Archive for Medicaid regulations for long-term care



The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The March 2023 MACPAC meeting began with a staff presentation on potential recommendations for countercyclical disproportionate share hospital (DSH) allotments. Medicaid DSH payments offset hospital uncompensated care costs for Medicaid-enrolled and uninsured patients. During economic recessions, Medicaid enrollment and the number of people who are uninsured increases.

During the October 2022 MACPAC meeting, Commissioners agreed that a countercyclical policy should be implemented during future economic recessions, and asked for additional analyses of the effects of making this policy permanent. This presentation looked at the state and federal effects of implementing this policy only during economic recessions versus also implementing this policy during periods of normal economic growth. The Commission will vote on recommendations to Congress during the April 2023 meeting.

Next, the Commission examined key implementation considerations for states looking to offer pre-release Medicaid services to justice-involved adults. The presentation included an overview of California’s recently approved Section 1115 demonstration to provide a set of pre-release services to certain individuals leaving incarceration. Staff also highlighted key takeaways regarding implementation considerations based on MACPAC’s


The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The December 2022 MACPAC meeting began with a Commission discussion on two potential recommendations for improving Medicaid race and ethnicity data reporting. As part of its commitment to prioritizing health equity in all of its work, the Commission is focused on how to improve Medicaid race and ethnicity data collection and reporting. In October, staff presented findings from a literature review and key stakeholder interviews, as well as possible approaches for improving the collection and reporting of these data. In this presentation, staff reviewed the state data collection and reporting processes, data quality priorities, and barriers to improvement. Staff also presented two potential recommendations for the Commission’s consideration, with the goal of making recommendations in MACPAC’s March report to Congress. The Commission will vote on these recommendations in January 2023.

Next, the Commission discussed two potential recommendations to improve the transparency of nursing facility payment data. The Commission has undertaken long-term work to examine the extent to which Medicaid nursing facility payment policies are consistent with the statutory goals of efficiency, economy, quality,

Federal Health Policy Update for October 27

The following is the latest health policy news from the federal government for the week of October  21 to October 27.  Some of the language used below is taken directly from government documents.


  • Responding to a federal court ruling that the federal government has shortchanged hospitals in its payments for 340B-covered prescription drugs, CMS has announced how it will compensate hospitals for its underpayments – at least for the 2023 fiscal year.  According to CMS, it “…will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year.  CMS also will reprocess claims our contractors paid on or after September 28, 2022, using the default rate (generally ASP plus 6%).”  Learn more here.

Centers for Medicare & Medicaid Services

  • CMS has published a guide for states on how they can maximize the use of automation when they review current Medicaid participants’ eligibility when the COVID-19 public health emergency ends, doing so by using reliable information that is already available to state Medicaid agencies and without seeking information directly from the individuals whose Medicaid eligibility is under review.  Learn more from the CMS document “Ex Parte Renewal:  Strategies to Maximize Automation,

Federal Health Policy Update for Thursday, June 30

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, June 30.  Some of the language used below is taken directly from government documents.

White House

The White House has unveiled its “White House Blueprint for Addressing the Maternal Health Crisis.”

Monkeypox Update

  • The White House has announced the first phase of its national monkeypox vaccine strategy, a part of its monkeypox outbreak response.  The major components of the strategy include expanded efforts to vaccinate those most at risk, expanded testing supply and availability, and greater engagement with community leaders and stakeholders.  Learn more about the White House’s plan from this fact sheet.
  • HHS has announced an enhanced nationwide vaccination strategy to mitigate the spread of monkeypox.  The strategy includes vaccinating and protecting those at risk of monkeypox, prioritizing vaccines for areas with the highest numbers of cases, and providing guidance to state, territorial, tribal, and local health officials to aid their planning and response efforts.  HHS will provide 296,000 doses of monkeypox vaccine.  Of that amount, 56,000 doses will be made available immediately and an additional 240,000 doses will be made available in the coming weeks.  HHS expects more

Pennsylvania Considers Screening Would-Be Nursing Home Buyers

Even before the federal government announced that it would release data on hospital and nursing home ownership as a means of casting light on the impact of private equity on provider quality and costs, regulators in Pennsylvania were proposing their own approach by seeking to vet those aspiring to purchase nursing homes in their state.

Under nursing home regulations proposed by the Pennsylvania Department of Health, regulators would have an opportunity to examine the past performance and financial strength of entities seeking to purchases nursing homes.  As more for-profit entities enter the industry, the department notes, they bring with them more complex financial arrangements, such as separate entities that divide the facility, the real estate on which it stands, and the company that manages the facility.  This is adding a new level of complexity to the challenge of holding operators accountable, understanding their financial performance, and analyzing the adequacy of the state’s Medicaid payments for long-term-care services, which the state’s nursing home industry has long complained are inadequate.

Learn more about Pennsylvania’s attempt to regulate entry into the long-term-care industry in the state in these proposed regulations that would govern nursing homes and their sale and the Philadelphia Inquirer article …