MHA's Executive Briefing

Meeting the Challenge of a Dual-Eligible Population

While the industry is headed in the right direction in coordinating care for dual eligibles, it still must overcome formidable challenges related to deploying clinical and care utilization management in the settings where it can be most effective: at the point of care. Read more from Hospitals & Health Networks magazine here.

CMS releases Medicaid DSH proposed rule

The Centers for Medicare & Medicaid Services on May 13 proposed a methodology for reducing federal Medicaid Disproportionate Share Hospital (DSH) allotments to states by an aggregate $500 million in fiscal year 2014 and $600 million in FY 2015 under the Patient Protection and Affordable Care Act, the amounts that were mandated in statute. The proposed rule establishes separate DSH reduction pools for “low-DSH” states and other states, then creates a formula for distributing the reductions in each pool based on five factors outlined in the law.

CMS said the proposed methodology gives one-third weight to the uninsured percentage factor and one-third weight to each of the two DSH payment targeting factors; encourages states to target Medicaid DSH payments to high Medicaid volume hospitals and hospitals with high levels of uncompensated care; and contains a procedure for protecting allotments that support Section 1115 demonstration coverage increases. CMS will revisit the methodology and promulgate new rules for DSH reductions in FYs 2016 and beyond.

“We continue to believe that both Medicaid and Medicare [DSH] cuts should be delayed for two years in order to better ascertain whether coverage expansions have been implemented,” said American Hospital Association Executive Vice President Rick Pollack, noting, however, that the proposed rule implementing the congressionally mandated cuts, “appears to have been accomplished in a responsible way” based upon AHA’s preliminary analysis. AHA supports the DSH Reduction Relief Act of 2013 (H.R. 1920), which would delay the cuts for two years.

The proposed rule will be published in the May 15 Federal Register, with comments accepted through July 12. The final changes will take effect Oct. 1, unless Congress acts to delay the cuts.

Bill would delay ACA DSH cuts until FY 2016

Rep. John Lewis (D-GA) on May 9 introduced the DSH Reduction Relief Act (H.R. 1920), American Hospital Association-supported legislation that would delay for two years cuts to the Medicare and Medicaid Disproportionate Share Hospital programs under the Patient Protection and Affordable Care Act.

“The [ACA] contains reductions to the DSH programs based on the assumption that many of the uninsured and underinsured would receive coverage under the law,” said AHA Executive Vice President Rick Pollack. “However, the Supreme Court’s decision that the federal government could not compel states to expand their Medicaid programs has negatively impacted projected health insurance coverage. The DSH Reduction Relief Act of 2013 will help hospitals and the patients they serve by delaying the Medicaid and Medicare DSH funding cuts for two years. This will allow for coverage expansions to be more fully realized.”

Obama's Budget To Spare Medicaid From Deep Cuts

President Barack Obama's budget this week will steer clear of major cuts to Medicaid, including tens of billions in reductions to the health care plan for the poor that the administration had proposed only last year. Big cuts in the federal-state program wouldn't go over too well at a time that Health and Human Services Secretary Kathleen Sebelius is wooing financially skittish Republican governors to expand Medicaid coverage to millions who now are uninsured.

 The president's budget is to be released April 10. Read more from NPR here.

CMS finalizes rule on Medicaid expansion payments

The Centers for Medicare & Medicaid Services on March 29 issued a final rule establishing the increased Federal Medical Assistance Percentage rates for newly eligible individuals under the Patient Protection and Affordable Care Act’s Medicaid expansion. In states that expand Medicaid, effective Jan. 1, 2014, the federal government will pay 100% of the cost of the newly eligible beneficiaries through 2016, phasing down to 90% in 2020.

The ACA authorizes states to expand Medicaid to adult Americans under age 65 with income of up to 133% of the federal poverty level, and the final rule describes the method states will use to claim the matching rate available under the Medicaid expansion. For states that had coverage expansions in effect prior to the ACA, the rule also provides information about the availability of an increased FMAP for certain adults who are not newly eligible.

CMS will accept comments on the rule for 60 days after its publication in the Federal Register on April 2.

[ via AHA News Now ]

Don't tie Medicaid, discharge data: study

As Medicaid costs surpass all other expenses in states' budgets, several states are considering legislation or regulations that limit payment for Medicaid enrollee emergency department visits that ultimately don't qualify as emergencies. But, a new study finds that it's often difficult to immediately determine whether patients are having a medical emergency based on their initial symptoms.

Read more from Modern Healthcare here.

MACPAC issues March report to Congress on Medicaid, CHIP

The Medicaid and CHIP Payment and Access Commission on March 15 recommended that Congress create a statutory option allowing states to implement 12-month continuous eligibility for the Children's Health Insurance Program and adults in Medicaid. The commission said the recommendation would improve enrollment stability after new income eligibility standards take effect in 2014.

MACPAC also recommended that Congress permanently fund the Transitional Medical Assistance program, allowing states to opt out of the program if they expand adult coverage under the Patient Protection and Affordable Care Act. TMA allows parents to keep their family's Medicaid coverage for at least six months after transitioning to a new job.

The March report to Congress also looks at service use and spending patterns for Medicare and Medicaid dual eligibles, a group for which the commission plans to explore policy options in the future.

GOP Budget Plan Promises To Repeal Obamacare, Cuts Medicaid

U.S. House Republicans unveiled their latest budget outline on March 12, sticking to their plans to try to repeal so-called Obamacare, cut domestic programs ranging from Medicaid to college grants and require future Medicare patients to bear more of the program's cost.

Senate Democrats plan to offer a counterproposal on March 13 with higher spending on domestic programs and additional tax hikes on top of the higher rates imposed on top-bracket earners in January. That plan will, in turn, arrive as a dead letter in the GOP-controlled House.

Read more from the Associated Press here.

CMS issues guidance on preventive services FMAP increase

The Centers for Medicare & Medicaid Services on Feb. 1 issued guidance to state Medicaid programs on the one percentage point increase in the Federal Medical Assistance Percentage applicable to expenditures for certain preventive services and adult vaccines provided without cost-sharing. To claim the FMAP increase, which took effect Jan. 1 under the Patient Protection and Affordable Care Act, states must cover in their standard Medicaid benefit package all preventive services assigned a grade of A or B by the U.S. Preventive Services Task Force, as well as adult vaccines recommended by the Advisory Committee on Immunization Practices.

[ via AHA News Now ]

Payment Matters: AHA Survey Identifies Continuing Problems with Medicare RAC Program

The American Hospital Association (AHA) published its RACTRAC Survey results for the third quarter of 2012. The AHA created the survey in response to the lack of information released by CMS on its Medicare RAC program.

For the third quarter of 2012, the survey notes several problems with the Medicare RAC program, including a significant rate of claims that were erroneously disallowed, as well as many issues with administration of the RAC program. The report is likely to be relevant to the litigation currently being pursued by the AHA.

Read more here.