Tag Archives: Medicaid

Energy and Commerce Committee Approves Medicaid, Public Health Bills

On November 18, 2015, the House Energy and Commerce Committee approved several public health policy bills. Two approved bills pertain to the Medicaid program: HR 3716, the Ensuring Terminated Providers Are Removed from Medicaid and CHIP Act – to implement several HHS OIG recommendations to improve CMS oversight of terminated providers and state screening of … Continue Reading

CMS Publishes Final Rule on Medicaid Fee-For-Service Ratesetting for Assuring Access to Covered Medicaid Services

On November 2, 2015, CMS published a final rule with comment period that is intended to provide a transparent, data-driven process for states to follow when they set Medicaid provider payment rates, effective January 4, 2016. Under the Social Security Act, state plans must ensure that payment rates for Medicaid services “are consistent with efficiency, … Continue Reading

Energy and Commerce Health Subcommittee Advances Mental Health, Medicaid, Synthetic Drug Legislation

On November 4, 2015, the House Energy and Commerce Health Subcommittee approved the following health policy bills: HR 2646, the Helping Families in Mental Health Crisis Act – includes a series of reforms intended to improve federal mental health research, screening, and treatment programs, some of which have met with strong opposition from House Democrats. … Continue Reading

Upcoming Energy & Commerce Committee Hearings on Medication Therapy Management, Medicaid/Exchange Eligibility Determinations

The House Energy and Commerce Subcommittee on Health has scheduled an October 21, 2015 hearing to examine the Medicare Part D Medication Therapy Management Program. In addition the Health Subcommittee is holding an October 23 hearing entitled “”Reviewing the Accuracy of Medicaid and Exchange Eligibility Determinations.”… Continue Reading

OIG Continues to Recommend Reduced Medicaid DME Reimbursement Rates

The HHS Office of Inspector General is once again calling for states to clamp down on Medicaid reimbursement for durable medical equipment (DME) and supplies. The OIG cites a series of earlier reports estimating that four states (California, Minnesota, New York, and Ohio) could have saved more than $18.1 million on selected DME items if … Continue Reading

Congressional Hearings to Focus on Health IT, Biosimilars, Medicaid Program Legislation

Two Congressional committees are holding hearings this week on health policy issues.  First, the Senate Health, Education, Labor and Pensions (HELP) Committee has scheduled a September 16, 2015 hearing on “Achieving the Promise of Health Information Technology: Improving Care Through Patient Access to Their Records.”   The HELP Committee also will hold a September 17 hearing on “Biosimilar Implementation: … Continue Reading

House Energy & Commerce Committee Schedules Hearing to Review Medicaid Program Integrity Legislation

On September 11, 2015, the House Energy & Commerce Subcommittee on Health will hold a hearing to discuss legislative proposals intended to reduce Medicaid waste, fraud, and abuse.  Bills to be discussed include: Draft legislation to encourage territories to create Medicaid Fraud Control Units. Draft legislation addressing recent OIG findings that health care providers terminated … Continue Reading

GAO Calls for Expanded State Reporting on Medicaid Prescription Drug Fraud Controls

In light of continuing indicators of potential prescription-medication fraud and abuse in state Medicaid programs, the Government Accountability Office (GAO) has reviewed federal and state pharmacy-related policies and processes to prevent and detect such abuses. The GAO identified two potential controls that are not included in CMS’s current reporting requirements: (1) lock-in programs for noncontrolled … Continue Reading

CMS to Host Webinar on Medicaid HCBS Quality Measures (Sept. 9)

On September 9, 2015, CMS is hosting a webinar on the development of quality measures for Medicaid fee-for-service beneficiaries using home- and community-based services (HCBS).  Specifically, the webinar will discuss efforts to establish measures of potentially avoidable hospitalizations due to:  severe pressure ulcers; acute ambulatory care sensitive conditions (e.g., dehydration, urinary tract infections); and chronic … Continue Reading

Terminated Medicaid Providers Continue to Participate in Other State Medicaid Programs

According to the HHS Office of Inspector General (OIG), 12% of providers terminated for cause by a state Medicaid program in 2011 continued participating in other states’ Medicaid programs as of January 2014, despite an Affordable Care Act (ACA) requirement that states terminate any provider terminated for cause by another state Medicaid program.  The OIG acknowledges … Continue Reading

Congressional Panels to Review Small Business Health Care, Medicaid Program Status

Two Congressional hearings are scheduled this week on health policy issues: On July 7, 2015, the Senate Health, Education, Labor and Pensions Committee has scheduled a hearing on “Small Business Health Care Challenges and Opportunities”; and On July 8, the House Energy & Commerce Health Subcommittee will focus on “Medicaid at 50: Strengthening and Sustaining the … Continue Reading

Congressional Health Policy Hearings

A House Ways and Means Subcommittee on Oversight hearing recently reviewed the effects of the Affordable Care Act (ACA) on health insurance premiums.  In addition, a House Energy and Commerce Health Subcommittee hearing examined the Obama Administration’s approval of Medicaid demonstration projects.   The Energy and Commerce Health Subcommittee also reviewed three bipartisan bills that aim to … Continue Reading

GAO Calls for Tighter Medicaid Fraud Controls

A recent GAO review of Medicaid claims in four selected states (Arizona, Florida, Michigan, and New Jersey) discovered that thousands of Medicaid beneficiaries and hundreds of providers were involved in potentially improper or fraudulent payments during FY 2011. Such potentially improper payments involved, among other things, beneficiaries concurrently receiving benefits paid by two or more … Continue Reading

CMS Issues Guidance to States on Medicaid/CHIP Provider Fingerprint-Based Criminal Background Checks

On June 1, 2015, CMS provided additional guidance to state Medicaid directors on implementation of fingerprint-based criminal background checks (FCBCs) as a component of ACA Medicare, Medicaid, and CHIP provider screening requirements. CMS stipulates that states have 60 days from the date of the letter to begin implementation of the FCBC requirement, and implementation must be … Continue Reading

Congressional Health Policy Hearings

A number of Congressional panels have held hearings this month on health policy issues, including the following: A House Ways and Means Committee hearing on Affordable Care Act implementation and the FY 2016 HHS budget request; A Senate Health, Education, Labor and Pensions (HELP) Committee hearing on “Health Information Exchange: A Path Towards Improving the … Continue Reading

GAO Report on Oversight of Medicaid Payments to Hospitals

The Government Accountability Office (GAO) has released a report entitled “Medicaid: CMS Oversight of Provider Payments Is Hampered by Limited Data and Unclear Policy.”  The report examines how state Medicaid payments to government hospitals compare to those made to private hospitals in selected states (Illinois, New York, and California) and CMS oversight of such payments. … Continue Reading

GAO Calls for Tighter Reins on Section 1115 Demonstrations

A recent GAO report examined expenditure authorities in “section 1115” demonstrations approved by HHS between June 2012 and October 2013. Section 1115 of the Social Security Act gives HHS broad authority to approve “expenditure authorities” that allow states to receive federal funds for costs that would not otherwise be matchable under Medicaid if the Secretary … Continue Reading

CMS Proposes Mental Health Parity Rules for Medicaid Managed Care/Alternative Benefit Plans, CHIP Coverage

CMS has published a proposed rule that would apply provisions of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to Medicaid beneficiaries who receive services through managed care organizations or alternative benefit plans and to the Children’s Health Insurance Program (CHIP). In general, such programs will be required to meet the mental health … Continue Reading

CMS Proposes Extension of Enhanced Funding for Certain Medicaid Eligibility & Enrollment Systems

On April 16, 2015, CMS published a proposed rule that would revise the definition of Medicaid mechanized claims processing and information retrieval systems to include Medicaid eligibility and enrollment (E&E) systems, which would make enhanced federal financial participation (FFP) available for such systems on an ongoing basis (current regulatory authority for such enhanced funding expired … Continue Reading

President Obama Signs MACRA: Permanently Reforms Medicare Physician Reimbursement Framework, Includes Other Health Policy Provisions

Today President Obama signed into law H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.… Continue Reading

OIG Posts FY 2014 State Medicaid Fraud Control Unit (MFCU) Data

The HHS Office of Inspector General (OIG) has released detailed statistical data on MFCU enforcement actions, recoveries, and expenditures for fiscal year 2014. Overall, state MFCUs reported more than $2 billion in criminal and civil recoveries (settlements, judgments, or prefiling settlements) in FY 2014, more than $1.7 billion of which were civil recoveries. The states … Continue Reading