Archive for Centers for Medicare & Medicaid Services


CMS Provides Guidance on Medicaid DSH Calculations

State Medicaid program accounting for hospital uncompensated care when calculating hospital-specific Medicaid disproportionate share limits is the subject of new guidance from the Centers for Medicare & Medicaid Services.

In the guidance, the Centers for Medicare & Medicaid Services explains that because of several court rulings, states can decide for themselves whether to offset third-party payer payments from costs in their Medicaid DSH calculations for periods prior to June 2, 2017 but that beginning with that date,  CMS will enforce its own interpretation of the policy.

In new guidance, CMS presents two methodologies for accounting for its mid-year policy change and reminds stakeholders about its new methodology for calculations after June 2, 2017.  Learn more from this Medicaid notice and from its accompanying CMS informational bulletin “Treatment of Third Party Payers (TPP) in Calculating Uncompensated Care Costs (UCC).”

OIG Cites Medicare, Medicaid Among Top Unimplemented Recommendations

CMS has failed to implement many of the policy changes recommended to it by HHS’s Office of the Inspector General, according to a new OIG report.

Every year the Department of Health and Human Services’ OIG offers recommendations for policy changes designed to reduce fraud, waste, and abuse in HHS programs.  This week, the OIG published “OIG’s Top Unimplemented Recommendations:  Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs.”

Among the top 25 unimplemented recommendations to the Centers for Medicare & Medicaid Services are 14 involving Medicare and Medicaid.  Its top 10 unimplemented Medicare recommendations are:

  1. CMS should take actions to ensure that incidents of potential abuse or neglect of Medicare beneficiaries are identified and reported.
  2. CMS should reevaluate the inpatient rehabilitation facility payment system, which could include seeking legislative authority to make any changes necessary to more closely align inpatient rehabilitation facility payment rates and costs.
  3. CMS should seek legislative authority to comprehensively reform the hospital wage index sy
  4. CMS should seek legislative authority to implement least costly alternative policies for Part B drugs under appropriate circumstances.
  5. CMS should provide consumers with additional information about hospices’ performance via Hospice Compare.
  6. CMS should continue to work with the Accredited

MedPAC Offers 2021 Medicare Rate Recommendations

MedPAC has recommended to Congress changes in Medicare payment rates in the coming year.

In its annual report to Congress, the Medicare Payment Advisory Commission recommended the following rate changes:

acute-care hospitals – a two percent rate increase and a suggestion that the difference between this two percent increase and the payment increase specified by law be used to increase the rewards hospitals may earn under Medicare’s hospital value incentive program.  As a result, the value incentive program would offer a possible 0.8 percent in bonus payments, and with the recommended elimination of the 0.5 percent penalty for which hospitals are at risk, hospitals could average net increases of 3.3 percent.

  • ambulatory surgical centers – no rate increase and a requirement that such facilities report cost data
  • physicians – rates updated as already provided for by law
  • long-term acute-care hospitals – a two percent increase
  • inpatient rehabilitation facilities – a five percent rate reduction
  • skilled nursing facilities – no rate increase
  • dialysis facilities – rates updated as already provided for by law
  • hospice services – no rate increase and the aggregate hospice cap should be wage-adjusted and reduced 20 percent
  • home health agencies – a seven percent rate reduction

While …

The Latest CMS and CDC Info on COVID-19 Measures

CMS updates COVID-19 guidelines, regulations, the waiving of regulations, and more daily on the “Current Emergencies” page of the CMS website.  Find it here.

In addition, the Centers for Disease Control and Prevention (CDC) regularly posts COVIS-19 updates of its own.  Find them here.…

CMS Posts COVID-19 FAQ for State Medicaid and CHIP Agencies

State Medicaid agencies and CHIP programs have received new guidance on the federal resources available to them to fight the COVID-19 national health emergency through a new FAQ published by the Centers for Medicare & Medicaid Services last week.

Among the issues addressed in the FAQ are eligibility, enrollment, benefits, cost sharing, workforce issues, telehealth, and more.  Health care providers may find this information useful when serving their patients.

See CMS’s news release describing the FAQ here and the FAQ itself here.…