MHA's Executive Briefing

CMS rescinds proposed Medicaid rehab rule

The Centers for Medicare & Medicaid Services on Nov. 23 withdrew an August 2007 proposed rule on Medicaid coverage for rehabilitative services, citing a congressional moratorium and resolution opposing issuance of a final rule. “In light of the clear congressional concern indicated by the statutory moratorium and the resolution opposing issuance of a final rule based on the proposed rule, as well as the complexity of the underlying issues and of the public comments received, we have decided to withdraw the August 2007 proposed rule in order to assure agency flexibility in re-examining the issues and exploring options and alternatives with stakeholders,” CMS said in a Federal Register notice.

The rule was one of six Medicaid regulations opposed by the American Hospital Association and halted by congressional moratoria. In June, CMS rescinded three of the rules and delayed another (related to health care provider taxes) until June 30, 2010.

States forecast continued budget troubles

Forty-two states cut their enacted fiscal year 2009 budgets by $31.2 billion and 33 states cut their fiscal 2010 expenditures by $53.5 billion to address drastic revenue shortfalls during the economic recession, according to preliminary data released Nov. 12 by the National Association of State Budget Officers. “The bottom line is that states will not fully recover from this recession until late in the next decade,” the National Governors Association said in a related report.

According to NGA, state Medicaid spending grew by 7.9% in FY 2009, the largest increase since the end of the previous economic downturn six years ago. Enrollment in the program grew by 5.4% in FY 2009 and is projected to grow 6.6% in FY 2010.

“The combination of falling revenues, which accompany high unemployment, and an explosion in Medicaid enrollment, which occurs very late in an economic recession, explain why a recession’s greatest impact on state budgets occurs one or two years after the downturn is over,” NGA said. For more information, visit www.nga.org.

[ via AHA News Now ]

Measure would give states break on repaying feds

States would have up to one year to repay the federal government a share of the money they recoup from fraudulent or improper Medicaid payments, under an amendment approved by the Senate Finance Committee.

Under current law, once state inspectors identify fraudulent practices, they have 60 days to return a portion of the federal dollars back to the government. Under the new amendment, states would instead have a full year to make those payments while expanding the role of recovery audit contractors.

States' Medicaid agencies have long struggled with snuffing out improper payments, and many of them have “turned a blind eye” because of the complexity of the problem, said Sen. Thomas Carper (D-Del.), who inked the amendment. The reform bill aims to strengthen fraud detection within Medicare and Medicaid.

Carper's provision costs $100 million, but would be offset by an expansion of the controversial Recovery Audit Contractor program. The Finance bill would extend the RAC to Medicare Advantage, the prescription drug program Medicare Part D and Medicaid. Carper's amendment requires the CMS to implement RAC programs in Medicare and Medicaid by the end of 2010 while requiring the CMS to submit an annual report on its effectiveness. The CMS would also coordinate the Medicaid RAC program with states.

[ via Matthew DoBias, Modern Healthcare's Daily Dose ]

Executive Summary of HB 71 (Medicaid bill)

Governor Barbour signed House Bill 71 into law on June 30 around 9:30 p.m. Attached is an Executive Summary of the major provisions in the statute, with a link for you to download the actual bill.

Download Executive-summary-of-hb71

HHS rescinds Medicaid outpatient rule, delays provider tax rule

The Department of Health and Human Services will rescind a proposed Medicaid rule limiting outpatient hospital and clinic benefits, and provisions of a Medicaid interim final rule restricting access to case management services, HHS Secretary Sebelius announced June 29. In addition, HHS said it will delay until June 30, 2010, enforcement of portions of a Medicaid rule that clarified limitations on health care related tax programs, so that the Centers for Medicare & Medicaid Services can determine whether states need additional clarification or guidance. All of the rules are under congressional moratoria set to expire July 1.

“We are very pleased that CMS has permanently withdrawn the Medicaid outpatient rule,” said American Hospital Association President and CEO Rich Umbdenstock. “The decision is important for those in need of outpatient service like dental care for children, screenings and physician services in the emergency department. We also are pleased that CMS has delayed, for one year, changes in the provider tax rule, especially during this time when states are facing great economic pressure and struggling to fund their Medicaid programs."

Medicaid directors ask CMS to withdraw DSH auditing rule

The National Association of State Medicaid Directors this week urged the Centers for Medicare & Medicaid Services to withdraw its Medicaid Disproportionate Share Hospital audit and reporting final rule, which implemented certain provisions of the Medicare Modernization Act. “We believe that this rule went beyond the statutory intent of the MMA’s reporting and auditing requirements and will restrict the type and nature of the hospital costs that states can reimburse through DSH payments,” NASMD said in a letter to CMS.

The letter asks CMS to postpone the deadline for the initial audit and state reports, and consider a new rulemaking process “to ensure that DSH is used in the manner that it was intended.” The American Hospital Association previously asked the administration to withdraw the rule.

CMS proposes to rescind Medicaid rules, delay enforcement of provider tax

The Centers for Medicare & Medicaid Services on May 1 issued a proposed rule rescinding its final rules on Medicaid outpatient services and school transportation services and an interim final rule on case management services, which are under a congressional moratorium set to expire July 1. The agency cited “concerns raised about the adverse effects that could result from these regulations, in particular the potential restrictions on services available to beneficiaries, potential deleterious effect on state partners in the economic downturn, and the lack of clear evidence demonstrating that the approaches taken in the regulations are warranted.”

In addition, the agency issued a proposed rule delaying the enforcement of certain portions of the Medicaid provider tax final rule, also under a congressional moratorium set to expire July 1. The proposed rule would delay until Oct. 1 enforcement of a change in the definition of the class of managed care organization services, and delay through June 2010 enforcement of American Hospital Association-opposed changes to the standards for determining a hold harmless arrangement.

The statutory change in the provider tax threshold and the removal of obsolete regulatory language would be unaffected. CMS will accept comments through June 1 on the proposed enforcement delays.

[ via AHA News Now ]

CMS further delays Medicaid benefits rule

The Centers for Medicare & Medicaid Services on April 3 delayed until Dec. 31 the effective date of a final rule giving states more flexibility in defining the benefits covered by their Medicaid programs, as provided under the Deficit Reduction Act of 2005. CMS also reopened the comment period through May 4, requesting comments on the final rule generally as well as whether it conforms with provisions in the recent Children’s Health Insurance Program Reauthorization Act.

Published last December, the rule allows states to amend their Medicaid plans to offer alternative benefit packages called "benchmark plans," which are either approved by the Health and Human Services secretary or equivalent to state or certain federal employee coverage. It had been set to take effect today under a 60-day delay imposed by the new administration in February.

[ via AHA News Now ]

CMS further delays Medicaid cost-sharing rule

The Centers for Medicare & Medicaid Services on March 26 delayed to Dec. 31 the effective date of a final rule giving state Medicaid agencies increased flexibility to impose premium and cost-sharing requirements on Medicaid beneficiaries. CMS also reopened the comment period through April 27, requesting comments on any portion of the final rule as well as whether the rule conforms with premium and cost-sharing provisions in the recent American Recovery and Reinvestment Act.

The rule, published last November, was set to take effect tomorrow under a 60-day delay imposed by the new administration in January. Among other provisions, the rule sets forth options for higher cost-sharing for non-emergency use of hospital emergency departments.

[ via AHA News Now ]

AHA advocates strengthening states’ FMAP MOE requirements

In a letter on Feb. 5 to Sen. Charles Grassley (R-IA), the American Hospital Association expressed support for the senator’s plan to offer an amendment to the economic stimulus bill (H.R. 1) that would require states receiving a temporary increase in the federal government’s share of Medicaid funding to maintain program eligibility, benefits and provider payments.

“These conditions are critical because states already have targeted their Medicaid programs, through provider payment freezes or reductions, and benefit and eligibility changes, in a search for budget savings,” AHA wrote. “While both the House and Senate versions of H.R. 1 impose [a maintenance of effort] requirement, it is limited to eligibility changes. We believe it is imperative to extend protections to provider payments and benefits as well, as any further cuts will weaken the already tenuous foundation of the health care safety net, dramatically harming the ability of providers to continue serving our most vulnerable patients.”

The Senate was debating amendments to H.R. 1, the American Recovery and Reinvestment Act. The House last week passed its own version of H.R. 1.