Some Hospitals Stand to Lose Medicaid Expansion, DSH Money
When the Supreme Court made Medicaid expansion optional rather than mandatory for states, its decision affected the delicate balance of one aspect of the Affordable Care Act. Hospitals that serve large numbers of low-income and uninsured patients receive special supplemental [...]
CMS Seeks to Shape Provider Networks
Insurers offering qualified health plans in the federally facilitated marketplace will soon be required to meet federal standards for the adequacy and breadth of their provider networks. According to a letter issued by the Centers for Medicare & Medicaid Services [...]
Observation Status, the “Two-Midnight Rule,” and Continuing Controversy
Amid continuing complaints from hospitals, the Centers for Medicare & Medicaid Services (CMS) has delayed implementation of its so-called Medicare two-midnight rule for another six months. Implementation of the rule, originally scheduled for October 1, 2013 and delayed for six [...]
ACOs Show Encouraging Signs
Provider groups that just completed their first year in Medicare’s ACO programs are showing encouraging signs of producing health care savings. In all, the Centers for Medicare & Medicaid Services (CMS) reports $380 million in savings for first-year participants. Nearly [...]
States Using Medicaid Expansion to Pursue Innovation
While many of the states that have chosen to expand their Medicaid programs under the terms of the Affordable Care Act did so by embracing those terms, others are viewing Medicaid expansion as an opportunity to pursue wholesale changes in [...]
CMS Offers Advice on Managing Expected Upsurge in ER Visits
With Medicaid enrollment rising because of eligibility changes introduced through the Affordable Care Act, hospital emergency rooms expect to see an increase in the number of emergency room visits as new Medicaid enrollees seek care for long-neglected health problems. In [...]
MedPAC Endorses Site-Neutral Payments
MedPAC has recommended to Congress that Medicare equalize the rates paid to hospital outpatient departments and private physicians’ offices for many outpatient services. Currently, hospital outpatient departments are paid more than physician offices for many Medicare-covered services. MedPAC, which advises [...]
MedPAC Recommends Raise for Hospitals
The independent agency that advises Congress on Medicare payment issues has recommended a 3.25 percent increase in Medicare payments to hospitals for inpatient and outpatient services in FY 2015. The Medicare Payment Advisory Commission (MedPAC) also recommended an increase of [...]
Medicare Appeals Go on Back Burner
Faced with a backlog of more than 350,000 appeals of claims decisions, Medicare has announced that that it will suspend acting on new requests for appeals hearings made by hospitals, doctors, nursing homes, and other providers for approximately two years. [...]
Retail Recruiting During Wholesale Times
While most observers keep an eye on state-wide and national health insurance enrollment figures in search of leaps in the tens and even hundreds of thousands of people, the process of enrolling low-income adults in state Medicaid programs for which [...]
