Archive for November, 2019


Hospitals Sue HHS Over Payment Cut

Medicare cut hospital payments $840 million a year more than it should have and now, hospitals are suing to get their money back.

According to the lawsuit, Congress authorized Medicare to include a cut of 0.7 percent in hospital inpatient payments through FY 2017 to recoup past Medicare overpayments but Medicare continued the cut, without Congress’s approval, in FY 2018 and FY 2019.

The 600 hospitals that filed the suit estimate that the allegedly illegal cut cost them about $200,000 each and now, they want their money back – with interest.

Learn more in the Becker’s Hospital Review article “622 hospitals sue HHS, accused of illegally allowing reimbursement cut.”

Medicaid DSH Cut Delayed

Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20.

A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress.  If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025.

Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible hospitals.

The current cut is only temporary and expires when the continuing resolution expires after December 20.…

Administration Reveals Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”

The statement, an annual OMB document, organizes the priorities as follows:

  • Facilitating patient-centered markets
  • Fixing health care financing through protecting private insurance and Medicare
  • Fixing health care financing through reforming the individual market
  • Fixing health care financing through making the ACA and Medicaid fiscally sustainable
  • Bringing value to health care through price and quality transparency
  • Bringing value to health care through patient-centered health IT
  • Bringing value to health care through deregulation, especially for coordinated care
  • Bringing value to health care through tackling the high cost of prescription drugs
  • Bringing value to health care through accelerated drug and device approval and reimbursement
  1. Promoting health and protecting life
  • Addressing impactable health challenges: kidney health
  • Addressing impactable health challenges: combatting the opioid crisis
  • Protecting conscience and life at all stages
  • Reducing the disease and death associated with tobacco use
  1. Promoting independence
  • Returning TANF to promoting work, marriage and family
  • Supporting adoption
  • Empowering Americans to improve their nutrition
  • Promoting flexibility for states, grantees, and regulated entities

Learn more about the regulatory directions the …

Medicaid Block Grants Hit Bump in Road

The drive toward encouraging states to implement Medicaid block grants hit a bump in the road last week when the formal guidance for states that Centers for Medicare & Medicaid Services administrator Seema Verma suggested was imminent apparently became not-so imminent.

At the time Verma spoke, draft guidance from CMS to the states was under review by the federal Office of Management and Budget.  Last week, however, CMS withdrew that draft, which also was to address state Medicaid per capita cap programs.

The bump in the road does not, however, appear to be more than a temporary detour.  While CMS has not explained why the draft was withdrawn, Verma indicated that the agency still intends to provide guidance to state on Medicaid block grants and per capita spending limits.

Learn more from the McKnight’s Long-Term Care News article “CMS withdraws proposed guidance on Medicaid block grants, funding caps.”

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019.

According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments.  The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments.  Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion.

CMS maintains that the improper Medicaid payment rate will decline in future years because it has introduced more rigorous enforcement of Affordable Care Act requirements to determine and periodically redetermine eligibility for Medicaid participants.  Because each state is reviewed for improper payments only every three years, the agency maintains, it will take time before the full impact of the more rigorous review of beneficiary eligibility will be seen in annual statistics

Learn more about improper Medicaid and CHIP payments in the CMS fact sheet “2019 Estimated Improper Payment Rates for Centers for Medicare & Medicaid Services (CMS) Programs.”