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Governor drops proposal for Medicaid budget cut

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Governor Little dropped a planned $30M cut to Medicaid because he says the enhanced federal funds under the Public Health Emergency (PHE) funding will cover the revenue gap this year.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

C. Scott Grow
 

BOISE — There was big news at Thursday’s Medicaid budget hearing at the state Legislature: Gov. Brad Little has withdrawn a recommendation in his budget proposal for next year to find $30.2 million in state general fund savings in the Medicaid budget, which would come to a cut of $118.4 million in total funds including federal matching funds, because the state has been informed it’ll get much more than that in Medicaid funding from the federal government due to the COVID-19 pandemic.

The Biden administration notified the state two weeks ago that it will continue a significantly higher federal matching rate for Medicaid throughout calendar year 2021, according to state Health & Welfare Director Dave Jeppesen and Alex Adams, Little’s budget director.

The “cost containment” proposal had aroused big controversy, at a time when Idaho’s health system is struggling with the COVID-19 pandemic.

Idaho also is seeing increased numbers of its residents take advantage of its Medicaid expansion program, which voters authorized in November of 2018 and which started covering Idahoans who earn up to 138% of the federal poverty level just over a year ago, on Jan. 1, 2020. The federal government picks up 90% of the cost of that program.

Joint Finance-Appropriations Committee members expressed concerns over future Medicaid costs. Sen. Jeff Agenbroad, R-Nampa, said although the increased federal funding can “fill in some of the holes,” it’s a temporary fix. “We have to look beyond this year,” he said. “This is an anomaly.”

Once the pandemic is over, he noted, Idaho could see its federal matching rate for traditional Medicaid drop because of the state’s strong economy; that’s part of the federal calculation for the non-expansion portion of Medicaid in normal times.

Agenbroad said long-term reforms, including moving Idaho’s Medicaid program to a value-based, rather than fee-for-service, payment system, are “probably the longer-term solution.”

Jeppesen agreed. He noted that the Legislature last year enacted significant cost-containment moves for Medicaid that are underway, including shifting more and more of Medicaid onto value-based, rather than fee-for-service, payment models, in which payment is based on good health outcomes rather than number of services provided. Contracts with major hospital systems and nursing homes to accomplish that change are set to be signed by July 1, he said.

“We will continue to look at other cost containment efforts and will be back next session,” Jeppesen said, possibly proposing other cost-containment legislation.

Earlier in this year’s legislative session, the department proposed legislation to allow it to cut reimbursements to providers at its discretion to achieve savings; lawmakers rejected it.

Jeppesen said the administration is recommending that rather than cut $30 million in in state funds from Medicaid next year to achieve cost savings, the Legislature tap the additional federal matching funds to cover that amount, and funnel additional savings from the boost in federal funding into a “stabilization account” to hedge against future Medicaid cost increases.

Because of the COVID-19 pandemic, the federal government has temporarily increased the amount of Idaho’s regular Medicaid costs it covers from about 70 percent to about 76%, through an increase in the Federal Medical Assistance Percentage, or FMAP. Now, that increase will last through the end of the year. Jeppesen said that means $28.7 million more in Medicaid funds for Idaho this year, “and additional savings of $56 million in fiscal year ’22 that was not otherwise built into the governor’s budget recommendation.”

In addition to the direct impact of the pandemic on Idaho’s health care system, Idaho has been seeing significantly increased costs in Medicaid in part because of pent-up demand for medical care among new enrollees in Medicaid expansion, and in part because the federal government has cut off disenrollment of those who no longer qualify during the pandemic. That’s led to roughly 32,000 Idahoans currently staying on the Medicaid rolls who otherwise wouldn’t be eligible, including more than 13,000 in Medicaid expansion.

Legislative budget analyst Jared Tatro told lawmakers, “As of Jan. 27, it was 32,914 individuals, and of those, 13,217 were related to Medicaid expansion. … When the public health emergency ends, the department knows who they are, and they’re ready to start the process of disenrolling effective immediately.”

JFAC members had lots of questions about how much Medicaid expansion has actually cost the state and how much the state has saved in offsets in existing programs that now are 90% federally funded, rather than 100% state-funded as they were previously. Tatro said, “There are cost offsets.” For the first year, the net cost to the state was zero, he said, due to about $32 million in cost offsets in Corrections, courts, Health & Welfare and the Catastrophic Health Care program. Since then, Tatro said, estimates forecast by Milliman, an actuarial consulting firm, now appear to be off and costs are expected to be higher than anticipated, “basically almost double.” But there still are offsets, he said, “And we know there are more offsets coming.”

Initial Milliman projections put the state’s cost for the first full year of Medicaid expansion, this current year, at around $41 million, which is where it was budgeted; all of those costs were offset through a combination of savings in existing state programs and an allocation of $12.6 million from the Millennium Fund, a state fund that holds tobacco settlement proceeds. But now Milliman has issued a revised report projecting costs this year will be nearly 66% higher than it originally projected, based on higher medical and pharmacy costs, COVID-19 impacts and economic conditions. That would mean another $22.8 million in state costs this year.

Tatro said the new report bases its projections on just a few months of Idaho experience during a pandemic, while the original forecasts were based on experiences of other states, so there are still plenty of unknowns.

“With hospitals shut down, it’s going to be hard to realize what is the cost of these individuals,” he said, “so we won’t know the net impact this session.” Longer term, additional savings from Medicaid expansion are expected in the state’s Catastrophic Health Care fund, mental health services and psychiatric hospitals, child welfare and public health, he said.

“We’re just going to have to be a little patient before we fully realize the actual net. But right now about half is being offset,” he said.

Rep. Ron Nate, R-Rexburg, called the increased Milliman projections “a disturbing increase,” and said, “These costs are outrageous, and I wonder if the voters who voted for Medicaid expansion really knew what it was going to cost us and all the trouble it’s causing with budgeting, (if they) would have voted for it.”

Idaho voters approved Medicaid expansion by a more than 60% margin in 2018, after the Legislature discussed it but didn’t act for six straight years. The expansion covers Idahoans who previously fell into an insurance gap: They made too much to qualify for Medicaid, but not enough to qualify for subsidized health insurance through the Your Health Idaho insurance exchange.

Sen. C. Scott Grow, R-Eagle, noted the way Medicaid expansion costs doubled from the first year of enactment to the second, and asked whether that’s likely to continue. Tatro responded, “If we double again I’ll take you to lunch. … We don’t anticipate doubling year after year after year. That is six months compared to one year.” That’s because expansion started halfway through Idaho’s state fiscal year, which runs from July 1 to June 30.

Jeppesen told lawmakers, “I just wanted to close by reminding the committee that the department exists to serve the people of Idaho and specifically to promote their health safety and independence. I remain committed to working as I have been for the last three years in a collaborative, transparent way, and I only know of one way to solve problems, and that’s to talk through them.”

JFAC is scheduled to start setting agency budgets Feb. 19.

Clipped from: https://www.idahopress.com/news/local/governor-drops-proposal-for-medicaid-budget-cut/article_d464ebf8-999b-5369-bb26-ea7661757912.html

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Indiana Lawmakers Propose Using Cigarette Tax For Medicaid

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The state is considering a new $1 tax to cigarettes and redirect 40% of the existing tax to Medicaid providers.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The proposal, now headed to the House Ways and Means Committee, would add $1 to the state’s current 99.5 cents per pack cigarette tax.

 
 

INDIANAPOLIS (AP) — A House committee made significant changes Thursday to the way Indiana would spend proceeds from a proposal to hike the state’s cigarette tax for the first time in more than a decade and impose a new state tax on vaping liquids.

House legislators revised the measure in committee to direct 40 percent of Indiana’s cigarette tax revenue toward Medicaid reimbursements for health care providers. That’s a change from the original proposal, which would have deposited a majority of the new revenue generated by the tax hike — estimated to be nearly $290 million a year — into the state’s general fund and pension programs.

The proposal, now headed to the House Ways and Means Committee, would add $1 to the state’s current 99.5 cents per pack cigarette tax. It also would charge a 39 percent tax on the liquids used in e-cigarettes, which bill sponsor Rep. Julie Olthoff, a Crown Point Republican, said would be roughly equivalent to the cigarette tax.

Olthoff said Thursday she welcomed the change, noting Medicaid covers the health care expenses of eligible smokers. The lawmaker has maintained that the legislation is aimed at reducing Indiana smoking rates. The state’s 21.1 percent smoking rate among adults was the fourth-highest in the country for 2018, according to the federal Centers for Disease Control and Prevention.

A separate amendment seeking to allocate more of the tax revenue toward public health initiatives was voted down by committee members. The proposal, authored by Democratic Rep. Robin Shackleford, would create a health improvement fund to help the State Department of Health treat and prevent tobacco addiction, drug addiction, diabetes, mental illness, obesity and other health disparities.

Republicans on the committee said they prefer the proposal be reconsidered in Ways and Means, and after more progress has been made on the state budget.

Casey Smith is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

 
 

Clipped from: https://www.wfyi.org/news/articles/indiana-lawmakers-propose-using-cigarette-tax-for-medicaid

 
 

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Medicaid, education numbers most notable in Gov. Sisolak’s proposed 2021-2023 executive budget

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Nevada Medicaid enrollment grew 18.7% more than expected, and now the bill is coming due.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

CARSON CITY, Nev. (KLAS) — The COVID-19 pandemic devastated Nevada’s economy which relies so heavily on tourism. Gov. Steve Sisolak’s 2021-2023 proposal reveals the financial challenges the state continues to face. Medicaid and education numbers were of the most notable in his plan.

When the state legislature first approved budget cuts, it was for a devastating 12%. That will not be the case, however, due to higher December revenue projections than predicted.

“My Executive Budget for 2021-2023 recognizes the emergency we are
experiencing as a result of the COVID-19 pandemic while also setting forth a clear plan to revitalize, innovate, and grow Nevada’s economy,” Sisolak said in a news release. “I am committed to remaining flexible and working closely with the legislature in this unprecedented and evolving fiscal situation.”

Full 2021-23 executive budget highlightsDownload

Moving into Medicaid, the proposal preview shows that during the current biennium, 2019-2021, the number of enrollees increased by 18.7% more than projected. An additional increase of 2.2% is projected for 2021-2023. These numbers are due in part to job losses.

The budget predicts by the end of the upcoming biennium, one in four Nevadans will be enrolled in Medicaid.

Education is also highlighted, with $331 million in supplemental appropriations designated to K-12. In the current biennium, K-12 and Nevada System of Higher Education (NSHE) state expenditures total $7 billion. Federal aid is expected to be a large part of funding for education.

A state official also noted no school will receive less than they did coming into this budget, which includes revenue from marijuana excise taxes.

Another big item to note is that state employee furloughs that went into effect on January 1, 2021 will not continue in fiscal year 2022-23.

Sisolak says his priorities are still recovering from the ongoing crisis, creating jobs, educating children, promoting justice and equality and protecting citizens’ health.

The proposal lists general fund expenditures $8,688,624,000, a 2% reduction from 2019-2020.

“Ultimately, State revenues, while still severely impacted by the economic crisis, never dropped as low as our worst expectations and this budget reflects that inconsistent, if not positive, ending point,” the news release says.

Sisolak will discuss his proposal during the State of the State address, slated to air at 6 p.m. on Tuesday, Jan. 19. Channel 8 will carry coverage of the speech and it will also be livestreamed on 8NewNow.com as well as the governor’s Facebook page.

 
 

 
 

Clipped from: https://www.8newsnow.com/news/local-news/medicaid-education-numbers-most-notable-in-gov-sisolaks-proposed-2021-2023-executive-budget/

 
 

 
 

 
 

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Medicaid pays $6.6 billion for HCBS for older adults through Section 1915c waivers – News – McKnight’s Senior Living

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HCBS spending decreased 26% in 2018 compared to 2017.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Expenditures for home- and community-based services for Medicaid-eligible older adults and disabled individuals through Section 1915(c) waivers, used by some assisted living providers and others, topped $6.6 billion in 2018, according to a report released this week by the Centers for Medicare & Medicaid Services.

The amount was a 26% drop from the outlay of $8.9 billion in 2017, but it represented 7.1% of overall spending for long-term services and supports in 2018.

Twenty-nine states used Section 1915(c) waivers to cover services in residential care settings in 2016, according to separately reported data from the Medicaid and CHIP Payment and Access Commission.

Other highlights from the Medicaid report:

  • During 2017 and 2018, all states except Arizona, Rhode Island and Vermont operated at least one section 1915(c) waiver program.
  • In 2017, 80 programs in 41 states targeted older or disabled individuals.
  • Older or disabled individuals accounted for the majority of total LTSS spending in 2017 and 2018, representing approximately 55% to 56% of total expenditures in these years.
  • Section 1915(c) waiver programs for older or disabled individuals accounted for approximately 22.1% of total Section 1915(c) expenditures in 2017 and 22.4% in 2018. 
  • In 2017, states spent $56.1 billion for LTSS for older or disabled individuals, with 33.7% of total Medicaid LTSS expenditures devoted to HCBS. In 2018, states spent $50.8 billion, with 32.9% of total LTSS for HCBS.

In a separate report also released this week, CMS said that there were 2.24 participants per 1,000 residents in Section 1915(c) waiver programs for older or disabled individuals in 2016 and 2.23 per 1,000 in 2017. Average waiver expenditures per older or disabled individual were $13,543 in 2016 and increased approximately 10% to $14,949 in 2017.

For section 1915(c) waiver programs serving older or disabled individuals, Minnesota, Illinois, Oregon, Mississippi and Idaho served the greatest number of participants as a proportion of their populations, exceeding six per 1,000 residents in both years.

Other highlights of that report:

  • Forty-one of the 47 states (87%) with Section 1915(c) waiver programs in 2016 and 2017 provided services for older or disabled individuals. Delaware, Florida, Hawaii, New Mexico, Tennessee and Texas did not operate any waiver programs for this LTSS population in 2016.
  • The number of older or disabled waiver program participants per 1,000 state residents in 2016 ranged from less than one (Virginia and Colorado tied for lowest) to almost 10 (Minnesota).
  • Six states served fewer than one older or disabled 1915(c) waiver program participant per 1,000 state residents (Virginia, Colorado, California, Wisconsin, North Dakota and Utah) in 2016. Twenty-five of the 41 states (61%) had higher rates than the U.S. rate (2.2) that year.
  • States in the lowest quartile in 2016, with fewer than 1.5 participants per 1,000 residents, were Virginia, Colorado, California, Wisconsin, North Dakota, Utah, Nevada, Louisiana, North Carolina, New York, Maine and Michigan. Those in the highest quartile (where participants were greater than or equal to 4.5 per 1,000 residents) were Kansas, Connecticut, Pennsylvania, Oklahoma, Washington, Ohio, Idaho, Mississippi, Oregon, Illinois and Minnesota.
  • In 2016, average waiver expenditures per Section 1915(c) waiver program older or disabled participant ranged from $913 in Oregon to $37,321 in Kansas. Washington, which had the second-lowest average expenditure, spent $3,857 more per participant on average than Oregon in 2016 (or a total of $4,770 per older or disabled individual). States in the lowest quartile of average waiver expenditures per waiver program participant were Oregon, Washington, Missouri, Nevada, New York, Iowa, California, Idaho, Alabama, Wyoming and Kentucky.
  • In 2016, 18 of 41 states (44%) had average waiver expenditures greater than the U.S. total average. Among those in the highest quartile of average waiver expenditures were Connecticut, Wisconsin, North Carolina, Michigan, Maine, Louisiana, Minnesota, Colorado, Pennsylvania, Alaska and Kansas.
  • In 2017, seven states served fewer than one older or disabled waiver program participant per 1,000 state residents (Virginia, Colorado, New York, Wisconsin, California, North Dakota and Utah). Similar to 2016, 25 of the 41 states (61%) had higher rates than the U.S. rate in 2017 (2.2).
  • In 2017, average waiver expenditures ranged from a low of $1,061 in Oregon to a high of $53,987 in Kansas in 2017, and 19 of 41 states (46%) had average waiver expenditures greater than the U.S. total average.
  • The states in the lowest quartile of average waiver expenditures per older or disabled individual remained the same in 2017 as in 2016, except for the addition of Illinois and Oklahoma to the lowest quartile in 2017, replacing Kentucky and New York. 
  • The state with the largest decline in average waiver expenditures per older or disabled adult Section 1915(c) waiver program participant between 2016 and 2017 was Washington, which was a 69% decline. Among the states with the largest increases from 2016 to 2017 were Wisconsin (12%), California (14%), Connecticut (15%), Oregon (16%), Pennsylvania (17%), Iowa (18%), Virginia (41%), District of Columbia (44%), Kansas (45%) and New York (700 %).

 
 

Clipped from: https://www.mcknightsseniorliving.com/home/news/medicaid-pays-6-6-billion-for-hcbs-for-older-adults-through-section-1915c-waivers/

 
 

 
 

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Nevada lawmakers told Medicaid will require nearly $12 billion over 2 years

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Medicaid now consumes more than 33% of the Nevada budget, and will spend $2B next year than the year before.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Lawmakers were told Thursday that the total Medicaid budget will consume $11.87 billion over the coming two-year budget cycle, more than a third of the total state budget for the coming two years.

That is an increase of $2.3 billion over the current budget, largely the result of the economic collapse caused by the pandemic.

Medicaid Administrator Suzanne Bierman told members of the Senate Finance and Assembly Ways and Means committees the reason is that the number of people receiving Medicaid coverage increased 128,139 since February 2020. By the end of the coming biennium, officials predict Medicaid will be serving 788,000 Nevadans — more than a quarter of the state population.

The federal government is currently covering 68 percent of that amount through the enhanced federal contribution that historically pays most of Medicaid for the states. Bierman said projections are that the percentage will decrease to 63 or 64 percent in the coming two years.

Officials are hoping the enhanced match percent will be extended but that decision hasn’t yet been made.

The total budget proposed by Gov. Steve Sisolak is $31.4 billion for the coming two years. While Medicaid is the majority of HHS spending, the department’s total budget is fully half the entire state budget at just over $15 billion when its other divisions are added in.

The proposed Medicaid budget does restore the 6 percent Medicaid provider rate reduction enacted by the special legislative session last summer. But Bierman said clearing that reduction through the Centers for Medicare and Medicaid Services takes time and it has not yet been authorized.

She said, however, her division is in contact with hospitals and other providers, advising them that, if and when the reductions are approved, the payments to those providers will be reduced retroactively back to August. Providers, she said, are still getting paid at the pre-reduction rates.

Several lawmakers questioned some of the reductions in other parts of the department.

There will be reductions in other divisions including Child and Family Services, Behavioral Health, Aging and Disability Services and Welfare that officials concede could impact clients in a long list of programs to achieve the necessary budget reductions and extend some waiting lists for different services. Dozens of positions will remain vacant in fiscal 2022 but the proposed budget says most will be restored and filled in 2023 as the state continues to recover.

HHS provides all those social, mental health and health services relied upon by the poor, mentally and physically disabled, the medically frail, children and the elderly including those in all categories in long-term care facilities.

In most cases, department officials say there won’t be a reduction in services in most cases but it may take longer for new clients to get services.

Lawmakers expressed concerns about holding some professional positions vacant in the northern and southern Nevada Mental Health facilities but division officials said they are having extreme difficulties filling those posts because private facilities pay significantly more for doctors, nurses, mental health professionals and other medical and psychiatric professionals.

The legislative briefings continue Friday with overviews of the K-12 and the Nevada System of Higher Education budgets along with the military department budget.

 
 

 
 

Clipped from: https://www.nevadaappeal.com/news/nevada-lawmakers-told-medicaid-will-require-nearly-12-billion-over-2-years/

 
 

 
 

 
 

 
 

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Congress Delays Medicaid DSH Cuts, Makes Targeted Medicaid Policy Changes | Manatt, Phelps & Phillips, LLP – JDSupra

 
 

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The latest COVID relief bill also delays DSH reductions another 4 years (they have been continuously delayed for more than 10 years now).

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

In late December, following several weeks of dynamic negotiations, Congress passed the Consolidated Appropriations Act, 2021 (the Act).1 The massive legislative package includes appropriations through September 30, 2021, $900 billion in supplemental appropriations to address COVID-19, a ban on surprise billing, extensions of expiring health programs and an amalgam of odds-and-ends health policy provisions.

The Act contains several key Medicaid provisions, including a delay in Medicaid Disproportionate Share Hospital (DSH) allotment reductions, new Medicaid supplemental payment reporting requirements for states and codification of non-emergency medical transportation (NEMT) rules, described below.

But despite the vastness of the legislation, key Medicaid priorities were not included. States and other stakeholders have been lobbying Congress to increase the Medicaid enhanced matching rate that applies to medical expenditures for the duration of the public health emergency (PHE) and extend it beyond the duration of the PHE. This COVID-19 relief provision and other Medicaid proposals, such as a proposal to extend Medicaid coverage of postpartum women eligible for Medicaid on the basis of their pregnancy, will be high priorities for Democrats as they work with the incoming Biden administration to secure a fifth round of COVID-19 stimulus funding early this year.

DSH and Supplemental Payment Reporting Requirements

Delay in Medicaid DSH Allotment Reductions. The Act eliminates reductions in Medicaid DSH allotments—that is, the cap on federal match for state Medicaid DSH expenditures—in fiscal year (FY) 2021. It also delays the remaining four years of cuts until FY 2024, as shown in Figure 1 below.

Figure 1. Change in Medicaid DSH Allotment Reductions

  

FY 2021

FY 2022

FY 2023

FY 2024

FY 2025

FY 2026

FY 2027

Previous Reduction Amounts

$4 billion2

$8
billion

$8
billion

$8
billion

$8
billion

Modified Reduction Amounts

$8
billion

$8
billion

$8
billion

$8
billion

 
 

Changes to Calculation of Hospital-Specific DSH Limit. The Act also modifies the maximum amount of Medicaid DSH payments an individual hospital may receive, by redefining what costs are included when calculating hospital-specific DSH limits. States’ DSH payments to individual hospitals may not exceed a hospital’s uncompensated care costs for uninsured patients and Medicaid-enrolled patients. The second component—uncompensated care costs for Medicaid-enrolled patients—is the difference between the costs of services provided and payments received from Medicaid, and is referred to as the Medicaid shortfall.

Department of Health and Human Services (HHS) guidance and rulemaking regarding how hospitals calculate Medicaid shortfall for DSH purposes have been contentious and led to a litany of lawsuits. The issue at hand is how to account for Medicaid enrollees who have another source of coverage, such as Medicare or commercial insurance, when calculating Medicaid shortfall. Although HHS policy has been that states must account for all third-party payments when calculating hospital-specific DSH limits, some hospitals have argued that only Medicaid payments should count against the hospital-specific DSH limit.

Congress adopts an entirely different method for calculating Medicaid shortfall, as recommended by the Medicaid and CHIP Payment and Access Commission (MACPAC). Rather than focus on whether payments for individuals with third-party coverage should count in the hospital-specific DSH limit calculation, the Act simply omits from the calculation all costs for Medicaid-eligible patients with third-party sources of coverage where the third-party source of coverage is the primary payer. As a result, hospitals that treat high volumes of patients with Medicaid and third-party coverage (such as children’s hospitals that treat neonates, who commonly are covered by commercial insurance and Medicaid, or hospitals serving large numbers of dual eligibles) may report less Medicaid shortfall. And because many states use hospitals’ uncompensated care amounts to distribute DSH payments among hospitals, this change is likely to impact the distribution of Medicaid DSH payments among hospitals in certain states.

Supplemental Payment Reporting Requirements. The Act imposes new requirements on states to report any supplemental payments made through their Medicaid programs. By October 1, 2021, HHS must establish a system for states to submit reports on supplemental payment data as a requirement for a State Plan Amendment that would provide for a supplemental payment. In their reports, states will be required to explain, among other elements, (1) how supplemental payments are in keeping with the Social Security Act’s mandate that Medicaid payments be consistent with “efficiency, economy, quality of care, and access,” as well as with the purpose of the supplemental payment; (2) the criteria used to determine which providers qualify for a supplemental payment; (3) the methodology used to distribute the supplemental payments; and (4) the amount of supplemental payments made to each provider.3

Supplemental payments will continue to be a hot-button issue for many federal policymakers and increased transparency through required reporting may fuel future policy changes.

Other Medicaid Provisions

The Act includes several other Medicaid policies including:

  • Codification of NEMT Requirements. The Act requires states to provide NEMT to Medicaid beneficiaries who lack access to regular transportation (including those enrolled in benchmark and benchmark equivalent coverage). Previously, the requirement existed only in regulation, and the Trump administration had threatened to eliminate it. In making NEMT a mandatory benefit through statute, Congress also establishes some guardrails around the new benefit, namely by including NEMT provider requirements and by directing that the Medicaid state plan provide for methods and procedures to prevent unnecessary utilization and to ensure that payments are consistent with efficiency, economy, and quality of care and sufficient to promote access. The Act directs the Government Accountability Office to study NEMT services, with a particular focus on preventing and detecting fraud and abuse. The legislation also requires CMS to report Transformed Medicaid Statistical Information System data to Congress along with recommendations regarding coverage of NEMT to medically necessary services; to convene a series of stakeholder meetings to discuss best practices for improving Medicaid program integrity related to NEMT; and to review and update, as necessary, CMS guidance to states about designing and administering NEMT coverage. Finally, the legislation authorizes states that utilize NEMT brokerage programs, as permitted under Section 1902(a)(70), to consult stakeholders in establishing their programs.
  • Eligibility Restoration for Citizens of Freely Associated States. The Act eliminates the five-year bar on Medicaid eligibility for citizens of the freely associated states (i.e., Micronesia, Marshall Islands, and Palau) who are legally residing in the United States. The legislation restores access to Medicaid for this population after a drafting error in the 1996 Personal Responsibility and Work Opportunity Reconciliation Act excluded them from coverage.
  • Medicaid Extenders. The Act includes funding through FY 2023 for the Money Follows the Person Rebalancing Demonstration, which helps states rebalance utilization and spending toward home- and community-based services (HCBS) rather than institutional care; spousal impoverishment protections, which allow states to disregard individuals’ spousal income and assets when determining eligibility for Medicaid HCBS; and the community mental health services demonstration program, which provides eight states with enhanced funding to improve behavioral health services through Certified Community Behavioral Health Clinics.

1 P.L. 116-260.

2 Beginning in December 2020.

3 The Act indicates in what appears to be a drafting error that each state’s report must provide an assurance that the total payments made to an inpatient hospital provider (but excluding DSH payments) do not exceed the upper payment limit (UPL). However, there is no hospital-specific cap on supplemental payments subject to the UPL; rather, the UPL is assessed at an aggregate level for defined classes of providers (which is established in statute). Congress and/or the Centers for Medicare & Medicaid Services (CMS) may seek to clarify this provision.

 
 

Clipped from: https://www.jdsupra.com/legalnews/congress-delays-medicaid-dsh-cuts-makes-8125523/

 
 

 
 

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Corrado Bill Raising Reimbursement Rates for Medicaid Private Duty Nurses Advances (NJ)

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New Jersey legislation would raise home-based nursing care rates by about 50%.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Bipartisan legislation sponsored by Senator Kristin Corrado that would boost minimum Medicaid reimbursement rates paid for private duty nursing services (PDN) was advanced by the Senate Health, Human Services and Senior Citizens Committee.

PDN services are individualized nursing tasks provided by licensed nurses on a continuous basis in the homes of certain qualifying patients.

“Skilled medical professionals are delivering high-quality, in-home care, but reimbursement rates have failed to keep up with the true cost of services,” said Corrado. “Thousands of residents rely on PDN nurses to improve their health and maintain their standard of living. To ensure a reliable roster of skilled nurses to meet the need, it makes sense to escalate reimbursement rates to a level that more reasonably reflects the work. Reimbursing more money to the providers will allow them to increase pay to the hard-working professionals caring for patients.”

The bill, S-2191, is also sponsored by Senator Loretta Weinberg. It would establish minimum Medicaid reimbursement rates for PDN services provided in the Medicaid fee-for-service delivery system or through a managed care delivery system. The minimum reimbursement for services rendered by a registered professional nurse would increase to not less than $60 per hour, and $48 per hour for a licensed practical nurse (LPN).

Under current State regulations, the maximum Medicaid reimbursement rate is not more than $40 per hour when a registered nurse provides the services, and not more than $28 for an LPN.

The bill will require all providers that receive reimbursement for PDN services under a Medicaid managed care contract to annually report to the State Division of Medical Assistance and Health Services (DMAHS) regarding the use of funds as reimbursement for the healthcare workers.

 

Clipped from: https://www.insidernj.com/press-release/corrado-bill-raising-reimbursement-rates-medicaid-private-duty-nurses-advances/

 
 

 
 

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Virginia May Have to Foot the Bill for Commonwealth Center’s Mistake

MM Curator summary- an incorrect facility type designation lead to $11M in inappropriate payments for a Virginia behavioral health facility.

 
 

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Clipped from: https://vadogwood.com/2020/12/28/virginia-may-have-to-foot-the-bill-for-commonwealth-centers-mistake/

 
 

State Faces Medical Challenges

Group’s improper accreditation could cost Virginia more than $11 million. 

RICHMOND-A mistake by the Commonwealth Center for Children and Adolescents (CCCA) could cost Virginia more than $11 million. CCCA is a 48-bed mental health facility located in Staunton. Last year, the center served 1,079 children. In 2020, that number was near 1,000.
The Virginia Department of Medical Assistance Services (DMAS) labels CCCA as a psychiatric hospital, and it does provide essential psychiatric services to young Virginians. However, the facility is accredited as a behavioral health organization, and has been since 1990. CCCA officials thought such an accreditation was sufficient to bill Medicaid for the services it provided, but recently discovered their error. 

During its last session, the Virginia General Assembly convened a Children’s Inpatient Services Workgroup that uncovered the incongruity. 

The U.S. Department of Health and Human Services requires that all DMAS facilities be “Medicare certified” or accredited as a psychiatric hospital with The Joint Commission. If the facilities, such as CCCA, are not properly accredited, they can’t be enrolled with DMAS. And that’s important because DMAS administers Medicaid services.

Virginia Department of Behavioral Health and Developmental Services (DBHDS) Commissioner Alison Land explained the problem to the Joint Subcommittee on Mental Health Services in the 21st Century during its meeting Dec. 21. 

The department has a plan to make CCCA compliant with federal regulations. If it fails to do so, however, the state government may be liable for bills it improperly processed. Virginia may also be on the hook for between $11 and 20 million in repayments to the federal government. 

 
 

Who Pays for Medicaid?

In describing the accreditation snafu to the subcommittee on Monday, Land called the situation “pretty critical, because those are the only pediatric beds we have.” In other words, CCCA is located in Central Virginia, but it’s a resource for children struggling with their mental health from around the state. It’s the only resource they have. 

Children must be pre-screened for admission to CCCA by a community health board, which decides whether the child is “in crisis” in their current environment. If so, CCCA can provide support for children who have threatened or attempted suicide; displayed aggressive or assaultive behavior or exhibited a need for evaluation and medication management. 

According to DBHDS Chief Public Relations Officer Meghan McGuire, approximately 60% of CCCA patients are Medicaid-eligible upon admission for a temporary detention order. 

These children come from low-income backgrounds. Medicaid is a program funded jointly by the state and federal government to ensure people without sufficient financial means can still access necessary medical care. 

Since 1990, Virginia has been contributing 50% to the cost-share for Medicaid patients at CCCA. The federal government covered the other 50%. Now, since it appears CCCA was not properly accredited as a Medicaid enrollee, legislators are wondering whether the federal government’s half needs to be paid back. 

According to Land, CCCA stopped billing Medicaid on June 2, 2020. The group notified the Centers for Medicare and Medicaid Services of the issue on Dec. 14. DBHDS has a 12-month plan to address the accreditation issue and potential revenue shortfalls. If needed, DMAS will be working with federal regulators to pay back money owed. That money will be due by Dec. 14, 2021.

 
 

Mental Health Services Budget Already Slashed

Luckily, while DBHDS sorts out the paperwork, there will be no interruption of services at CCCA. “We were doing an inpatient, acute level of care at CCCA and continue to do that, so we just need to get this right from a billing perspective,” Land said during Monday’s subcommittee meeting. 

However, CCCA predicts a $2.8 million revenue shortfall from the 12-month suspension in Medicaid billing. The accreditation process itself will also cost nearly $1 million. The facility will spend $718,000 on one-time capital improvements and operational modifications to meet requirements of a psychiatric hospital. It will also hire two staff members at a cost of $170,000 to guide the process. Land said DBHDS will absorb these staffing costs within its existing operating plan. 

All these additional expenses come in a context of funding for mental health services being reduced dramatically in the past year. Multiple departments saw budgets cut due to the pandemic. State Senate Finance Committee Legislative Analyst Mike Tweedy explained these cuts during Monday’s meeting. 

In the governor’s proposed 2021 budget, he removed $442 million from the state’s Department of Health and Human Resources. The General Assembly restored $224 million during the special session, but that still represents a $218 million cut. Specifically, community-based mental health services saw more than $52 million cut, Tweedy said.

Many of the programs that the joint subcommittee listed as top priorities during its last meeting on Dec. 9 were among those facing budget cuts. These included jail diversion programs, pilot programs to discharge geriatric patients with dementia from state mental health hospitals and the STEP-Virginia program.

Future of Deeds Commission in Virginia

The Joint Subcommittee on Mental Health Services in the 21st Century wants to restructure the mental healthcare system in Virginia. It’s been working as part of the Deeds Commission to fulfill that goal for seven years. But next year, the Deeds Commission expires. 

So during the Dec. 21 meeting, legislators on the call also discussed what comes next for the subcommittee. The consensus was that the work needs to continue, but finding funding for staff the subcommittee needs is a primary obstacle. 

“Four years is great, but you know, the work goes on forever. This is not an easy subject, and that’s because it’s complex and the issues constantly have to be considered and reconsidered to get the right approach,” said Sen. Creigh Deeds (D-Charlottesville), for whom the commission is named.

After some discussion, Del. Marcia Price (D-Newport News) made a motion to extend the commission for one year and to revisit the question of sustainable funding in the future. The motion passed. 

Ashley Spinks Dugan is a freelance reporter for Dogwood. You can reach her at info@vadogwood.com.

 
 

 
 

Posted on

As relief stalls, restoring Medicaid for Dubuque’s Marshallese is hanging in the balance

MM Curator summary:

Funding for Medicaid services in the Marshall Islands may resume at higher levels under the latest coronavirus relief bill.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Clipped from: https://kwwl.com/2020/12/23/as-relief-stalls-restoring-medicare-for-dubuques-marshallese-is-hanging-in-the-balance/

DUBUQUE, Iowa. (KWWL) —– It’s Wednesday night, December 23rd, 2020. Two days ago, leadership in the U.S. House and Senate passed a coronavirus relief bill. Americans are waiting for details of long-awaited relief to be cemented.

For the Marshallese community, the wait for relief has lasted over 20 years.

Maitha Jolet is a Marshallese man living in Dubuque. He’s been watching national cable news, wishing for the moment the bill passes.

“[The pandemic] is really hard for the Marshallese community,” said Jolet.

Within the federal COVID-19 relief bill text, a proposal: restoring Medicaid eligibility for the roughly 30,000 migrants from the Marshall Islands who now live in the States.

U.S. troops took control of the Islands from the Axis powers near the end of World War II. U.S. nuclear testing started after the war, forcing migrants out.

Doctors think the testing resulted in staggeringly high rates of pre-existing conditions, including diabetes and heart disease.

This puts Islanders at extremely high risk for COVID-19 complications. Marshallese people make up less than 1% of the county’s population. By summertime, more than 20% of the county’s COVID-19 deaths were among Marshallese.

The community reacted, working fast with outreach groups, physicians and translators to get Marshallese connected to the care they needed, according to Kelly Larson, director for Dubuque’s Human Rights department.

“Pre-existing conditions — things that people from the Marshall Islands experience —- come from us having bombed their islands,” Larson said.

A pact between these Pacific islands and the U.S. (called COFA) gave the Marshallese the freedom to live and work in the U.S. In return, the States could sustain military presence there.

In 1986, the U.S. promised migrants eligbility for Medicaid coverage. Then, when Medicaid was reformed in 1996, the promise was broken.

 
 

Maitha Jolet

Jolet hopes the decades-long struggle will end soon.

“The government still owes people for what has been done,” Jolet said. “One of my friends’ wife, she died from the COVID. And he showed me the bill. The bill is around $114,000.”

“Something is not right. We are in poverty. We don’t have money.”

Two days before Christmas, Jolet waits with all of us for relief to be certain.

 
 

 
 

Posted on

Larry Hogan announces that Medicaid reimbursement increases will go into effect January 1

MM Curator summary:

 
 

Maryland will begin paying BH and LTC providers more January 1 via a rate increase of 3.5% and 4%, respectively.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

 
 

 
 

 
 

Clipped from: https://stateofreform.com/featured/2020/12/60078/

Behavioral health and long-term care Medicaid reimbursement rate increases are set to go into effect on Jan. 1.. They were initially set to go into effect on July 1. The rate increases were passed through legislation in 2019.

Governor Larry Hogan announced the change on Thursday. Reimbursement rates will affect private health care providers who provide services to Marylanders on Medicaid.

 
 

 
 

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The changes to long-term care reimbursement will include nursing facilities, Rare and Expensive Case Management (REM), Development Disabilities Administration (DDA) targeted case management for certain individuals and private duty nursing. The Medicaid reimbursement rate for each will increase by 4 percent.

Behavioral health programs included in the bill will see a 3.5 percent increase in reimbursement. This includes behavioral analysis, adult residential and community-based substance use disorder treatment (SUD), mental health services, behavioral health targeted case management for children and adults, the 1915i community-based services program and therapeutic behavioral services.

The costs associated with the changes will be split between the state’s general funds and federal Medicaid funding.