Archive for Medicaid upper-payment limit

 

Federal Health Policy Update for Wednesday, March 16

The following is the latest health policy news from the federal government as of 2:30 p.m. on Wednesday, March 16.  Some of the language used below is taken directly from government documents.

Provider Relief Fund

  • On March 22, 2022 at 11:59 p.m. (eastern), the HRSA COVID-19 Uninsured Program will stop accepting claims for testing and treatment due to lack of funds.  On April 5, 2022 at 11:59 p.m. (eastern), the HRSA COVID-19 Uninsured Program and COVID-19 Coverage Assistance Fund will stop accepting vaccination claims due to a lack of funds.  See the announcement of these changes.
  • Providers that received Provider Relief Fund payments of more than $10,000 in the aggregate between July 1 and December 31, 2020 must report on their use of those funds to HHS by March 31.  For information about reporting requirements, forms, reporting instructions, and more on what the agency refers to as “Reporting Period 2,” go here.

White House

MACPAC Meets

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 2022 meeting began with a follow-up discussion on directed payments in managed care. This presentation reviewed a package of five proposed recommendations related to:

improving the transparency of existing directed payment approval documents, rate certifications, and evaluations;

collecting new provider-level data on directed payment spending;

further clarifying directed payment goals and their relationship to network adequacy requirements;

providing guidance for more meaningful, multi-year assessments of directed payments; and

improving the coordination of reviews of directed payments and managed care rate setting.

The Commission is expected to vote on these recommendations at its April 2022 meeting.

The Commission then continued its discussion on how greater adoption of health information technology could facilitate clinical integration for behavioral health. Prior Commission meetings discussed barriers to adopting electronic health records (EHR), including financing and available products that support behavioral health providers. This presentation had two recommendations for the Commission to discuss: (1) creation of voluntary standards for behavioral health-focused EHRs, and (2) Medicaid mechanisms to finance EHR adoption among behavioral health providers. The Commission will vote

Federal Health Policy Update for Thursday, November 4

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, November 4.  Some of the language used below is taken directly from government documents.

New Federal Vaccination Requirements

CMS has unveiled its new COVID-19 vaccine requirements for health care providers that receive reimbursement from the federal government.  The highlights include:

  • CMS is requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs.
  • The staff vaccination requirement applies to the following Medicare and Medicaid-certified provider and supplier types:  ambulatory surgery centers, community mental health centers, comprehensive outpatient rehabilitation facilities, critical access hospitals, end-stage renal disease facilities, home health agencies, home infusion therapy suppliers, hospices, hospitals, intermediate-care facilities for individuals with intellectual disabilities, clinics, rehabilitation agencies, public health agencies as providers of outpatient physical therapy and speech-language pathology services, psychiatric residential treatment facilities, Programs for All-Inclusive Care for the Elderly Organizations (PACE), rural health clinics/federally qualified health centers, and long-term care facilities.
  • Facilities covered by this regulation must establish a policy ensuring that all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care,

MACPAC Meets

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 Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources.

Later the Commission discussed a proposed rule that the Centers for Medicare & Medicaid Services issued in November, which—among other changes—would increase federal oversight of Medicaid supplemental payments. The final morning session addressed payment error rates in Medicaid, with a briefing on the annual Department of Health and Human Services Agency Financial Report (AFR). Fiscal year 2019 was the first time that the AFR incorporated eligibility errors since the Patient Protection and Affordable Care Act’s Medicaid eligibility and enrollment changes took effect in 2014.

After lunch, MACPAC staff summarized themes from expert roundtables convened in November, one to explore Medicaid policy on high-cost specialty drugs and another on the need for more

Verma Addresses Medicaid Issues

Earlier this week, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors.

In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed:

  • Medicaid demonstration programs
  • Medicaid work requirements
  • a shift toward value-based payments
  • better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare)
  • enrollment issues
  • improvements in the efficiency of the federal Medicaid bureaucracy

Read Verma’s complete remarks here.…