Posted on

Threat of Medicaid block grants could be axed under Biden

MM Curator summary


The new HHS administration has been ordered to review all policies and waivers that may restrict Medicaid “coverage.”


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.



Long-term care providers who opposed a federal proposal to turn the Medicaid program into a block grant system may get a solid stamp to their leanings under a new move by President Joe Biden. 

Biden on Thursday signed an executive order aimed at strengthening the Medicaid program and Affordable Care Act. Among its actions, the order tasks several agencies, including the  Department of Health and Human Services, to review all existing regulations, orders, guidance and policies related to Medicaid.

It also calls on them to examine “demonstrations and waivers, as well as demonstration and waiver policies, that may reduce coverage under or otherwise undermine Medicaid or the ACA.” 

Medicaid expert Joe Weissfeld noted that order could be the demise of block grants, which were pushed on a national scale by the Trump administration. He told Inside Health Policy the hope is that the order “marks the beginning of the end of work requirements, block grants, and attacks on reproductive health in the Medicaid program.”

A spokesman for the American Health Care Association once called block grants “an existential threat” to long-term care providers.

Last year, the Centers for Medicare & Medicaid Services announced its “Healthy Adult Opportunity” (HAO) program, which allowed participating states to receive a block grant for a specific population enrolled in Medicaid. That initiative was met with backlash from long-term care providers, among many others.CMS in mid-January approved an unprecedented demonstration for Tennessee to convert its Medicaid program into a block grant system.


Clipped from:



Posted on

Key MS House leader offers bill to restructure authority over Division of Medicaid

MM Curator summary

Mississippi wants to take away Medicaid from the Governor.


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.


Rep. Trey Lamar

A new bill from the Mississippi House of Representatives, HB 1013 authored by House Ways and Means Chairman Trey Lamar (R) would establish a Medicaid Commission to oversee the Division of Medicaid currently operated under the instruction of the Governor’s office.

The proposed Commission would be made up of seven members. Three would be appointed by the Governor and four by the Lt. Governor initially, with later appointments made with the advice and consent of the state Senate. The Speaker of the House would have the ability to nominate two of the Lt. Governor’s appointees.

This marks a departure from the current circumstance as Medicaid is part of the executive branch with the Executive Director appointed by and reporting to the Governor.

The bill further clarifies the qualifications of the members and what experience they bring to the table, requiring some be a representative of Medicaid providers or from each Supreme Court or Congressional District.

It will then be up to the Commission of seven to appoint an Executive Director, who is required to either be a physician with administrative experience or a person holding a graduate degree in medical care administration, public health, hospital administration or something similar. The individual can also hold a bachelor’s degree with at least three years experience in management-level administration for policy development for Medicaid.

“House bill 1013 would essentially remove the Division of Medicaid from underneath the Governor and place a seven member board over the Division of Medicaid,” said Representative Lamar.

The language of the bill could cause some confusion when it states that it would “Abolish the Division of Medicaid and transfer the powers, duties, property and Employees of the Division to the Medicaid Commission.”

However, Lamar said this language is a matter of semantics. In laymen’s terms the bill would take the infrastructure and operations of the Division of Medicaid and rename the program under the Medicaid Commission within Mississippi Law. The substantive change would be that the authority would be moved from the Governor to the commission.

Rep. Lamar said with this change you would have seven sets of eyes over what has become a $6 billion industry. Medicaid is the largest budget in the state. There is roughly $1 billion of state dollars that go into the program and $5 billion of federal. While much of how those dollars is dictated by the federal government, the new board would also have input.

He said this commission would function similarly to the Department of Education, Institutions of Higher Learning, and Department of Health.

This would go into effect by July 1, 2021.

The appointment of the Medicaid Executive Director is at this time reserved for the Governor.

Currently, Medicaid is led by Executive Director Drew Snyder who was first appointed to the position by Governor Phil Bryant. The team also consists of a Deputy Executive Director, with several offices that work in conjunction with each other to accomplish regular work.

Medicaid serves roughly 720,000 Mississippians.

Mississippi’s Division of Medicaid was established in 1969 by the Mississippi Legislature.  It is housed within the Office of the Governor and is designated by state statute as the single state agency responsible for administering Medicaid. It currently employs over 1,300 people with 30 regional offices and over 80 outstations.

Lamar said this bill would not impact those jobs, but simply remove the division from under the Governor’s purview.

While tensions have been high in the past concerning Medicaid spending, the Division of Medicaid has made great strides fiscally since Snyder took over. For FY 2022, Medicaid did not request the typical $50 million deficit that the Legislature has become accustomed to in recent years.

Prior to the COVID-19 pandemic, the Division had roughly $40 million in special funds due to safe budgeting for the last few years. They have also continued to expand telemedicine opportunities, a program that was being prepped before the necessity of at home doctor visits due to social distancing.

In late 2020 Medicaid hearings, even providers complimented Snyder on the job he was doing to re-vamp the program, applauding his “open door” policy with everyone. Lamar echoed many of these sentiments, saying Snyder has done a great job over the Division.

The current concerns over Medicaid in Mississippi seem to revolve around Managed Care, the five percent reimbursement for providers and the difficult credentialing process. Many providers told lawmakers in October that they would like to see a more streamlined credentialing process.

Over the years there have been unsuccessful attempts by Legislative Democrats to expand Medicaid in Mississippi.  Republicans have fought the measure believing that the long term impact of substantially higher Medicaid enrollments would have a devastating effect on the state’s budget.  Many lawmakers believe that Snyder and his team have demonstrated Medicaid expansion is not necessary to run an efficient and effective program.

Lamar said a change like this is not unprecedented. It was only in the mid-80’s that the authority over the Division of Medicaid was handed over to the Governor.

“This would just be returning the state of Mississippi back to the way we use to do it and I think it makes sense,” said Lamar.


Clipped from:



Posted on

Senators negotiate first steps in funding Missouri’s mandated Medicaid expansion

MM Curator summary


Lawmakers are looking for ideas on how to pay for what the voters decided.


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.


Republican state Sen. Dan Hegeman, of Missouri, discusses voter approval of a ballot measure he sponsored during an interview on Thursday, Nov. 5, 2020, in his state Capitol office in Jefferson City, Mo. 

AP Photo/David A. Lieb

(The Center Square) — Missouri voters in August approved a constitutional amendment that expanded Medicaid despite fierce opposition by the Legislature’s GOP majority and Republican Gov. Mike Parson. 

Now, those same lawmakers and governor must execute the will of the people when they approved Amendment 2 by a 53-percent margin, meaning they must find a way to fund healthcare coverage for an additional 200,000 people now potentially Medicaid eligible this session, which began Jan. 6 and ends May 31.

Amendment 2 expands Medicaid eligibility under the 2010 Affordable Care Act (ACA), which provides a higher federal funding share for states that extend Medicaid to adults earning up to 138 percent of the federal poverty level.

State Auditor Nicole Galloway, the Democratic gubernatorial candidate defeated by Parson Nov. 5, estimates expanding Medicaid under the ACA could cost the state at least $200 million or save it as much as $1 billion annually by 2026.

But it will require upfront investment and some Republicans vow not to fund it. A more common goal among Republicans is to restrict its growth by imposing work requirements and creating a stringent enrollment-verification process.

“Amendment 2 will be a knockout blow to the state budget as more services will be cut or eliminated to pay for the healthcare of able-bodied adults,” state House Budget Chairman Rep. Cody Smith, R-Carthage, said before the session began.

Parson and legislative leaders, however, say they will push for Medicaid expansion as approved by voters less than six months ago under Amendment 2.

As part of that effort, the Senate Appropriations Committee got its first look at a bill that would extend the state’s federal match program — the Federal Reimbursement Allowance (FRA) — for Medicaid payments.

Senate Bill 1, filed by committee chair Sen. Dan Hegeman, R-Cosby, would extend the FRA for another year as state lawmakers have done every year since 2005.

The state’s FRA program was established as voluntary before being enacted into law as a provider tax in 1992. Hospitals contribute to the FRA and Missouri’s Medicaid program — MO HealthNet — uses the funds to earn higher returns in federal matching dollars. 

The FRA has grown to surpass all but two general revenue sources in the state budget. Nearly 85 percent of all payments to Missouri hospitals through MO HealthNet are covered by the FRA.

SB 1 would continue maximizing federal matching dollars and reducing the burden on state general revenues, Hegeman told the panel Wednesday.

“As most of you know, the FRA is how we fund over $1 billion of our state Medicaid program, and it is vitally important to our state budget,” Hegeman said. 

Among extensions is continuing to allow the Missouri Department of Health (DOH) to collect approximately $1.28 billion in Hospital Tax in Fiscal Year 2022 (FY22), which begins July 1, and in FY23. Hospital tax revenues will, in turn, draw approximately $2.391 billion in federal funds each year to the state.

Missouri Hospital Association (MHA) Executive Director Rob Monsees told the panel that adding 200,000 to the state’s Medicaid program will generate “a substantial amount of new FRA dollars. Some of those dollars can help provide an offset to the cost of expansion.”

If SB 1 fails, he said, it “would radically destabilize that funding mechanism.”

Sen. Bill Eigel, R-Weldon Spring, wondered why the FRA is approved each year with little debate when it is one the largest troughs of public money in the state budget.

“The FRA is a mechanism, which (funds) the largest government program we have, sees no reform,” he said. “We have thrown money at a broken program with no meaningful reform whatsoever.”

Clipped from:



Posted on

Outgoing HHS Secretary Files Supreme Court Brief Supporting Medicaid Work Requirements


MM Curator summary


Azar filed a brief on his way out, reiterating the argument that applying enrollment controls helps preserve limited resources in Medicaid and thus facilitates the goals of the program.


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.


[author: Regina DeSantis]

On December 4, 2020, the Supreme Court agreed to hear arguments to decide the legality of the Department of Health and Human Services’ (HHS’s) authorization for states to incorporate work requirements into their Medicaid programs.  The consolidated cases, Azar v. Gresham and Arkansas v. Gresham, challenge the legality of work requirements in two states’ Medicaid programs—Arkansas and New Hampshire.  On January 19, 2021, the last full day of the Trump Administration, outgoing HHS Secretary Alex Azar filed HHS’ main Supreme Court brief supporting the states’ work requirements.

We first wrote about the Centers for Medicare & Medicaid Services’ (CMS’s) policy allowing states to require some Medicaid recipients to hold employment or participate in community engagement activities back in 2018.  Since then, we also reported on how a federal district court twice invalidated those requirements.  Last year, we reported that a three-judge panel of the D.C. Circuit Court of Appeals struck down Arkansas’ work requirements [1].  The D.C. Circuit reasoned that a waiver can be approved if it “promotes the objectives” of Medicaid, and Medicaid’s principal “objective” is to provide health coverage to low-income people.  By approving Arkansas’ waiver, the court determined that HHS did not assess how requiring Medicaid beneficiaries to work (as a condition for receiving health coverage) promoted the program’s main objective.

In the Supreme Court brief, Azar and the petitioners argue that HHS was acting within its authority by approving the waivers, explaining that 42 U.S.C. 1315 allows the HHS Secretary to approve experimental state initiatives if the Secretary determines they are “likely to assist in promoting the objectives” of Medicaid.  Further, Azar argued, the statute allows the HHS Secretary to “waive compliance with any of the [state Medicaid plan’s] requirements” under §1396a if the Secretary determines doing so is “necessary to enable” the experiment.  The brief reiterates the argument that requiring Medicaid recipients to work as a condition of coverage helps stretch limited state resources by giving beneficiaries opportunities to seek commercial health coverage (e.g., through an employer).  “Conserving scarce resources enables the States to expand or maintain coverage, and thus promotes the Medicaid statute’s undisputed objective of providing health coverage to needy persons,” the brief explains.

The Supreme Court might not hear arguments before the early spring, and it is possible the new Biden Administration could rescind approval for the Medicaid work requirements before then.  On the other hand, the Biden Administration may want to allow the case to go forward in order to prevent an adverse decision that would hinder the flexibility that the Secretary of HHS has to issue Medicaid waivers.  A decision strictly interpreting the Secretary’s waiver authority may limit the ability of the Biden Administration to use waiver authority to implement its own healthcare priorities.

[1] Later in 2020, the D.C. Circuit struck down New Hampshire’s work requirements.



Clipped from:






Posted on

WI Submits Medicaid Demonstration Waiver, Health Savings Account Program

MM Curator summary


Wisconsin has asked CMS to put all of the premium payments made by Medicaid members into an HSA regardless of whether they achieve healthy behavior requirements.


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 Medicaid demonstration waiver, submitted to CMS in late December, seeks to leverage health savings accounts for childless Medicaid enrollees.


Source: Getty Images


By Hannah Nelson

January 21, 2021 – The Wisconsin Department of Health Services (DHS) has submitted an amendment to their section 1115 Medicaid demonstration waiver “BadgerCare Reform” for Centers for Medicare & Medicaid Services (CMS) approval to leverage a Medicaid health savings account (HSA) program for childless adults in the state.

Submitted on December 21, the amendment proposes that the full amount paid in premiums by individuals within the Medicaid/BadgerCare Plus program be deposited into a Medicaid HSA. Individuals could use then use the funds from their Medicaid HSA toward health expenses upon disenrollment from the BadgerCare Plus program.

This amendment would apply to enrollees aged 19 to 64 with incomes between 50-100 percent of the federal poverty line. Additionally, qualified members must not be pregnant or have dependent children under the age of 19 living in their home.

The federal public comment period will span from January 7, 2021 to February 6, 2021.

Under Wisconsin’s existing approved waiver, enrollees who fulfill healthy behavior incentives are charged lower premiums. However, this amendment would deposit additional funds to these enrollees’ HSAs so that regardless of whether an enrollee fulfills the healthy behavior incentives or not, the same amount of money would be deposited.

HSAs are considered an experimental approach in Medicaid programs. According to a 2018 Health Affairs study from Harvard T.H. Chan School of Public Health, there may be unintended consequences of an HSA program since these accounts are not commonly used. For instance, enrollees could be confused by the HSA program which may dissuade some people from enrolling.

“There’s been a lot of recent research showing that expanding Medicaid leads to improved access to care and better quality of care—which suggests that any expansion will be better for public health than not expanding. But our findings suggest that some of the benefits of expanding Medicaid may be at least partially compromised by some of the current innovations in use,” said Benjamin Sommers, associate professor of health policy and economics at Harvard T.H. Chan School and lead author of the study.

Under the Trump Administration, which prioritized increased state flexibility for Medicaid programs, some states have experimented with new approaches.

The researchers assessed views about new Medicaid policies approved by CMS in Ohio, Indiana, and Kansas through a telephone survey of 2,739 low-income adults. The survey gathered responses related to health savings accounts, financial well-being, access to care, experiences with the Affordable Care Act (ACA), work requirements, and private vs. public insurance coverage.

In 2015, Medicaid coverage was expanded in Indiana, but enrollees are required to pay premiums and contribute to HSAs, similar to what Wisconsin is proposing in their Medicaid demonstration waiver. On the other hand, Ohio expanded Medicaid coverage without premiums and with minimal cost-sharing.

The researchers found that cost-related barriers to care were more prevalent in Indiana, where enrollees were required to contribute to HSAs.

According to the survey respondents from Indiana, the health savings accounts caused confusion. Nearly 40 percent of those interviewed said they had never heard of the required accounts, and only 36 percent made regular required payments. This means that two-thirds of beneficiaries were at risk of losing benefits or coverage.

“For both work requirements and health savings accounts, the policies may operate as intended for modest numbers of Medicaid beneficiaries who understand or react to the incentives. But there’s a real risk that even greater numbers of low-income adults will be adversely affected because they don’t understand the new policies, can’t afford them, or get tied up in administrative complexity. For these reasons, it’s critical that there be ongoing independent monitoring of these approaches,” Sommers said.


Clipped from:




Posted on

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


MM Curator summary

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





Modified Reduction Amounts






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:



Posted on

CMS won’t add new Medicaid accountability rule

MM Curator summary

Industry opposition has officially killed the last effort to reform entrenched Medicaid financing schemes.


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.


CMS has officially withdrawn its proposed Medicaid fiscal accountability rule.

CMS proposed the rule in November 2018. It aimed to promote transparency and fiscal integrity by establishing new reporting requirements for state supplemental payments to Medicaid providers.

But last August, some hospital associations called on CMS to withdraw the rule, arguing that it could exacerbate the challenges U.S. hospitals.

The hospital associations, including America’s Essential Hospitals and the American Health Care Association, argued that finalizing the rule would introduce “unprecedented restrictions on states’ ability to fund their share of the Medicaid program” at a time when hospitals are facing challenges and an uncertain future due to the COVID-19 pandemic. 

CMS Administrator Seema Verma tweeted last September that the agency would move to scrap the rule after listening to concerns from hospitals and other stakeholders.

The action taken by CMS officially withdraws the rule. The document officially withdrawing it is scheduled to be published in the Federal Register Jan. 19. 

“Today I took action to withdraw the proposed Medicaid fiscal accountability rule from the federal register,” Ms. Verma tweeted. “While we support its intent, further work is needed to ensure accountability for states while protecting critical safety-net care for vulnerable patients.” 

Clipped from:



Posted on

Colorado public option bill sponsor says the proposal will be reintroduced this year

MM Curator summary

The Colorado public option is back on the table, with perhaps a few changes since we last saw it in March 2020.


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 Colorado Senate sponsor of last year’s public option health insurance proposal said that she definitely plans to resurrect the idea in the soon-to-convene 2021 legislative session, though she acknowledged that details could be different from the derailed 2020 effort.

Sen. Kerry Donovan, D-Vail, seemed to quell speculation that Democrats might be moving on from the idea when she said during the Denver Metro Chamber of Commerce legislative preview event Tuesday that she and sponsoring Rep. Dylan Roberts, R-Avon, are “in the initial phases” of drafting a new bill. And while Donovan, the Senate president pro tempore, didn’t offer details as to how this new proposal would be shaped, she did say that it “will look different than last year’s bill.”

The 2020 proposal would have required any insurer offering private plans within a county also to offer a public option plan that kept premiums below market rates by reimbursing health care providers at 155% of Medicaid rates — a level much lower than many now charge. Colorado Hospital Association leaders opposed the bill, saying that it would weaken the state health care system by taking money out of it, and business leaders were concerned that it would shift the cost of care to people in private employer-provided plans.

That bill received approval from its first legislative committee the week before the state declared the coronavirus pandemic to be a public health emergency, and it was shelved after the Legislature adjourned for more than two months, as officials sought to concentrate on limited Covid-focused bills upon their return. After the 2020 session, several Democratic leaders implied that they would need to rethink whether it was part of future reform efforts, but Donovan and House Speaker Alec Garnett both seemed to say Tuesday that it will be part of a renewed focus on ways to lower health care costs for more Coloradans.

Sen. Kerry Donovan, Rep. Dylan Roberts and Rep. Chris Kennedy present the Colorado Option bill in 2020.

Jensen Werley

Clipped from:



Posted on

CMS Releases Guidance on Funding for SDH Programs

MM Curator summary


The 51-page new guidance layouts several details CMS will use to assess whether state programs are complying with Medicaid rules re: addressing non-healthcare costs.


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:

Posted on

Appeals Court Upholds Trump Rule Requiring Hospitals to Show Prices Upfront

MM Curator summary

Despite industry opposition, hospitals will now have to report the prices they accept from insurers as payment.

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 U.S. Court of Appeals for the D.C. Circuit on Tuesday upheld a Trump administration rule that requires hospitals to disclose the prices they negotiate with insurers for a range of health tests and procedures.

The 2-0 decision by the appeals court means that American patients will have access to hospital pricing information starting on Jan. 1, 2021, helping them find the lowest costs and the highest quality of care when deciding on treatment.

“This transformative hospital price transparency rule has been fought at every step by the swamp and defenders of the status quo,” White House Press Secretary Kayleigh McEnany said in a statement.

“Today’s ruling should reassure the American people that President Donald J. Trump refuses to bow to the influence of special interests who would prefer to keep patients in the dark. This initiative is just one in a series of rules that will bring unprecedented price transparency to all elements of healthcare,” she added.

The Centers for Medicare & Medicaid Services (CMS) issued the transparency rules in November 2019, calling on hospitals to make public the often-secret rates that they negotiate with insurance companies for all services, drugs, and supplies. The Department of Health and Human Services (HHS) said in a statement at the time that hospitals must make public all standard hospital charges in a single data file.

The moves came as a result of Trump’s signing of an executive order in June 2019 over price transparency.

Hospitals, insurer organizations, and advocacy groups objected to the rules, and said that the Trump administration did not have authority to require the disclosures, which they held to be trade secrets. The hospitals also disputed that the policy would benefit consumers and lead to lower costs, arguing that compliance would instead be too burdensome and interfere with their care for patients.

The finalization of the rule prompted the American Hospital Association (AHA) to file a legal challenge. They argued that the White House didn’t have the authority to make the rule and in doing so had violated the First Amendment in its creation, and had acted in an “arbitrary and capricious” manner.

A federal judge ruled on June 23 that the Trump administration rules were legal. But the groups appealed on Oct. 15.

In the appeal, the groups said that the price transparency rules would pose a “herculean” and costly task of compiling health care costs, while reducing competition and causing confusion about patients’ out-of-pocket expenses.

Circuit Judge David Tatel, however, said concerns about the burdens “miss the mark,” and pointed to HHS Secretary Alex Azar’s findings that greater disclosures would benefit the “vast majority” of consumers and likely result in lower—not higher—prices.

“The Secretary weighed the rule’s costs and benefits and made a reasonable judgment that the benefits of easing the burden for consumers justified the added burdens imposed on hospitals,” Tatel wrote.

The latest decision upholds the June 23 ruling by U.S. District Judge Carl Nichols.

Melinda Hatton, the AHA’s general counsel, said the group was disappointed and hopes that a potential Biden administration would revise the rule and exercise “enforcement discretion” until the CCP (Chinese Communist Party) virus pandemic runs its course.

On Twitter, Azar praised the decision. “Big win for American patients today. The DC Circuit ruling is another major victory for President Trump’s transformative healthcare agenda. Starting January 1, Americans will have access to the actual prices paid for the most common hospital services,” he wrote.

The U.S. Chamber of Commerce supported the hospital groups, saying the rule could cause hospitals to demand higher prices for their services if they saw other hospitals charging more.

The case is American Hospital Association et al v. Azar, D.C. Circuit Court of Appeals, No. 20-5193.

Janita Kan and Reuters contributed to this report.

Clipped from: