18 Recent Medicare, Medicaid Issues
1. CMS issued its annual Medicare Recovery Auditor report to Congress, confirming that recovery audit contractors collected $797.4 million in overpayments from hospitals and other providers and repaid $141.9 million in underpayments in fiscal year 2011.
2. For the second time, President Barack Obama nominated Marilyn Tavenner to lead CMS.
3. CMS announced changes to its Medicare Medically Unlikely Edits program, which screens claims for likely errors under Part B to avoid excess payments.
4. Fourteen hospitals across Texas asked the state Supreme Court that the Texas Health and Human Services Commission recalculate Medicaid reimbursements for fiscal years 2008 and 2009.
5. The state Senates in both Oklahoma and Utah agreed to extend hospital provider fees, which have raised hundreds of millions of dollars in extra Medicaid reimbursement.
6. U.S. Reps. Joe Heck, DO (R-Nev.), and Allyson Schwartz (D-Pa.) introduced new legislation that would permanently repeal the sustainable growth rate, which dictates Medicare reimbursement to physicians.
7. Healthcare spending on Medicare and Medicaid has grown slower than many have predicted, and the most recent report from the Congressional Budget Office showed federal spending for the two programs was 5 percent lower than it estimated in March 2010.
8. In an address, President Barack Obama urged Congress members to find a "balanced mix of spending cuts and tax reform" in order to avoid impending automatic budget cuts.
9. Michigan Gov. Rick Snyder became the sixth GOP governor to recommend an expansion of the state's Medicaid program to include individuals slightly above the poverty line.
10. HHS and CMS issued a proposed rule that would modify or eliminate Medicare regulations deemed to be unnecessary or obsolete — reforms the government expects will save hospitals and healthcare providers up to $676 million per year and $3.4 billion over five years.
11. Cleveland-based safety-net health system MetroHealth was approved to operate a Medicaid waiver program that will allow up to 30,000 Ohioans who fall under 133 percent of the federal poverty line to obtain free healthcare coverage.
12. CMS announced a new initiative to improve care for Medicare beneficiaries with end-stage renal disease.
13. Sens. Claire McCaskill (D-Mo.) and Tom Coburn, MD (R-Okla.), introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act — a controversial provision that sets the Medicare hospital wage index floor for the entire country.
14. Kansas moved its Medicaid recipients at the start of this year onto a flat-fee managed care program called KanCare, in hopes the switch would lower costs or slow growth in spending for its Medicaid population.
15. Six lawmakers from both sides of the aisle released a report outlining recommendations from more than 160 stakeholders on methods to combat fraud and abuse in the Medicare and Medicaid programs.
16. HHS Secretary Kathleen Sebelius stressed federal funding for states that expand their Medicaid programs to include more poor residents will be protected from budget battles.
17. CMS released its final rule that will require drug, device, biologic and medical supply manufacturers to report payments and gifts they provide to physicians and teaching hospitals — better known as the Sunshine Act.
18. Tampa, Fla.-based health insurer WellCare Health Plans completed its acquisition of Minnetonka, Minn.-based health giant UnitedHealthcare's Medicaid business in South Carolina.
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