The OIG has issued a memo to CMS suggesting that some states may be claiming matching funds for government-owned but privately-operated hospitals, where no state or local government funds are used to operate the hospital. The OIG suggests that CMS consider requiring that an entity be operated by a unit of government in order to … Continue Reading
CMS has issued a proposed rule to make changes to the PERM and MEQC programs to align with changes to state adjudication of Medicaid and Children’s Health Insurance Program (CHIP) eligibility under the Affordable Care Act. The proposed rule also includes revisions to PERM and MEQC policies that are intended to reduce state burdens associated … Continue Reading
The HHS Office of Inspector General (OIG) recently issued a report examining implementation of Medicaid National Correct Coding Initiative (NCCI) edits, as required by the Affordable Care Act since October, 2010. The report finds that several problems have limited the success of these edits (medically unlikely edits and procedure-to-procedure edits), which are designed to encourage … Continue Reading
CMS has published a notice giving states more time to submit state access monitoring review plans under a November 2015 rule intended to assure access to covered Medicaid services. By way of background, the final rule required states to develop and submit to CMS an access monitoring review plan for the following service categories: primary … Continue Reading
The House of Representatives has unanimously approved H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act. The bill, which still awaits Senate consideration, would implement several OIG recommendations to improve CMS oversight of terminated providers and state screening of providers. Among other things, H.R. 3716 would require states and Medicaid managed care plans to … Continue Reading
The House Energy & Commerce Committee has voted to approve H.R. 4725, Common Sense Savings Act of 2016, which includes a number of Medicaid and Children’s Health Insurance Program (CHIP) reforms. Among other things, the bill would: reduce the limit on Medicaid provider taxes from 6% to 5.5% of net patient revenues; reduce federal Medicaid … Continue Reading
The House Budget Committee has approved the budget resolution providing instructions to Congressional committees on the federal spending framework for FY 2017. The resolution calls for the adoption of major reforms to the Medicare program that would cut spending by $449 billion over 10 years, while Medicaid and other health care spending would be reduced … Continue Reading
CMS published a final rule on February 2, 2016 to implement statutory requirements regarding documentation of face-to-face encounters with Medicaid beneficiaries within certain timeframes as a condition of Medicaid coverage of home health services and certain medical equipment. The rule also makes several clarifications to Medicaid policies related to coverage of home health services, including … Continue Reading
The Government Accountability Office (GAO) has issued a report on trends in Medicaid managed care spending, enrollment, and oversight. Notably, the GAO reports that over 10 years (FY 2004 through 2014), federal Medicaid managed care spending grew from $27 billion to $107 billion, representing 38% of total federal Medicaid spending in 2014. The report also … Continue Reading
On December 4, 2015, CMS published a final rule that extends enhanced federal funding for the design, development, installation, or enhancement of Medicaid eligibility and enrollment systems. The rule also updates standards for Medicaid Management Information Systems (MMIS). According to CMS, the final rules will help states automate the application and renewal process, improve the … Continue Reading
CMS has announced that the CY 2016 provider enrollment application fee is $554, up slightly from $553 in 2015. This application fee is required for institutional providers that are initially enrolling or revalidating enrollment in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP) or adding a new Medicare practice location on … Continue Reading
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
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
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
Today, the House Energy and Commerce Health Subcommittee has scheduled hearings and votes on a variety of health policy bills. First, the Subcommittee will discuss the following five bills intended to improve the Medicare and Medicaid programs: … Continue Reading
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
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
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
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
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
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
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
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
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
