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CMS Unveils Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.”

The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas:  state health system performance, state administrative accountability, and federal administrative accountability.

The scorecard currently offers information on selected health and program indicators.  Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and key state documents such as state plan amendments, waivers, and managed care program overviews.  The site also presents individual state and comparative state performance based on a variety of metrics while also reporting on federal turnaround time on matters such as waiver requests and rate reviews.  CMS envisions the scorecard evolving from year to year by offering more and different information.

Go here to see a CMS fact sheet on the new Medicaid scorecard and go here to visit the scorecard’s home page.

ACOs Moving Into Medicaid

Accountable care organizations, one of the centerpieces of recent Medicare efforts to test new ways to deliver care more effectively and at less cost, are finding their way into state Medicaid programs as well.

Today, a dozen states employ Medicaid ACOs and another ten are planning to do so.

Learn more about Medicaid ACOs, and how one state (Minnesota), in particular, is using them, in this Kaiser Health News report.

Amid Budget Woes, States May Look to Medicaid for Savings

Budget challenges may lead some states to seek changes in their Medicaid programs aimed at saving money.

Or so reports Fitch Ratings, the bond rating company.

According to Fitch, health care was the biggest driver in rising state spending between 2005 and 2015 and the portion of state spending on health and social services will increase from 30.7 percent in 2015 to 38.3 percent in 2025.

Among the measures states will turn to in an effort to manage rising health care costs, according to Fitch, are Medicaid work requirements, reductions in Medicaid retroactive coverage, new Medicaid premiums, and lifetime limits on Medicaid benefits.

Learn more about the challenges facing state governments in the coming years in this Fitch news release and this summary on the Healthcare Dive web site.

 

CMS Introduces Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services has unveiled a “scorecard” through which interested parties will be able to monitor outcomes for state Medicaid programs, state CHIP programs, and CMS itself while also comparing the performance of states to one another.

The purpose of the scorecard, according to CMS, is “to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes.”

CMS also explained that

The first version of the Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. The metrics included in the first Scorecard reflect important health issues such as well child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions. The Scorecard represents the first time that CMS is publishing state and federal administrative performance metrics – which include measures like state/federal timeliness of managed care capitation rate reviews, time from submission to approval for Section 1115 demonstrations, and state/federal state plan amendment processing times.

It is not clear at this time how CMS will use the scorecard or what its value might be.

Learn more about the new CMS Medicaid scorecard by reading the complete CMS news release, which can be found here, accompanied by links to further information about the scorecard and a CMS fact sheet.

CMS Rejects Bid to Impose Lifetime Limit on Medicaid Services

The Centers for Medicare & Medicaid Services has denied a request from the state of Kansas to impose a lifetime limit on the Medicaid benefits individuals may receive.

In a move that the agency appeared to signal last week and that appears to have national implications, CMS administrator Seema Verma explained that

 We have determined that we will not approve Kansas’ recent request to place a lifetime limit on Medicaid benefits for some beneficiaries…We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them.

Medicaid advocates feared that benefit limits would follow in the footsteps of the recent efforts of some states to impose work requirements on many Medicaid participants – efforts that, in some cases, have proven successful.

Such a decision, if it becomes policy, would be beneficial for private safety-net hospitals.  These hospitals serve more Medicaid patients than the typical hospital and would therefore be more likely to encounter patients whose eligibility would be jeopardized by a limit on lifetime Medicaid benefits.

Learn more about Medicaid lifetime benefit limits and the CMS decision in this article in the online publication The Hill.

Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing.

Or so reports a new study published in the journal Health Affairs.

According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims.  While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims.

This can pose a special challenge to private safety-net hospitals because they care for so many more Medicaid patients than the typical hospital.

Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity Of Billing And Paying For Physician Care” or see this Healthcare Dive summary of the study.

MACPAC Issues Annual Report, Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress.

MACPAC’s report addresses three primary areas:  Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH).

With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts:

  • permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan
  • extend Medicaid managed care section 1915(b) waivers from two to five years
  • permit states to obtain waivers to waive freedom of choice and selective contracting restrictions

MACPAC notes the growing use of telehealth by state Medicaid programs and encourages states to continue this expansion while learning more from the efforts of one another to use telehealth effectively.

Finally, MACPAC notes that it

…continues to find little meaningful relationship across the country between DSH allotments and number of uninsured individuals, hospitals’ uncompensated care costs, and the number of hospitals providing essential community services that have high levels of uncompensated care. Total hospital charity care and bad debt continue to fall, especially in states that expanded Medicaid coverage, but Medicaid shortfall showed an uptick as a result of increased Medicaid enrollment. Now that Congress has delayed DSH allotment reductions for two years, the Commission will explore opportunities to improve the targeting of DSH payments in future reports.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the CHIP program.

Medicaid DSH is very important to the nation’s private safety-net hospitals so NAUH will carefully monitor the response to MACPAC’s Medicaid DSH recommendations.

Learn more about MACPAC’s recommendations to Congress in its Report to Congress on Medicaid and CHIP, which can be found here.

Addressing Socio-Economic Challenges Through Medicaid Payment Policies

Amid the growing awareness of the impact of social factors on health, policy-makers are increasingly interested in finding ways to address those factors through state Medicaid programs.

In a new blog post, the journal Health Affairs offers six ways for states to address social determinants of health through Medicaid managed care programs.

  1. classify certain social services as covered benefits under the state’s Medicaid plan
  2. explore additional flexibility afforded states through section 1115 waivers
  3. use value-based payments to support investment in social interventions
  4. use incentives and withholds to encourage plan investment in social interventions
  5. integrate efforts to address social issues into quality improvement activities
  6. reward plans with effective investments in social interventions with higher rates

Learn more about how states can use these approaches to empower Medicaid managed care plans to address social determinants of health in the Health Affairs Blog post “Practical Strategies for Integrating the Cost of Social Interventions Into Medicaid Managed Care Rates,” which can be found here.

 

NQF to Medicaid: Do a Better Job of Addressing Social Determinants of Health

State Medicaid programs need to do a better job of measuring and addressing the social risks their patients face, the National Quality Forum has asserted in a new report.

To do so, NQF concluded, state Medicaid programs should “…work more with healthcare organizations and communities to better manage social disparities.”

How?

According to the NQF, state Medicaid programs should:

  • Acknowledge that Medicaid has a role in addressing social needs that impact health.
  • Create a comprehensive, accessible, routinely updated list of local community resources for healthcare organizations.
  • Harmonize tools that assess social needs that impact health to ensure that they collect and document the same type of information.
  • Create standards for inputting and extracting social needs data from electronic health records to strengthen information sharing between health and non-health providers and programs
  • Increase information sharing between government agencies.
  • Expand the use of waivers and demonstration projects to begin to learn what works best for screening and addressing social needs that impact health.

Learn more about how the NQF wants state Medicaid programs to address the social determinants of health in the new report Food Insecurity and Housing Instability Final Report, a link to which can be found here.

Medicaid in the Spotlight

State-option work requirements.

A cap on federal spending.

New flexibility for states to address eligibility, benefits, and provider payments.

Rolling back the Affordable Care Act’s eligibility expansion.

Medicaid is under the policy microscope in Washington these days in ways it has not been for many years as the new administration continues to work to put its stamp on the federal government’s major program to provide health care to low-income Americans.

These and other possible changes are of great interest to the nation’s private safety-net hospitals because these hospitals care for so many more Medicaid and low-income patients than the typical community hospital.

What are policy-makers considering and what are the potential implications of their efforts?  Learn more in the new Health Affairs blog article “Medicaid Program Under Siege,” which can be found here.