommodated at home rather than an inpatient rehab facility or a [skilled nursing facility], they should be.

According to Azar, HHS’s Center for Medicare and Medicaid Innovation will be looking for new ways to address social determinants of health that have an impact on Medicare beneficiaries’ health.

What if we provided more than connections and referrals?  What if we provided solutions for the whole person including addressing housing,