Feds Propose New Medicaid Managed Care Regs
The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade. In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on [...]
Underinsurance Remains a Problem
Twenty-three percent of American adults are uninsured, according to a new survey by the Commonwealth Fund. Among them, 14 million had deductibles that exceeded five percent of their income while another 24 million had deductibles that fell below that threshold [...]
GAO Examines Medicaid Section 1115 Waivers
The U.S. Department of Health and Human Services (HHS) frequently exercises the authority granted to it under section 1115 of the Social Security Act to authorize Medicaid expenditures for uses not strictly permitted under that law if those uses extend [...]
Post-Mortem on the Medicaid Primary Care Fee Bump
The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was [...]
5% of Medicaid Recipients Account for 50% of Costs
Just five percent of all Medicaid recipients are responsible for nearly half of the program’s expenditures. Or so says a new report by the U.S. Government Accountability Office (GAO). Conversely, the 50 percent of Medicaid’s least costly recipients account for [...]
New 340B Rules Expected Soon
The federal Health Resources and Services Administration (HRSA) is expected to release new rules governing its section 340B prescription drug discount pricing program in the near future. The new rules have long been in development and were in the verge [...]
CMS Presents Vision for Future Physician Quality Reporting Efforts
The federal government has unveiled its vision for the future of physician quality reporting in the Medicare program. In the new document CMS Physician Quality Reporting Programs Strategic Vision, the Centers for Medicare & Medicaid Services (CMS) presents, according to [...]
Chairmen Seek Ideas for Improving Medicaid
The chairmen of four key congressional committees have written to the Medicaid and CHIP Payment and Access Commission (MACPAC) seeking “assistance in developing policy options to ensure the sustainability of the Medicaid program so it can continue to provide essential [...]
DSRIP Presentation
More states are looking to Delivery System Reform Incentive Payment programs – DSRIP – to generate the resources they need to improve their Medicaid delivery and payment systems. A number of states, including New York, Texas, California, Illinois, and New [...]
Mixed Results for Doc Quality Reporting Program
Nearly a half-million providers will see their Medicare payments docked this year because they failed to submit to Medicare data required by its Physician Quality Reporting System in 2013. On the other hand, nearly 650,000 will receive a 0.5 percent [...]
