Archive for Medicaid regulations

 

Immigrants Intimidated by New Public Charge Guidelines?

Immigrants served by community health centers appear less inclined than in the past to seek public aid to help them with their medical problems.

And community health center staff believes this is the result of confusion and fear as a result of changing federal immigration policies.

As stated in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients,”

  • Health centers reported that, in recent months, immigrant patients have declined to enroll or reenroll themselves and/or their children in Medicaid for fear of public charge.
  • Health center respondents reported patients are confused about the new rule and are afraid to provide identifying information.
  • According to respondents, the public charge rule is creating a “chilling” effect, leading to decreased enrollment in other programs not subject to public charge.
  • About half of health centers reported a drop in utilization by immigrant patients, especially among pregnant women.
  • Health centers are training staff to answer questions on public charge and are working to ensure access to care for their patients.

Learn more in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among

Stakeholders Respond to CMS “Patients Over Paperwork” RFI

More than 400 stakeholders responded to the federal government’s request for ideas to reduce the administrative burden associated with serving publicly insured patients.

The request was disseminated via a Centers for Medicare & Medicaid Services request for information that was part of the agency’s “Patients over Paperwork” initiative.  Among the groups that responded were the American Hospital Association, The American Association of Colleges of Nursing, the Critical Access Hospital Coalition, the Coalition of Long-Term Acute-Care Hospitals, the National Rural Association of Rural Health Clinics, the American Academy of Ophthalmology, the American Academy of Family Physicians, the American Hospital Association, and others.

Among the suggestions they offered were reconsideration of quality  metrics, changes in the merit-based incentive payment system (MIPS), the inclusion of social determinants of health in quality metrics, changes in star rating systems, greater efficiency in prior authorization processes, changes in interoperability requirements, and others.

Learn more about who submitted comments in response to this RFI and what they proposed in their comments in the Healthcare Dive article “CMS says it wants to cut paperwork. Providers have ideas.”

CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals.  Now, CMS proposes rescinding this requirement, writing in a news release that

This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries.  CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that …

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services.

In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve”

  • reporting and documentation requirements
  • coding and documentation requirements for Medicare or Medicaid payment
  • prior authorization procedures
  • policies and requirements for rural providers, clinicians, and beneficiaries
  • policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries
  • beneficiary enrollment and eligibility determination
  • CMS processes for issuing regulations and policies

Comments are due to CMS by August 12.

For further information, see the CMS news release “CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs” or go here to see the RFI itself.…

PACE Regulation Updated

PACE programs will have new flexibility under a recent update of regulations governing Programs of All-Inclusive Care.

As described by the National Association of Medicaid Directors, the new regulation

  • Allows PACE team members to fulfill multiple roles on the care team;
  • Allows certain non-physician providers to serve in the place of primary care physicians on the care team;
  • Clarifies that PACE programs offering prescription drug benefits are subject to Medicare Part D regulations;
  • Eliminates requirements for PACE organizations to seek waivers for several of the most commonly waived aspects of PACE regulation; and
  • Updates CMS’s enforcement actions to promote accountability in PACE.

PACE, as described in the CMS fact sheet announcing the regulation update,

… provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. The majority of participants served by PACE are dually eligible for both Medicare and Medicaid. More than 45,000 older adults are currently enrolled in more than 100 PACE organizations in 31 states…

Learn more from the CMS fact sheet describing the updated regulation or go here to see the regulation itself.