The Department of Health and Human Development (HHS) announced (press release) it began processing targeted distributions from the Provider Relief Fund to hospitals in high-impact areas and to rural providers. A breakdown of where funding is going (by state and/or county) is available here. Key points about both of the targeted funding distributions follow: COVID-19 High-Impact Distribution. HHS is distributing... Read More
HHS: Next Provider Relief Fund Payments Expected April 24; $10B Allotments Included for High Impact Areas and Rural Health Providers
The Department of Health and Human Services (HHS) announced its plan for allocating and disseminating the remaining $70B of the $100B appropriated to the Provider Relief Fund under the CARES Act. General Allocation HHS will distribute $20M to providers weekly, on a rolling basis, beginning April 24, 2020 as part of $50B in general distributions ($30B was delivered to providers... Read More
MACPAC: March 2020 Report to Congress Addresses the Status of DSH Allotments to States, State Readiness for Core Measure Reporting in 2024, and Section 1115 Demonstration Evaluations
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its March 2020 Report to Congress on Medicaid and the Children’s Health Insurance Program (CHIP). In three chapters, the report addresses: (1) disproportionate share hospital (DSH) payments to safety-net hospitals; (2) state reporting on the quality of behavioral health care and care provided to children who have health coverage through... Read More
MACPAC: Citing Inadequately Assessed Impact on Beneficiary Access, MACPAC Urges CMS Not to Finalize Provider Payment Restrictions under Medicaid Fiscal Accountability Regulation (MFAR)
The Medicaid & CHIP Payment and Access Commission (MACPAC) published a formal comment letter in response to the Center for Medicare & Medicaid Services’ (CMS) proposed Medicaid Fiscal Accountability Rule, or “MFAR.” Under the proposed rule, CMS aims to implement multiple changes to federal oversight of Medicaid fee-for-service (FFS) payment and financing policies, and to increase the transparency of Medicaid... Read More
House Appropriations: Legislative Text of FY 2020 Appropriations Packages
House Appropriations Committee Chairwoman Nita Lowey (D-NY) released the legislative text of two appropriations packages to fully fund the government for the remainder of fiscal year 2020. The appropriations minibus, H.R. 1865 provides a total of $94.9 billion for the Department of Health and Human Services (HHS), a $2.6 billion increase from the 2019 enacted level and $7.5 billion above... Read More
MACPAC: Review of Draft MACPAC Chapter on Disproportionate Share Hospital Allotments
The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to review a draft report chapter on disproportionate share hospital (DSH) allotments. MACPAC Senior Analyst Ryan Greenfield presented a review of the draft chapter, addressing changes made based on Commissioner feedback provided during the October meeting session on DSH. He closed by noting that the chapter assumes DSH... Read More
Finance: Updated Drug Pricing Bill Released with Bipartisan Health Extender Agreement
The Senate Finance Committee unveiled an updated version of its drug pricing package (bill text; extenders; press release) that adds and revises several provisions and includes a newly reached bipartisan agreement on key health extenders, including a two-year delay of Medicaid DSH cuts. The bill continues to include inflation rebates in both Medicare Parts B and D. The updated legislation... Read More
WH: President Trump Signs Second Continuing Resolution; Extends Funding Through Dec. 20
President Trump signed a second continuing resolution (H.R. 3055) to extend current funding levels through December 20 to avert a government shutdown. Like the previous continuing resolution, H.R. 3055 temporarily reauthorizes funding for community health centers; teaching health centers; the certified community behavioral health clinic demonstration; National Quality Forum; and other public health, Medicaid, and Medicare programs. Additionally, the continuing... Read More
MACPAC: Commissioners Discuss Recommendations for the Disproportionate Share Hospital Allotment Report
The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to discuss the statutorily mandated analyses of disproportionate share hospital (DSH) allotments. Senior Analyst Ryan Greenfield provided updates on the number of uninsured, uncompensated care costs, and Medicaid shortfall. Additionally, the presentation highlighted the pending DSH allotment reductions and California’s Global Payment Program (GPP). Commissioners debated what to... Read More
CMS: Agency Issues Final Rule to Implement DSH Allotment Reductions
Today, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to implement statutorily required Medicaid disproportionate share hospital (DSH) allotment reductions. Section 2251 of the Affordable Care Act (ACA) requires reductions to state DSH allotments to occur annually, but the reductions have been delayed several times due to congressional intervention. Although the final rule is set to... Read More
CRS: Medicaid's IMD Exclusion
The Congressional Research Service (CRS) released a brief report on Medicaid’s Institutions for Mental Disease (IMD) exclusion. The IMD exclusion prohibits the federal government from reimbursing states for services furnished to certain Medicaid beneficiaries who are patients in IMDs. An IMD is defined as “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged... Read More
CMS: FY 2020 Inpatient and Long-Term Care Hospital PPS Final Rule Addresses Rural Wage Index Changes, New Technology Add-On Payments
The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2020 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule (press release; fact sheet), which applies to acute care hospital and LTCH payments beginning Oct. 1, 2019. What it is. The wide-ranging final rule would affect payments for discharges occurring... Read More
GAO: Agency Issues Report on States' Use of Medicaid DSH Payments
The Government Accountability Office (GAO) conducted a study to examine Medicaid Disproportionate Share Hospital (DSH) payment and how each state utilizes these payments. DSH payments are used to offset hospitals' uncompensated care costs for serving Medicaid beneficiaries and uninsured patients. The GAO used 2014 DSH audit data to determine the levels of uncompensated care and DSH payments. The GAO found... Read More
E&C: Health Subcommittee Advances 10 Bills to Full Committee on Surprise Billing, Drug Pricing, Extenders
The House Energy and Commerce Subcommittee on Health convened a markup of 10 health care bills, including advancing H.R. 3630, the “No Surprises Act,” bipartisan legislation to address surprise medical bills. The Subcommittee also advanced H.R. 2296, the FAIR Drug Pricing Act, which requires pharmaceutical manufacturers to justify price increases above a certain threshold. The Subcommittee adopted an amendment in... Read More
MACPAC: Commission Releases June 2019 Report to Congress with Recommendations on Prescription Drug Policy, Medicaid Shortfall, Program Integrity, Therapeutic Foster Care; Medicaid Funding in Puerto Rico Addressed
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its June 2019 Report to Congress. The report, in five chapters, addresses policy and payment considerations related to prescription drugs, Medicaid shortfall, program integrity, therapeutic foster care, and Medicaid funding in Puerto Rico. Chapter 1: Next Steps in Improving Medicaid Prescription Drug Policy – Under current law, a state... Read More
CRS: Health Care-Related Expiring Provisions of the 115th Congress, First Session
This report provides descriptions of selected health care-related provisions that are scheduled to expire during the 115th Congress, first session (i.e., during calendar year [CY] 2017). For purposes of this report, expiring provisions are defined as portions of law that are time limited and will lapse once a statutory deadline is reached absent further legislative action. The expiring provisions included... Read More
E&C: Health Subcommittee Examines Public Health Program Extenders; DSH Cuts, NQF, and Behavioral Health Clinics Discussed
The House Energy & Commerce Subcommittee on Health convened a hearing to discuss twelve legislative proposals that are aimed at extending public health care programs, and are detailed in a Subcommittee memorandum. This summary reflects the second panel discussion and legislation regarding Certified Community Behavioral Health Clinics (CCBHCs), proposed repeal of disproportionate share hospital (DSH) payment cuts, the National Quality... Read More
Supreme Court: Justices Rule Against 2012 DSH Payment Calculation Changes
In a 7-1 decision, the U.S. Supreme Court ruled against the Department of Health and Human Services's decision to include the count of Medicare Advantage beneficiaries in its calculation for disproportionate share hospital (DSH) payments for FY 2012 without offering a public comment period. The court ordered HHS to vacate the rule, though it is currently not clear how the... Read More
CMS: FY 2020 Inpatient and Long-Term Care Hospital PPS Proposed Rule Addresses Rural Wage Index Changes, New Technology Add-On Payments; Comments Due June 24
The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2020 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule (press release; fact sheet), which applies to acute care hospital and LTCH payments beginning Oct. 1, 2019. What it is. The wide-ranging proposed rule would affect payments for discharges occurring... Read More
MACPAC: Commission Votes on Recommendations for the Definition of Medicaid Shortfall for Purposes of DSH
Today, the Medicaid Payment and Access Commission (MACPAC) convened a hearing to discuss how to treat third-party payments in the Medicaid shortfall. The Commission recommended that the definition for Medicaid shortfall exclude cost and payments for all Medicaid-eligible patients for whom Medicaid is not the primary payer. Commissioners overall voted in support of the recommendation, with only one Commissioner, Charles... Read More
MACPAC: In March 2019 Report to Congress, Commission Recommends Improvements to Medicaid DSH Allotment Reductions, Stronger Oversight of UPL Supplemental Payments
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its March 2019 Report to Congress. The report, in three chapters, addresses policy and payment considerations related to disproportionate share hospital (DSH) payments in Medicaid and upper payment limit (UPL) supplemental payments to hospitals. Chapter 1: Improving the Structure of Disproportionate Share Hospital Allotment Reductions – Under current law,... Read More
E&C: Subcommittee on Health Questions Secretary Azar on FY 2020 HHS Budget
The House Energy and Commerce (E&C) Subcommittee on Health convened a hearing to examine the President’s fiscal year (FY) 2020 budget for the Department of Health and Human Services (HHS). Most members used the opportunity to question Secretary Azar on HHS’ policy positions and actions on several issues, including: (1) prescription drug prices, particularly on the proposed rules on drug... Read More
MACPAC: Commissioners Discuss Alternative Options to Account for Third Party Payments in Definition of Medicaid Shortfall
The Medicaid and CHIP Payment Advisory Commission (MACPAC) convened a session to discuss the disproportionate share hospital (DSH) definition of Medicaid shortfall and whether third-party payers should be included in the equation. MACPAC staff presented to commissioners regarding the outcome of a 2018 lawsuit that excluded third-party payments from the definition and has resulted in greater shortfall for dually eligible... Read More
Notice: Final FY 2017 and Preliminary FY 2019 Disproportionate Share Hospital Allotments
The Centers for Medicare & Medicaid Services (CMS) recently published a notice containing: (1) the final federal share disproportionate share hospital (DSH) allotments for fiscal year (FY) 2017 (see Addendum 1); (2) the preliminary federal share DSH allotments for FY 2019 (see Addendum 2); and (3) the final FY 2017 and the preliminary FY 2019 limitations on aggregate DSH payments... Read More
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