“Rejected” Medicaid Reforms May Resurface

Partial Medicaid expansion, desired by some Republican governors but rejected by the Trump administration last year, may not be so rejected after all.

At least not according to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, which oversees the federal Medicaid program.

In a recent interview, Verma said the administration is reconsidering its rejection of partial Medicaid expansion, an idea she supports and that

What I have said to states and to governors [is] “Tell me what you want to do, and it’s my job to help you get to where you want to go.”

To emphasize this point, Verma also said that

We are changing the partnership between the federal and state government.  We are trying to empower states.

Learn more about Verma’s recent remarks about Medicaid expansion in the Politico article “Seema Verma:  Medicaid reform rejected by Trump is ‘under review.’”


MedPAC Discusses ED Coding Changes

Members of the Medicare Payment Advisory Commission discussed the possibility of recommending to Congress that it call for national guidelines for how hospitals code emergency department services.

The change may be needed, the commissioners suggested at their March meeting, because hospitals have gravitated toward coding for higher intensity services as time passes.

Such a change, if implemented, could result in less emergency department revenue for some hospitals.

Learn more in the Healthcare Dive article “MedPAC eyes changes to ED coding, Part B drug pricing.”

Sneak Preview of Medicaid Spending Limits?

The imposition of spending limits for individual Medicaid recipients has been discussed in Washington policy circles for years and was offered in the White House’s recent FY 2020 budget proposal.  While deliberations on such a proposal have never advanced in a meaningful way, the state of Utah is doing more than talking about such an approach:  it has petitioned the Centers for Medicare & Medicaid Services for a Medicaid waiver that would enable it to introduce such a system in its state Medicaid program.

Under the state’s proposed Medicaid waiver, Utah asks the federal government to limit its own Medicaid contributions to a fix amount for each Medicaid enrollee – a per capita limit, as this approach has often been called.  Utah has joined this request with a proposal to expand its Medicaid program, as permitted under the Affordable Care Act – but to do so only for individuals earning up to 100 percent of the federal poverty level and not the 138 percent level authorized by the 2010 health care reform law.

While the request is still under consideration in Washington, state officials are reportedly optimistic:  they expect to begin enrolling new recipients on April 1.

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Administration Asks if Providers Should Reveal Negotiated Rates

A proposed regulation published by the Centers for Medicare & Medicaid Services asks stakeholders if they believe hospitals, doctors, and other providers should be required to share with their patients the rates they are paid by insurers for services, medical devices, prescription drugs, and more.

Such transparency, on one hand, would give consumers a better sense of the cost of the services they receive and how their insurers reimburse providers for those costs.  Providers, suppliers, and insurers, on the other hand, might be concerned about the loss of what they have come to regard as confidential, proprietary information.

Hospitals are already required to post their standards charges online.  Since so few people pay actual charges, however, the value of such information has been questioned – and it is not clear what the value would be of knowing more about the financial arrangements between providers, suppliers, and insurers.

The request for comment on such a concept is a minor part of the proposed regulation on health care interoperability published by CMS last month.  Comments are due by May 3.

Learn more from CMS’s news release on the proposed regulation and from the proposed regulation itself.


MedPAC Debates Post-Acute Payments

As the Centers for Medicare & Medicaid Services continues to develop a unified payment system for all post-acute-care providers, Congress’s advisors on Medicare payment policy appear ready to weigh in on an important aspect of such a system:

Whether payments should be based on entire episodes of care or individual stays in post-acute-care facilities.

And at least for now, the Medicare Payment Advisory Commission is leaning toward recommending that post-acute-care payments be based on individual stays.

At their March public meeting, MedPAC commissioners expressed concern that post-acute-care payments based on entire episodes of care might create financial incentives for providers to discharge their patients prematurely.  Payments based on individual stays pose no such temptation, they believe.

Learn more about the current effort to develop a unified payment system for post-acute care and the challenges that effort faces in addressing both quality and costs in the McKnight’s Long-Term Care News article “Medicare advisors urge Congress against an episode-based payment system for post-acute care.”