16 Recent Medicare, Medicaid Issues — Bundled Payments, IPAB & More
1. Last month, CMS unveiled the Bundled Payments for Care Improvement initiative, which is considered to be a bellwether on how bundled payments will work in the future. Because the program has such a large scope, hospital executives — regardless of whether their organization is participating in BPCI or not — need to familiarize themselves with the program, theories and pitfalls.
2. Republican senators reintroduced a bill to repeal Medicare's Independent Payment Advisory Board.
3. For the 11th straight year, Rep. John Conyers Jr. (D-Mich.) proposed the Expanded and Improved Medicare for All Act, legislation that would establish a universal, single-payor healthcare program akin to Canada's and other developed countries' healthcare systems.
4. Wisconsin Gov. Scott Walker (R) refused the federal government's offer to cover an expansion of the state's Medicaid program if it met full criteria, but he said he would begin to include the poorest childless adults on the state-federal health plan.
5. A recent study found by expanding its Medicaid program with federal funding, Colorado could save $133.8 million by 2025.
6. House Energy and Commerce Committee Chairman Rep. Fred Upton (R-Mich.) and other representatives of his party released a framework of their plan to permanently replace the sustainable growth rate that would make drastic cuts to Medicare payments to physicians.
7. University of Maryland St. Joseph Medical Center in Towson failed a Medicare inspection after the University of Maryland Medical System acquired it late last year, and the hospital is likely losing millions in Medicare payments as a result.
8. Medicare dominated healthcare components of President Barack Obama's State of the Union address and was one of the largest targets in the Republican response delivered by Sen. Marco Rubio of Florida.
9. Georgia Gov. Nathan Deal (R) signed the hospital provider fee bill into law, injecting millions of dollars in extra Medicaid reimbursement to the state's distressed hospitals.
10. HHS and the Department of Justice announced the federal government recovered $7.90 for every dollar spent on Medicare and Medicaid fraud investigations over the past three years.
11. North Carolina Gov. Pat McCrory issued a statement, claiming a review of the state's readiness to implement parts of the health law indicated North Carolina was not prepared to take on the financial risk of an expanded Medicaid program, nor was it prepared to build and run its own health insurance exchange.
12. A Robert Wood Johnson Foundation report found Medicare readmission rates in hospitals across the U.S. have not changed significantly from 2008 to 2010.
13. An audit found that Arkansas' Medicaid program erroneously distributed $1.36 million in payments to ineligible recipients since 2009.
14. CMS clarified that critical access hospitals will not need to apply for special exemption when providing outpatient therapy treatments to Medicare patients who have exceeded their annual payment cap for such services.
15. New Mexico's Human Services Department announced four health insurers will be the primary managed care organizations for New Mexico's revamped Medicaid program.
16. U.S. District Judge David Campbell in Phoenix ordered that HHS re-review a waiver application for Arizona's Medicaid copay demonstration project within 60 days, claiming the department's original approval did not offer adequate explanation.
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