The Daily Scan

August 27, 2018

Last Updated: 8:55 AM EST

Medicaid

  • A proposal to expand Medicaid to about 90,000 low-income Nebraskans will be on the November general election ballot, Nebraska Secretary of State John Gale announced Friday. (Omaha.com)

 

  • The Trump administration is reviewing a proposal from the Tennessee Medicaid program (TennCare) that would exclude any entity that performed, or operated or maintained a facility that performed, more than 50 abortions in the previous year, including any affiliate of such an entity. On April 12, 2018, the Tennessee General Assembly enacted Public Chapter No. 682, establishing that it is the policy of the state of Tennessee to favor childbirth and family planning services that do not include elective abortions within the continuum of care or services, and to avoid the direct or indirect use of state funds to promote or support elective abortions. The objective of the proposed Amendment 36 is to implement this state policy. TennCare enrollees would continue to have access to family planning services from other providers within the TennCare demonstration that meet the state’s proposed criteria. (Medicaid.gov)

Legislation

  • On Thursday, a group of Republican Senators introduced the "Ensuring Coverage for Patients with Pre-Existing Conditions Act," legislation that would guarantee Americans have equal health care coverage, regardless of their health status or pre-existing conditions. The legislation prohibits discrimination against beneficiaries based on health status, including the prohibition against increased premiums for beneficiaries due to pre-existing conditions. Senator Thom Tillis of North Carolina commented: “There are strong opinions on both sides when it comes to how we should overhaul our nation’s broken health care system, but the one thing we can all agree on is that we should protect health care for Americans with pre-existing conditions and ensure they have access to good coverage. This legislation is a common-sense solution that guarantees Americans with preexisting conditions will have health care coverage, regardless of how our judicial system rules on the future of Obamacare.” (Tillis.Senate.gov: Press Release, Legislation)

Medicare

  • The Government Accountability Organization (GAO) released the results of a new study on Friday titled: "Medicare Fee-for-Service: Information on the First Year of Nationwide Reduced Payment Rates for Durable Medical Equipment." The Centers for Medicare & Medicaid Services (CMS) implemented a competitive bidding program (CBP) for certain durable medical equipment (DME), such as wheelchairs and oxygen, in 2011 that is currently operating in 130 designated U.S. areas. On January 1, 2016, CMS used information from the CBP to start adjusting Medicare fee-for-service payment rates for certain DME throughout the country in areas that had previously not been subject to the CBP (known as non-bid areas). For the first year adjusted rates were in effect in non-bid areas, GAO found:

    • Reductions in payment rates were generally significant but varied by category of DME item. The unweighted average reduction in payment rates for the five rate-adjusted DME items with the highest expenditures in 2016 within each DME category was 46%.

    • Changes in the number of suppliers furnishing rate-adjusted items were generally consistent with the years before adjusted rates went into effect. GAO found that the number of suppliers furnishing rate-adjusted items in non-bid areas in 2016 decreased 8% compared to 2015.

    • GAO’s review of Medicare claims data found that beneficiary utilization of rate-adjusted items in non-bid areas in 2016 showed little change compared to 2015. GAO also found that CMS’s activities to monitor beneficiary access, including changes in health outcomes, showed little change between 2015 and 2016 (GAO.gov)

Regulation

  • The Department of Health & Human Services Office of Inspector General (OIG) issued an Request for Information (RFI) this morning titled: "Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements." As explained in the RFI: "The OIG seeks to identify ways in which it might modify or add new safe harbors to the anti-kickback statute and exceptions to the beneficiary inducements civil monetary penalty (CMP) definition of ‘‘remuneration’’ in order to foster arrangements that would promote care coordination and advance the delivery of value-based care, while also protecting against harms caused by fraud and abuse." (FederalRegister.gov)

 

 

 

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