W3vina.COM Free Wordpress Themes Joomla Templates Best Wordpress Themes Premium Wordpress Themes Top Best Wordpress Themes 2012

Tag Archive | "Medicaid"

MACPAC Releases Report on Medicaid Managed Care

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2011 Report to the Congress: The Evolution of Managed Care in Medicaid. The Commission’s report provides an overview of Medicaid managed care, including information on populations enrolled, plan arrangements, payment policy, access and quality, as well as program accountability, integrity, and data.

Posted in ReformComments Off on MACPAC Releases Report on Medicaid Managed Care

MACPAC Convenes Meeting Focused on Managed Care

In considering the Medicaid expansion beginning in 2014, states may seek to encourage Medicaid managed care plans to offer both Medicaid and health insurance exchange coverage, in order to prevent disruptions in coverage as individuals shift in and out of Medicaid eligibility based on changes in their income level.  On May 19, the Medicaid and CHIP Payment and Access Commission (MACPAC) convened to discuss managed care, which is among its highest priorities and will be the focus of the Commission’s June 2011 Report to Congress.  State Medicaid Directors in New York and Oklahoma discussed current managed care initiatives as well as identify challenges and opportunities for the future.  Both states have a long history of managed care and note that it will have a significant role in the future to ensure coverage while establishing the correct incentives for appropriate utilization of care.  The New York State Medicaid Director noted that the underlying question that remains to be answered is whether managed care controls costs over time.

Posted in ReformComments Off on MACPAC Convenes Meeting Focused on Managed Care

Republican Governors Outline Policy Options for Medicaid Reform

The Republican Governors Public Policy Committee issued a report in response to a request from House Energy and Commerce Committee Chairman Fred Upton that includes the following policy options for Medicaid reform:

  • Repeal the Affordable Care Act and replace it with market-based reforms;
  • Allow states to define an outcome-based program operating agreement with CMS (program would include a limited number of measures and eliminate federal review process for Medicaid programs);
  • Enable states to measure accountability through measures of quality, cost, access and customer satisfaction;
  • Repeal maintenance of effort requirements; Entrust the state with responsibility for program integrity;
  • Require the federal government to assume the cost of uncompensated care for illegal aliens;
  • Allow states to pilot programs to reduce the occurrence of cost-shifting between the state and federal programs;
  • Permit a state (if it can demonstrate budget neutrality) to use state or local funds to pay for Medicaid services of system improvements that are not currently “matchable;”
  • Encourage states to develop innovative programs to reduce chronic illnesses, emergency room visits, and hospitalizations;
  • Provide states with the ability to implement bundling projects;
  • Allow states to use only one managed care organization (rather than at least two as currently required by CMS);
  • Amend ACA’s eligibility definition to reverse the use of MAGI;
  • Allow states to contract with private firms to streamline eligibility determination;
  • Provide states with flexibility to design benefit structures;
  • Eliminate benefit mandates that exceed private insurance market benchmark or benchmark equivalent;
  • Permit states to divide Medicaid into different parts; and
  • Engage in shared savings arrangements for dual eligible beneficiaries.

The report will serve as the basis for the Committee’s Health Care Summit in Washington in October.

Posted in ReformComments Off on Republican Governors Outline Policy Options for Medicaid Reform

HHS Outlines Regulatory Review

Earlier this year, President Obama issued an Executive Order directing Department and Agency heads to submit a plan for retrospective review of regulations that may be obsolete or burdensome to businesses. Federal Departments submitted preliminary plans in the spring and just this week issued their final plans.

HHS’s plan notes that the goal of the retrospective review of the regulations is to improve patient care and outcomes and reduce system costs by removing obsolete or burdensome requirements.  The Centers for Medicare and Medicaid Services will publish a rule in September related to this regulatory review and estimates that the changes outlined in the plan will result in savings of $600 million annually and $3 billion over five years.

HHS plans to revisit regulations a number of issues including the following:

  • Use of telemedicine to increase access to improve the ability of rural and critical access hospitals to provide care more broadly and reduce provider burden by removing credentialing requirements;
  • Increase use of electronic reports and submissions at the FDA and the Administration for Children and Families;
  • Align reporting for electronic prescribing requirements and the EHR incentive program in Medicare;
  • Improve pre-market review for medical devices;
  • Reduce certain burdens imposed by the FDA’s medical device regulations;
  • Continue to review the FDA’s Good Manufacturing Practices regulations for foods and drugs and establish preventive controls for food facilities, as well as accommodate advances in technology relating to pharmaceuticals;
  • Revise and update labeling regulations for food and drugs at the FDA;
  • Develop a CMS work plan to better align Medicare and Medicaid; and
  • Review quality reporting requirements.

Posted in ReformComments Off on HHS Outlines Regulatory Review

Sen. Coburn Proposes Deficit Reduction Plan

Yesterday, Sen. Tom Coburn (R-OK) proposed a deficit reduction plan, “Back in Black,” which would achieve $106.7 billion/10 years in savings from the Department of Health and Human Services (HHS).  His proposal:

  • Reduces Medicare and Medicaid fraud, waste, and abuse
  • Repeals the Affordable Care Act
  • Repeals the Independent Payment Advisory Board (IPAB)
  • Repeals the Community Living Assistance Services and Supports program (CLASS)
  • Repeals policies that increase the cost of health care insurance for individuals – the medical device and pharmaceutical drugs fees and the health insurance excise tax
  • Repeals Medicaid expansion
  • Repeals individual mandate
  • Eliminates Children’s Hospital GME
  • Reduces improper payments, modernizes HHS’ systems, controls unnecessary costs, and improves management of resources
  • Cuts administrative budget
  • Allows American to purchase health insurance across state lines
  • Adopts medical malpractice reform

Posted in Legislation, ReformComments Off on Sen. Coburn Proposes Deficit Reduction Plan

Lieberman/Coburn Bipartisan Plan to Save Medicare and Reduce Debt

On June 28, 2011, Sen. Joe Lieberman (I-CT) and Sen. Tom Coburn (R-OK) presented a proposal– the Lieberman/Coburn Bipartisan Plan to Save Medicare and Reduce Debt – that would reform Medicare in order to save at least $500 billion over 10 years. The reforms include:

• Eliminating the variation in beneficiaries’ deductibles depending on the services provided and, instead, establishing an annual deductible of $550 for both Medicare Part A and Part B services;

• Establishing an “out-of-pocket maximum” of $7,500 for Medicare beneficiaries with higher income Americans having a higher out-of-pocket maximum;

• Increasing beneficiary cost-sharing in Medigap by requiring the enrollee to pay the first $550 in cost-sharing and limiting the coverage to half of the remaining coinsurance up to $7,500 of the new out-of-pocket maximum;

• Increasing the Medicare eligibility age to 67 by 2025;

• Accelerating the implementation of the productivity adjustments and rebasing for home health payments;

• Phasing out the Medicare payments for bad hospital debt;

• Requiring higher income Americans to pay more for Medicare Part B services;

• Increasing the Medicare Part B premium until enrollees premium level reaches a minimum of 35 percent of the program’s costs in 2019; and

• Requiring individuals 65 years of age and older who are making more than $150,000 annually ($300,000 for couples) to pay the full premium costs for their Medicare Part D coverage.

The plan would include provisions focused on preventing fraud, waste, and abuse from the “Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayer Dollars (FAST) Act” (S.1251), which was introduced by Sen. Tom Carper (D-DE) and Sen. Coburn. The Senators propose to use the cost savings generated from the above changes to pay for a three-year Medicare physician fee fix.

Posted in Capital Check-Up, Podcasts, ReformComments Off on Lieberman/Coburn Bipartisan Plan to Save Medicare and Reduce Debt

MACPAC Releases 2011 Report to Congress

In its first report, MACPAC does not make recommendations to Congress. The report (1) provides an overview of Medicare and Medicaid; (2) sets forth the analytical framework that MACPAC will use to consider policy issues; (3) outlines factors for accessing access, evaluating payment policies, and identifying key data sources; and (4) includes a compilation of key data on Medicaid and CHIP enrollment, program characteristics, and expenditures.

MACPAC reviews the history of Medicaid and the State Children’s Health Insurance Program (CHIP) and the importance of their roles at the local, state, and Federal levels.  The report explains Medicaid and CHIP’s impact on state and federal budgets, and emphasizes the fiscal difficulties states face in the midst of an economic recession.  The report emphasizes Medicaid’s unique role of covering services often not covered by under traditional health insurance, while being subject to and struggling to adhere to medical cost drivers, such as medical malpractice patterns and new, high-cost technologies.  MACPAC highlights two major upcoming policy changes – CHIP’s interaction with exchange coverage and when new federal CHIP funding will not be available under current law, as authorized by the Affordable Care Act.  It notes that there is a potential for cases where children who are eligible for CHIP (or Medicaid) will be prohibited from enrolling in their parents’ federally subsidized family coverage through an exchange due to new eligibility requirements.

The Commission’s evaluation of access to primary and specialty care will focus on study of enrollees and their characteristics, availability of providers, and utilization.  MACPAC intends to identify a set of measures by which to monitor access and to identify opportunities that would appropriately enhance access to Medicaid and CHIP.  The report outlines potential measures that could be used for this purpose.

MACPAC also outlines potential areas for the Commission’s work in evaluating Medicaid payment policies, including: (1) evaluate the impact of the required increase in primary care fees; (2) evaluate specific payment policies for improving efficiency, economy, and quality and increasing availability of providers; and (3) examine the impact of state financing approaches and supplemental payments on providers, payment policy, and states’ ability to adopt payment innovations.

Consistent with Commission meetings, the report includes a chapter focused on improving Medicaid and CHIP data. The chapter outlines the current data sources used to collect Medicaid and CHIP data. The report acknowledges that the Centers for Medicare and Medicaid Services (CMS) is working to resolve data issues and update its computer and data systems. MACPAC, in its report, urges CMS to move forward with these efforts and also to develop a strategic plan to gather feedback from stakeholders. The Commission outlines the specific data areas for improvement: (1) encounter data by managed care plans; (2) timeliness of enrollment; (3) consistency of data across sources; and (4) information about state program policies.

Posted in Capital Check-UpComments Off on MACPAC Releases 2011 Report to Congress

CMS Proposed Rule on Provider and Supplier Enrollment

CMS released the Proposed Rule: “Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers.” The Proposed Rule will be published in the September 23 Federal Register.

The Affordable Care Act made statutory changes to the Medicare and Medicaid programs and CHIP to enhance provider and supplier enrollment and to reduce fraud, waste, and abuse.

The Proposed Rule will have implications for both new and existing providers and suppliers. For example, the Proposed Rule would establish new screening procedures for newly enrolling providers and suppliers beginning on March 23, 2011. The new procedures would apply to current Medicare, Medicaid, and CHIP providers beginning on March 23, 2012.

Comments on the Proposed Rule are due to the Agency by November 16, 2010 at 5:00 pm.

Posted in ReformComments Off on CMS Proposed Rule on Provider and Supplier Enrollment