A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Medicare

CMS releases interim final rule in response to AHA

Posted on October 2, 2013

The Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on disproportionate share hospital (DSH) payments. The rule alters when certain hospitals, specifically those with reporting periods that do not align with the fiscal year, will receive Medicare DSH payments. The discrepancy was causing administrative and financial issues for these hospitals, which CMS ultimately determined were not in the best interest of the patient population of these hospitals. The new rule was issued with significant encouragement from the American Hospital Association and Association of Medical Colleges.

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CMS issues proposed rule for FQHC and RHC

Posted on September 18, 2013

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule impacting both federally qualified health centers (FQHC) and rural health clinics (RHC). Beginning in October 2014, the rule implements the prospective payment system (PPS) for FQHC under Medicare Part B in conjunction with the Affordable Care Act (ACA). The proposed rule also states that RHC may contract with nonphysician practitioners, such as nurse practitioners and physician assistants, as long as these practitioners meet the employment requirements for the health center. Lastly, the rule alters the Clinical Laboratory Improvement Amendments in regards to proficiency testing referrals.

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Medicare and Medicaid Disproportionate Share Hospital Payments: Proposed Rules

Posted on June 13, 2013

For thirty years, the Medicare and Medicaid programs have furnished additional payments to hospitals that furnish a disproportionate share of services to low income populations. Despite the fact that the two disproportionate share hospital (DSH) programs share a common mission, they function differently in terms of how the funds actually move to hospitals and in the formulas used to make DSH payments. The Affordable Care Act makes significant adjustments in both DSH programs beginning in 2014 in anticipation of a significant expansion in the proportion of people who have health insurance coverage. With the United States Supreme Court’s decision in 2012 in NFIB v Sebelius, which permits states to opt out of the Medicaid expansion without risking the loss of federal funding for their existing Medicaid programs, the downward DSH payment adjustments become an even more significant matter for hospitals that treat large volumes of low income patients…

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Interview of Phyllis Borzi, Assistant Secretary of Labor of the Employee Benefits Security Administration (EBSA), United States Department of Labor

Posted on June 11, 2013

Recently, Sara Rosenbaum, the Hirsh Professor of Health Law and Policy at the GW Department of Health Policy, had an opportunity to interview Phyllis Borzi, the federal official in charge of overseeing the Employee Benefits Security Administration (EBSA), for Health Reform GPS. EBSA is an agency of the United States Department of Labor responsible for administering, regulating and enforcing the provisions of Title I of the Employee Retirement Income Security Act of 1974 (ERISA), and the agency is playing an important role in the implementation of the Affordable Care Act….

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CBO report addresses characteristics, spending and policies for duals

Posted on June 7, 2013

The Congressional Budget Office (CBO) published a report describing the characteristics and costs associated with dual-eligible beneficiaries. A dual-eligible beneficiary, or dual, is someone that is eligible to receive benefits from both Medicare and Medicaid. Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies uses data from 2009 to examine the different payment systems used in both Medicare and Medicaid to pay for dual benefits, as well as methods by federal and state governments to integrate the payments systems and better coordinate care for this growing population.

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CMS releases additional hospital spending data

Posted on June 3, 2013

In an expansion to the hospital charges data released last month, the Centers for Medicare and Medicaid Services (CMS) provided data describing charges for 30 different outpatient procedures. The data include charge estimates for Ambulatory Payment Classification Groups, which are paid under the Medicare Outpatient Prospective Payment System. Presented data are hospital-specific and report charge values collected during calendar year 2011.

CMS also released data on geographic variations in Medicare public use and Medicare utilization by those with chronic conditions.

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CMS rule requires MA and Medicare Part D to comply with MLR

Posted on May 20, 2013

The Centers for Medicare and Medicaid Services (CMS) released a final rule that requires Medicare Advantage (MA) and Medicare Part D issuers to comply with the medical loss ratio (MLR), which states that these issuers must spend 85% of their premium revenues on patient services. The MLR permits only 15% of this revenue to be spent on organization administrative and overhead costs. MA and Part D issuers are required to submit data to CMS that allows consumers to use the sponsor’s MLR as a measure of efficiency. If the plan sponsors do not meet the MLR requirements, they will be subject to financial penalties, enrollment sanctions, and potential contract termination if issuers repeatedly miss the minimum MLR requirement.

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CBO releases new report describing budgetary impact of the ACA

Posted on May 15, 2013

The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…

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CMS releases data on hospital charges

Posted on May 8, 2013

In an effort to increase health care affordability and transparency, the Centers for Medicare and Medicaid Services (CMS) published data pertaining to hospital charges for the 100 most common services provided during Medicare inpatient stays. With more than 163,000 entries, the data released by CMS indicated wide variation in costs, both across the country and within similar regions. For instance, a joint replacement procedure can cost $5,300 in Ada, Oklahoma, while a similar procedure may cost upwards of $223,000 in Monterey Park, California. Similarly, heart failure treatments can cost anywhere between $9,000 and $51,000 in Jackson, Mississippi. To further promote the spirit of the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) will also be offering grants for entities to collect and analyze medical pricing and reimbursement data to aid consumers in their health care decision-making and promoting cost-effective care.

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Brookings proposes reforms to save hundreds of billions in health care

Posted on April 30, 2013

The Brookings Institution recently released a study that indicates how value-based payments and small, conscientious quality improvements to both the private and public insurance sectors can significantly reduce health care costs in the future. Bending the Cure: Person-Centered Health Care Reform, describes how such changes could save the federal government $300 billion over the next 10 years and more than $1 trillion over the next 20 years. Brookings finds that moving to patient-centered care is the ultimate means by which future cost savings can be achieved. For a specific example, the study proposes that Medicare should move away from the fee-for-service model and embrace comprehensive payment organizations.

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