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Medicaid DSH cuts nixed from Build Back Better Act

 
 

MM Curator summary

[ MM Curator Summary]: Dems were unable to punish hospitals in non-expansion states with DSH cuts.

 
 

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.

 
 

After receiving pushback from hospitals, the Senate scrapped plans to cut Medicaid disproportionate share hospital payments in 12 states from its version of President Joe Biden’s $1.7 trillion social spending package.

Under the House-passed Build Back Better Act, the 12 states that haven’t expanded their Medicaid programs faced a 12.5 percent reduction in Medicaid DSH allotments. The AHA said the cuts could be as much as $4.7 billion over 10 years. Under the House version, if a state chooses to discontinue its Medicaid expansion, its DSH allotments would be reduced as well.  

In early November, eight healthcare organizations argued that reductions in DSH allotments would be an “additional hardship for hospitals” in states that didn’t expand Medicaid and would “make it difficult for hospitals in those states to continue to serve their patients and their communities.”

Although the DSH cuts were scrapped, the Senate version keeps a provision to limit federal payments in states that didn’t expand Medicaid for a separate uncompensated care pool.

 
 

Clipped from: https://www.beckershospitalreview.com/finance/medicaid-dsh-cuts-nixed-from-build-back-better-act.html

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Biden Administration To Expand Vaccine Education For Medicare, Medicaid As Omicron Hits U.S.

MM Curator summary

[ MM Curator Summary]: CMS Administrator Lasure thinks members don’t know enough about their vaccine options.

 
 

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.

 
 

 
 

Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure.

Forbes

Chiquita Brooks-LaSure, who leads the federal Centers for Medicare and Medicaid Services (CMS), says her office will double down on vaccine education for seniors and low-income Americans as the country continues to battle the Covid-19 pandemic and the latest omicron variant. 

“We are really trying to make sure that everyone knows what is available to them,” Brooks-LaSure told the Forbes Healthcare Summit on Thursday. Her remarks coincided with the Biden-Harris Administration announcing a series of new actions to combat the pandemic, including tightened travel rules and requiring insurers to reimburse at-home Covid testing, a day after the first U.S. omicron case was detected in California.

While more time is needed to study and determine whether this new variant poses greater risk of severe disease or death, the Biden Administration’s position in recent weeks has been to encourage all adults to get a Covid-19 vaccine booster shot, especially for older or vulnerable people. 

Brooks-LaSure said she will be sending a letter to the 63 million people in the Medicare program “telling them to get boosted” and alerting them to where Covid-19 booster shots are available within their communities. This is the first time in four years that the agency has sent out a mass letter to all Medicare recipients, according to the White House. The CDC reports that 99.9% of percent of Americans aged 65 and over have gotten at least one dose, while 86.3% are fully vaccinated. Around 21 million seniors, or 44.7% of the 65 and older population, have received a booster shot. 

CMS will also focus on outreach to low-income Americans in the Medicaid program by providing federal matching funds and requiring states to reimburse Covid-19 vaccine counseling sessions “in which healthcare providers talk to families about the importance of kids’ vaccination” for the duration of the pandemic. 

“We’re requiring states to pay for vaccine education,” said Brooks-LaSure. One of the main reasons is trusted relationships with healthcare providers, be it doctors, nurses or community health workers, are one of the ways to move the needle when it comes to vaccine hesitancy. This also means reaching people where they live and work. “Whether it’s through churches, through [federally qualified health centers], through so many of the organizations that people trust, they want to hear from their friends and their neighbors about why they got vaccinated,” she said. 

“This effort of education is something that I hope we take with us,” Brooks-LaSure added. “Developing these relationships between providers and people in their communities is something that we can use to strengthen our healthcare system more broadly.”

 
 

Clipped from: https://www.forbes.com/sites/katiejennings/2021/12/02/biden-administration-to-expand-vaccine-education-for-medicare-medicaid-as-omicron-hits-us/?sh=32baff475b8d

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Medicaid contractor stops trying to recoup payments from mental health providers

MM Curator summary

[ MM Curator Summary]: Colorado will no longer recoup payments from providers who say they submitted them correctly in the first place.

 
 

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 announcement came two days after The Colorado Sun reported that mental health providers would no longer accept Medicaid patients because of the debacle.

 
 

 
 

The logo for the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state, on a sign in the department’s offices on Feb. 26, 2019. (John Ingold, The Colorado Sun)

Colorado mental health therapists will no longer have to pay back money they received for seeing Medicaid patients after a state contractor that had threatened to “recoup” the payments reversed course Wednesday. 

Mental health counselors at practices in eight Front Range counties received emails from Colorado Community Health Alliance — the contractor that processes their Medicaid claims — notifying them it was “stopping the current recoupment project.” This comes after the health alliance sent letters asking therapists to return thousands of dollars in payments they had already received, a financial debacle blamed on a software error.  

This week’s reversal by the state contractor came after reports in The Colorado Sun and 9News exposing the claims fiasco. Several mental health counselors and therapists working in small group practices told The Sun they would no longer accept Medicaid patients because of the paperwork headache and the latest fight with the state contractor. 

TODAY’S UNDERWRITER

For some, the reversal is too little, too late.

Carla D’Agostino-Vigil, one of the only specialists in obsessive-compulsive disorder who accepted Medicaid in Colorado, was among those who decided she would no longer see Medicaid patients because of the latest hassle. While she welcomed the health alliance’s announcement, D’Agostino-Vigil said Wednesday she had no plans to change her mind about accepting Medicaid clients. 

“I am cautiously optimistic this will result in a timely correction,” said D’Agostino-Vigil, who runs Ignite Counseling in Westminster. 

The licensed counselor already was suffering from a 20% rate cut for Medicaid patients that the health alliance put in place in January 2020. And D’Agostino-Vigil is still in the midst of an unrelated dispute with the health alliance over claims that were denied due to an alliance software issue, she said. 

Therapists who already paid a recoupment fee to the health alliance will get a refund, the alliance said.

The recoupment letters, copies of which were reviewed by The Sun, told providers they had 60 days to return the money or Colorado Community Health Alliance could withhold future payments. The health alliance, which is owned by insurance giant Anthem, is essentially the middle man between the providers and the state Medicaid department and is responsible for processing claims and dispensing payment. 

The therapists were not overpaid — they were asked to return money for services they provided during prior years because claims were missing a provider identification number. 

 
 

 

Mental health professionals said they included the provider identification number on their claims. It was the computer system used by the health alliance that scrubbed the identification numbers — required by state and federal law — from its claims. The contractor realized the mistake in July 2019 and fixed its software system in October 2020, said spokeswoman Colleen Daywalt. Mental health providers have been warned of the issue via email and in meetings since March 2020, but many said they were caught off guard when they received the recoupment notifications requesting payment this fall. 

Colorado Community Health Alliance is the payer for 1,175 behavioral health providers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties. About 200 providers who did not resubmit claims received the recoupment letters, which asked for amounts up to $18,000.

The health alliance said Wednesday that it was taking back the recoupment action “in light of recent feedback from behavioral health practices.” 

Instead of requiring therapists to pay up or resubmit claims, the health alliance is making plans to contact each counseling practice to retrieve the needed provider identification numbers, Daywalt said in an email to The Sun. “We plan to work with providers to collect the data to ensure we have proper documentation without requiring the providers to resubmit the claims,” she said. 

TODAY’S UNDERWRITER

She said the alliance is “dedicated to ensuring access” to mental health care in Colorado, noting there are now 3,514 practitioners in the network.

The billing issue comes as Colorado has tried to expand the number of mental health professionals who accept Medicaid, a government insurance program for low-income residents and those with disabilities. The Colorado Department of Health Care Policy and Financing, which runs the Medicaid program and contracts with the health alliance to disperse payments to the providers, said the number of providers statewide taking Medicaid reached 8,371 in June, compared with 6,029 in April 2020.

The department said Wednesday that it was pleased the state and its contractor “identified an easier way” to collect the required claim information. The process “was never intended to be about recouping payments from providers but rather to have accurate and compliant claims,” department spokesman Marc Williams said in an email to The Sun.

“While 84% of providers were able to comply with the claim data request during the 20-plus months of time provided, we understand that this issue presented a heavier administrative burden for the remainder of the providers.”

Williams added that the resolution “enables all our behavioral health providers to continue to deliver care to our Medicaid members — especially during this time of increased demand for such services due to the impacts of COVID-19.”

TODAY’S UNDERWRITER

Christia Young, a Brighton therapist who received a recoupment notice for $7,200, was skeptical that the announcement meant things with the alliance would improve. 

“It’s good news, but I already paid an attorney, drafted a letter, and spent a large chunk of my time faxing them all of the corrected claims,” said Young, who sees patients with chronic suicidal thoughts at Badass Therapy. “It also doesn’t fix all of the other issues providers have with them. I already had so many issues with billing prior to this.”

Young has stopped taking Medicaid patients through the health alliance. 

“My Medicaid clients are some of my favorites to work with,” she said. “It has been heartbreaking to have to prioritize my mental health and financial well-being because it is so difficult to work with Medicaid.” 

 
 

Clipped from: https://coloradosun.com/2021/12/02/medicaid-mental-health-claims-2/

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IL- Rate Increases to the Medicaid Fee Schedule (Dental)

MM Curator summary

[ MM Curator Summary]: IL dentists will get $10M in Medicaid payments next 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.

 
 

 
 

The Illinois State Dental Society (ISDS) advocated this past session to increase rates for dental care in the Illinois Medicaid program. ISDS was successful in the pursuit of the increased rates to the extent that $10 million was added to the budget for the rate increases.  

The Illinois Department of Healthcare and Family Services (DHFS) just announced these rate increases to the Medicaid Fee Schedule for select dental services that ISDS helped negotiate and are scheduled to begin January 1, 2022. The specific codes with rate increases can be found by clicking here. DHFS has highlighted the increased codes in yellow.

Highlighted in these new increases are restorative services, dentures, extractions, and anesthesia services.  To review the codes and see if participation in the Medicaid program would work in your practice, please click here to see the full Medicaid fee schedule.

To enroll and learn more about being a provider in the Medicaid program, please contact DHFS by calling 1-877-782-5565 (select option #1) or by going online to https://www2.illinois.gov/hfs/impact/Pages/ContactIMPACT.aspx.

We want to thank our members again for their persistent efforts in contacting and educating their legislators on the need for this additional funding. While we are very excited for this legislative win, our work is not done. We will continue, as always, to advocate for you, the members.

 
 

Clipped from: https://www.isds.org/news-details/2021/12/01/alert!-rate-increases-to-the-medicaid-fee-schedule

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State pushes back timeline for Medicaid bonuses; group home providers eye long-term solutions

MM Curator summary

[ MM Curator Summary]: Florida is using an application process to distribute the recently approved federal funds for HCBS services, and providers want the money right 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.

 
 

Florida may be getting a boost in money intended to help people with intellectual and developmental disabilities, but it doesn’t look like those additional federal Medicaid funds are going to be handed out soon.

And that’s a conundrum for a system that already is under strain.

The hopes were this “bonus money” could be distributed by the end of the year, but the administration of Gov. Ron DeSantis has pushed back the timeline to distribute the funds with the goal of having the money distributed by “winter 2022.”

Given the federal government approved the state’s plan to bolster home- and community-based services in September, the timeline has some wondering why it could take five months to see the money.

“It can’t come fast enough,” Sen. Aaron Bean, chairman of the health care spending panel, told Florida Politics Monday.

 
 

Agency for Health Care Administration Chief of Staff Cody Farrill told members of the Senate Appropriations Subcommittee on Health and Human Services earlier this month that the agency’s goal is to post employer and employee bonus applications on its website in December.

Of the $1.2 billion in additional federal money coming Florida’s way, the state is setting aside $403 million in one-time stipends for employers to apply for and another $266.6 million for their employees, Farrill said.

He said the AHCA is developing potential distribution methodologies but won’t finalize any until it determines how many employers applied for the stipends. Provider caseload will also be taken into consideration in the distribution formulas, but Farrill in his testimony offered few other details.

“We understand we want to get this out the door as quickly as possible, but also want to balance the fact that we make sure these (payments) are going to the right providers that are eligible,” Farrill said.

Philadelphia transplant Tamika Walker moved to Florida in 2014 to help care for her husband’s 100-year-old grandmother. Walker initially was hired by United Community Options of South Florida seven years ago at $10 an hour. After getting promoted, she now earns $11.30 an hour, well below the $17 hourly wage she was paid in Philadelphia.

 
 

Though she hasn’t gotten a pay raise since her promotion in 2015, Walker heaps praise on her employer. She told Florida Politics that while she’s able to “make do” because of her husband’s salary, she works with others who are financially struggling. Some staff, she says, can’t afford their own cars. They rely on Uber and Lyft to get to work.

“If they want to do it, just do it. Don’t tell us about it. Just do it.” Walker said of the pay raises. “We are trying to come out of a pandemic. We had to go to work every day and put our lives on the line.”

The DeSantis administration moved over the summer to take advantage of a 10% bump in federal Medicaid dollars available under the American Rescue Plan Act of 2021. Every state moved to tap into the increased federal funds, Farrill said.

Most Florida Medicaid patients who receive home- and community-based services either are enrolled in the Medicaid managed long-term care program or the Medicaid iBudget program. The former is for frail and elderly individuals who qualify for nursing home placement but choose to receive assistance with daily living activities, such as eating and dressing, that enable them to continue to live in their homes or another non-institutional setting.

Similarly, the Medicaid iBudget program allows adults with intellectual and developmental disabilities to tap into the home- and community-based services they require to continue living outside of an institution and in their family home or a group home.

Lawmakers in recent years have committed additional funding to serve more clients and whittle down what has been a lengthy waitlist. For the iBudget program to work, however, there must be a provider network willing to serve the clients. And there are worries that Florida’s network is beginning to erode.

The Agency for Persons with Disabilities reports that between March 1 and Sept. 30, 99 group homes closed, requiring relocation of 271 clients. But during that same time span, the state reports, 108 new group homes were licensed. The APD data doesn’t indicate how many clients the newly licensed homes serve.

The Florida Association of Rehabilitation Facilities data on closures tracks APD’s but FARF did not have information on new facilities opening.

FARF President and CEO Tyler Sununu said many of the group homes that remain open have stopped accepting new clients or have limited the services they provide. Sununu surveyed his group home members this summer and found that on average there has been a 41% turnover rate at the facilities.

The survey also showed that 23% of the positions at group homes are vacant, Sununu said.

Sununu attributes the 100 closures group home closures to the trifecta of the COVID-19 pandemic, a tight labor force, and historically low Medicaid reimbursement rates

“We were really hoping the money would be available for the holidays and it looks like it’s not going to be. And that’s unfortunate,” he said. “But we are really happy the money will be coming.”

Sununu, though, has his eye on the bigger picture: getting lawmakers to increase by $147.5 million the amount Medicaid pays providers. Of that increase, about $93 million would be funded with state general revenue. The remainder comes from matching federal dollars. The increase, he maintains, would allow group homes to pay direct care workers an average $14 an hour, up from the current average wage of $11 an hour.

Bean has either helped craft or has taken the lead on developing the state’s Medicaid spending plans during most of his lengthy legislative career. He says he is awaiting the results of a state-contracted study on the state’s new minimum wage requirements and the impacts it will have on the rates providers need to be paid.

Bean said APD will get its attention during the 2022 session but made no promises about increasing provider rates.

“I fully acknowledge they are struggling. But everybody is struggling. Nursing homes are struggling, retailers are struggling, restaurants are struggling. It seems like everybody has a supply chain crunch and a working shortage. So this industry is not spared from all of the above,” he said.

Florida Developmental Disabilities Council
Executive Director Valerie Breen is less focused on the home- and community-based industry and more focused on the workforce needed to provide services now and in the future

“Definitely we need providers. But more importantly, there isn’t the workforce there to support them. That is the critical issue,” she said.

While APD certifies direct support professionals who can work in Florida, Breen said there is no professional designation for the staff, whether they provide home- and community-based services at a family home or at a community group home. She said the workforce needs to be recognized and incentivized.

“It is a huge crisis nationally and we are definitely seeing it in Florida,” she said.

To that end, Breen said the Council will launch a message campaign dubbed “Pay Fair for Care.” She said hundreds of constituents will share their stories with lawmakers about the difficulty in getting direct support professionals.

“We are looking at an extreme caregiving situation. Where families are having to take it on,” she said. “They are absolutely having to take it on and they aren’t getting any support because the workforce that we depend on for direct support professionals is slowly and surely diminishing.”

Clipped from: https://floridapolitics.com/archives/476321-state-timeline-medicaid-bonuses/

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Some Colorado therapists will no longer take Medicaid patients

MM Curator summary

[ MM Curator Summary]: CO Medicaid is trying to recoup payments from years ago, and providers say they billed properly but a tech vendor took off key information.

 
 

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.

 
 

Several behavioral health providers say they will no longer treat Medicaid patients after 199 providers received letters ordering them to return payment for therapy already completed.

 
 

 
 

The logo for the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state, on a sign in the department’s offices on Feb. 26, 2019. (John Ingold, The Colorado Sun)

As a single parent going back to college, Carla D’Agostino-Vigil signed up for Medicaid and used the government-run health insurance to attend “life-saving” therapy. So when she graduated and started her own mental health counseling practice in Westminster, D’Agostino-Vigil was adamant that she would open her doors to Medicaid patients. 

“When it was my turn, I felt very strongly about being involved,” she said. “The way things have played out, my heart is broken.”

Two years after opening her practice, D’Agostino-Vigil is among the latest round of health care providers in Colorado who are quitting the Medicaid program. Nearly half of the 175 patients at Ignite Counseling Colorado are on Medicaid, and during a six-month transition phase, D’Agostino-Vigil will “try like heck” to find other counselors who will take them. If that doesn’t work, she intends to continue helping some pro bono. 

TODAY’S UNDERWRITER

Her list of reasons is long. There was the 20% rate cut in 2020, just ahead of an increase in need for mental health care because of the isolating days of the pandemic. There were the threatening letters warning her that she was “overusing” a billing code — the code for a full hour of therapy — and that she should instead see patients for 30- or 45-minute sessions. 

But what pushed D’Agostino-Vigil, one of the only specialists in obsessive compulsive disorder taking Medicaid in Colorado, over the edge was a “recoupment” notice received by her practice and nearly 200 others in Colorado this fall. The letter said that due to incorrectly filed claims, providers would have to pay hundreds or thousands of dollars to the agency – called Colorado Community Health Alliance — that dispenses their payments. In some cases, recoupment amounts have totaled $17,000 or $18,000 for a single mental health therapist in private practice. 

The letters, copies of which were reviewed by The Colorado Sun, warn that providers have 60 days to pay up or the management agency could withhold future payments. 

 
 

Nearly 200 behavioral health care offices received letters requesting recoupment for claims that were incorrectly filed. The letters said that if providers did not pay within 60 days, the contractor could recoup the funds by withholding future payments.

The debacle is the latest headache for Medicaid providers who for years have complained of redundant paperwork and clogged bureaucracy. And in this case, it’s not that therapists and counselors were overpaid — they are being asked to return money for services they provided during the prior two years, all because of a provider identification number that was not included in the claims. 

Multiple behavioral health clinicians told The Sun they included the provider identification number. It was the computer system used by their payer, Colorado Community Health Alliance, which is owned by private insurance giant Anthem, that scrubbed the identification numbers from its claims, thinking they were not needed. 

The health alliance, which is the middleman between providers and the state Medicaid program, realized its mistake two years ago and began warning therapy practices back in March 2020 that they would have to resubmit claims, said spokeswoman Colleen Daywalt. The provider number is required by state and federal law, so when the alliance discovered the problem in July 2019, the agency began working to correct its software system to include the number on its claim forms. The problem was fixed in October 2020, Daywalt said. 

Colorado Community Health Alliance, which is the payer for behavioral health providers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties, began notifying providers in March 2020 that claims filed during a two-year period were out of compliance. But many of the 1,175 providers under the alliance did not take action, overwhelmed by the task of resubmitting hundreds of claims. 

A therapist who saw a client weekly during those two years would have filled about 104 claims — and that’s just for one patient. 

Last month, the health alliance sent 199 letters asking for “recoupment” payments, setting off panic and a firestorm of complaints, including in a private Facebook group where therapists and counselors vent about Medicaid frustrations. 

 
 

Colorado Community Health Alliance sent letters to 199 mental health care providers asking for money to recoup payment for claims “paid in error.”

Daywalt said it’s not the health alliance’s intent to recoup any payments, only to comply with state and federal law. She would not say the total amount of money involved in the out-of-compliance claims or the range of recoupment amounts sent to providers. 

But several therapists contacted The Sun regarding the payment debacle and shared their recoupment amounts. 

Allison Harvey, who works at a small group practice in Arvada, said the health alliance is asking for $7,000 for 74 claims in 2020. “The problem is that we submitted all of these claims correctly with all of the information necessary for payment,” she said. “The data is getting removed sometime after the claims leave our hands. Our group, like all providers who choose to serve Medicaid clients, just want to simply be paid for the work we do with this important clientele.” 

 
 

Christia Young, with Badass Therapy in Brighton, was asked to return $7,200. Now Young has stopped taking Medicaid patients through Colorado Community Health Alliance. Even before the latest claims issue, she was spending 80% of her time dealing with Medicaid claims because the health alliance was “repeatedly auditing” her filings, she said. 

And Sarah Carlson, a licensed marriage and family therapist who has accepted Medicaid for 13 years, is quitting her Medicaid contract with the health alliance effective next month. She founded The Parent-Child Interaction Center, one of the largest group practices that accepts Medicaid in Larimer, Weld and Boulder counties. 

Carlson said she’s been fighting about claims with the health alliance for years. The agency owes her thousands of dollars in past claims and now is asking for about $6,000 in recoupment on payments she received for 2020 and 2021, she said. 

“I love how they can find the claims suddenly when they want the money back, but somehow manage not to have the others on file?” Carlson said. “It’s a game, and it’s disgusting. Especially during the pandemic when the need has been soaring.”

 
 

Carlson said she would struggle to pay her office rent just serving Medicaid clients and has to subsidize Medicaid patients with those who have private insurance. “Sadly, it’s my underserved clients who will suffer, but I cannot continue this way any longer,” she said. 

The Colorado Department of Health Care Policy and Financing, which runs the Medicaid program and contracts with Colorado Community Health Alliance to disperse payments to the providers, said providers have been warned of the claims error via multiple newsletters and meetings in 2020 and 2021. 

“While we understand this is frustrating for providers, providers and payers are responsible for submitting and processing compliant claims,” said an emailed statement from department spokesman Marc Williams. “Our contractor identified a system issue preventing this and corrected the issue. They have given providers 21 months to submit corrected claims, which they are still able to do before the recoupments take effect.”

While some providers are ending their Medicaid contracts this fall, the number of behavioral health providers who take Medicaid has grown statewide in the last year, Williams said. Practitioners in the network reached 8,371 in June, compared with 6,029 in April 2020, he said.

But Stephanie Farrell, CEO of Left Hand Management, a consulting group that helps behavioral health care offices across the state with billing and training, said the health alliance caused the problem and should have to fix it — not put the burden on small counseling centers. Colorado Community Health Alliance should pay the consequences, Farrell said, including any potential federal fines for submitting incomplete paperwork. 

TODAY’S UNDERWRITER

“It’s just a clerical issue. A data issue,” she said. “Can’t they say, ‘Let’s call it a mulligan?'”

It’s the latest example in what Farrell says is a messed-up system in which the people providing the mental health care have no voice and are buried by mountains of paperwork. She blames the organizational structure and the contractors that dispense payment.

“It’s the wild, wild West,” she said. “They just do whatever they want and they are grinding up providers in the process.” 

Clipped from: https://coloradosun.com/2021/11/29/medicaid-mental-health-claims/

 
 

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Missouri’s thin dental safety net stretched amid Medicaid expansion

[ MM Curator Summary] Missouri expansion is expected to place more strain on the dental network.

 
 

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.

 
 

Only 27% of dentists in Missouri accept Medicaid, one of the lowest rates in the country

 
 

Dr. Elena Ignatova prepares to make an impression of a patient’s mouth to fit dentures at CareSTL Health in St. Louis. Only 27% of Missouri dentists accept Medicaid, and many of those who do work at safety-net clinics like CareSTL Health (photo: Bram Sable-Smith).

This story was originally published by Kaiser Health News and KSMU.

At the Access Family Care clinics in southwestern Missouri, the next available nonemergency dental appointment is next summer. Northwest Health Services, headquartered in St. Joseph, is booked through May. The wait is a little shorter at CareSTL Health in St. Louis — around six weeks.

Roughly 275,000 Missourians are newly eligible this year for Medicaid, the federal-state public health insurance program for people with low incomes, and they can be covered for dental care, too. Missouri voters approved expansion of the program in 2020, the latest of 39 states to do so as part of the Affordable Care Act, but politics delayed its implementation until Oct. 1. Adults earning up to 138% of the federal poverty level — about $17,774 per year for an individual or $24,040 for a family of two — can now get coverage.

But one big question remains: Who will treat these newly insured dental patients?

Only 27% of dentists in Missouri accept Medicaid, according to state data, one of the lowest rates in the country. Many of them work at what are known as safety-net clinics, such as Access Family Care, Northwest Health Services and CareSTL Health. Such clinics receive federal funds to serve uninsured patients on a sliding scale and was experiencing huge demand for dental services before expansion.

The reason so few Missouri dentists accept Medicaid is simple, according to Vicki Wilbers, executive director of the Missouri Dental Association: The state’s program pays dentists extremely poorly compared with private insurance or what a dentist could charge a patient paying cash. Adding to the strain, said Wilbers, dentists who do accept Medicaid often must deal with the state plus private insurers that administer Medicaid through a program known as managed care.

“You have more people on the rolls, you still don’t have reimbursement rates increase,” Wilbers said. “And it’s cumbersome.”

Still, for these new patients, the coverage can be life-changing.

Only 37% of adults in the state with incomes under $15,000 per year saw a dentist in 2018 compared with 76% of adults earning over $50,000, according to a state report. A survey by the American Dental Association found 53% of low-income Missourians have difficulty chewing, 43% avoid smiling because of the condition of their mouth and 40% experience pain.

“I just don’t think those stories are told enough,” said Steve Douglas, spokesperson for Access Family Care in Neosho.

Douglas described a patient of the clinic who believes his so-far-unsuccessful quest for higher-paying work has been hindered by the appearance of his teeth.

“We’re hoping that with the Medicaid expansion we can get him in for some care,” Douglas said. “He would like to save some of his teeth and not go to full dentures.”

About 62% of Missouri adults making under $15,000 per year have lost at least one tooth to decay or gum disease, and 42% of people 65 and older in that income range have lost all of them, according to the state report. For Missourians earning over $50,000, those rates are 34% and 8%, respectively.

Part of the dental care backlog at Access Family Care, which offers dental services at five locations around southwestern Missouri, is due to the pandemic. The clinic laid off all 95 of its dental staffers in March 2020 before gradually building back to full capacity. As with dental practices nationwide, many of their patients are now coming to get the dental work done that they delayed earlier over fears of exposure to the coronavirus.

But central to the huge demand is an overall need for more providers. Nearly 1.7 million Missourians live in a federally designated dental professional shortage area, one of the highest levels of unmet needs in the country. It’d take another 365 dentists to fill that void, at least one extra dentist for every 10 already practicing in the state.

“We could easily employ another four dentists and still have high demand,” Douglas said.

His clinic, Access Family Care, has indeed hired two new dentists to start in 2022. To manage the dental caseload until then, though, it had to temporarily stop seeing new patients.

In St. Louis, Dr. Elena Ignatova, director of dental services at CareSTL Health, had 18 patients scheduled on a recent Wednesday in November. About a quarter of them were insured through Medicaid.

By 10 a.m., she had cast a mold of one patient’s mouth to fit dentures, referred another to an oral surgeon for a root canal and prepped a fourth-year dental student for the extraction of a Medicaid patient’s remaining teeth. In Missouri, Medicaid covers simple tooth extractions for adults but not root canals or crowns.

“We remove teeth because the other treatment is too expensive and they cannot afford it,” Ignatova said. “Then it can take years for those patients to come up with the money for dentures.”

Ignatova is booked into February, but the clinic still takes walk-ins for dental emergencies. She’s also working her way through a waiting list of 39 patients who might be able to show up quickly if a cancellation or no-show opens a spot in her schedule.

There is easily enough demand for another dentist, but Ignatova said they’re still working on hiring the dental assistants and hygienists needed to reopen the school-based clinics for kids they operated before the pandemic. Those hirings are in the works, but it is slow going. As with many health care facilities, she and others said, President Joe Biden’s vaccine mandates have added an extra hurdle to recruiting and retaining staff.

One clinic that isn’t seeing a bottleneck of dental patients, though, is KC Care Health Center in Kansas City. Kristine Cody, the clinic’s vice president of oral health services, said a new patient could be seen there in about a week. The Kansas City region benefits from having the University of Missouri-Kansas City School of Dentistry, which offers reduced-cost care to patients at the clinic where its students are trained, plus several other safety-net clinics.

KC Care also added two dentists and extended its clinical hours in anticipation of Medicaid expansion.

“I just hope people look to use it,” Cody said.

 

 
 

 
 

Clipped from: https://missouriindependent.com/2021/11/16/missouris-thin-dental-safety-net-stretched-amid-medicaid-expansion/

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Closing Medicaid coverage gap could widen hospital margins, report says

 
 

 
 

MM Curator summary

 
 

Subsidizing exchange plans in non-expansion states could add $12B to hospital profits.

 
 

 
 

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.

 
 

 
 

If the Build Back Better Act goes into effect, hospital margins in the 12 states that have not expanded their Medicaid programs will increase by an estimated $11.9 billion, according to a Nov. 4 report by USC-Brookings Schaeffer Initiative for Health Policy.

Through the Affordable Care Act, states can extend their Medicaid programs to adults under age 65 with incomes below 138 percent of the federal poverty level, but 12 states have not done so.

In those 12 states, people with incomes below 138 percent of the federal poverty level are mostly ineligible for subsidized coverage. But the current draft of Democrats’ Build Back Better Act wants to fill the coverage gap.

Here are five things to know:

1. The current draft for the Build Back Better Act would fill the Medicaid coverage gap by making people below the poverty line in those 12 states eligible for ACA marketplace coverage. More than that, it would change marketplace coverage by eliminating all premiums and cost-sharing for people with incomes below 138 percent of the federal poverty line. This would add services that are covered by Medicaid but not the marketplace.

2. By making these changes, the report estimates that hospital margins in the 12 states would rise by $11.9 billion if the Build Back Better Act went into effect in 2023. The reason for this improvement is because hospitals would be paid for services they’re delivering anyway but aren’t currently being paid for. Additionally, more patients would be seeking care because of increased coverage, which would raise profits.

3. Hospitals in these states also would have smaller Medicare disproportionate share hospital payments. This is because the payments use a formula that looks at the national uninsured rate and the distribution of uncompensated care across hospitals. Both of these items would change.

4. If policymakers instead chose a federal Medicaid plan, these hospitals would receive smaller increases in margins at $3.6 billion. A federal Medicaid plan would most likely pay hospitals less than marketplace plans, according to the report, leading to hospitals receiving less revenue and less patient volume for uncompensated care.

5. The draft Build Back Better Act could help patients by allowing hospitals to provide care even if they have fewer resources. However, it could also allow hospitals to accept higher profits and increase costs, therefore not helping patients.

 
 

Clipped from: https://www.beckershospitalreview.com/finance/closing-medicaid-coverage-gap-could-widen-hospital-margins-report-says.html

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Fact Sheet: Biden Administration Announces Details of Two Major Vaccination Policies | The White House

 
 

 
 

MM Curator summary

 
 

Details of the new CMS and OSHA vaccine requirements have been released, with compliance required by January 4.

 
 

 
 

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.

 
 

New OSHA and CMS Rules Mean Two-Thirds of All Workers Now Covered by Vaccination Rules

Thanks to President Biden’s focus on getting Americans vaccinated, 70 percent of adult Americans are now fully vaccinated—up from less than one percent when the President took office. This is significant progress, made possible by a vaccinations program that made shots free and convenient for months. But more vaccinations are needed to save lives, protect the economy, and accelerate the path out of the pandemic. To that end, in July, President Biden began rolling out vaccination requirements for federal employees and contractors and calling on employers to do the same. Thousands of organizations across the country have answered the President’s call, and vaccination requirements have already helped reduce the number of unvaccinated Americans by approximately 40 percent since July.

Today, the Biden Administration is announcing the details of two policies to fight COVID-19 that will drive even more progress and result in millions of Americans getting vaccinated, protecting workers, preventing hospitalization, saving lives, and strengthening the economy.


First, the Department of Labor’s Occupational Safety and Health Administration (OSHA) is announcing the details of a requirement for employers with 100 or more employees to ensure each of their workers is fully vaccinated or tests for COVID-19 on at least a weekly basis. The OSHA rule will also require that these employers provide paid-time for employees to get vaccinated, and ensure all unvaccinated workers wear a face mask in the workplace. OSHA has a strong 50-year record of requiring employers to take common sense actions to prevent workers from getting sick or injured on the job. This rule will cover 84 million employees.


Second, the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services is announcing the details of its requirement that health care workers at facilities participating in Medicare and Medicaid are fully vaccinated. The rule applies to more than 17 million workers at approximately 76,000 health care facilities, including hospitals and long-term care facilities.


The Administration has previously implemented policies requiring millions of federal employees and federal contractors to be fully vaccinated. To make it easy for businesses and workers to comply, the Administration is announcing today that the deadline for workers to receive their shots will be the same for the OSHA rule, the CMS rule, and the previously-announced federal contractor vaccination requirement. Employees falling under the ETS, CMS, or federal contractor rules will need to have their final vaccination dose – either their second dose of Pfizer or Moderna, or single dose of Johnson & Johnson – by January 4, 2022. OSHA is also clarifying that it will not apply its new rule to workplaces covered by either the CMS rule or the federal contractor vaccination requirement. And, both OSHA and CMS are making clear that their new rules preempt any inconsistent state or local laws, including laws that ban or limit an employer’s authority to require vaccination, masks, or testing.


The Administration is calling on all employers to ensure that as many of their workers are vaccinated as quickly as possible. As detailed in a recent White House report, vaccination requirements work and are good for the economy. Vaccination requirements have increased vaccination rates by more than 20 percentage points – to over 90 percent – across a wide range of businesses and organizations. According to Wall Street analysts, vaccination requirements could result in as many as 5 million American workers going back to work, and a survey of prominent, independent economists found unanimous agreement that vaccination requirements will “promote a faster and stronger economic recovery.”


Today’s announcements include:


New Vaccination Requirement for Employers With 100 or More Employees: OSHA is issuing a COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS) to require employers with 100 or more employees (i.e., “covered employers”) to:

  • Get Their Employees Vaccinated by January 4th and Require Unvaccinated Employees to Produce a Negative Test on at Least a Weekly Basis: All covered employers must ensure that their employees have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna, or one dose of Johnson & Johnson – by January 4th. After that, all covered employers must ensure that any employees who have not received the necessary shots begin producing a verified negative test to their employer on at least a weekly basis, and they must remove from the workplace any employee who receives a positive COVID-19 test or is diagnosed with COVID-19 by a licensed health care provider. The ETS lays out the wide variety of tests that comply with the standard. Given that vaccines are safe, free, and the most effective way for workers to be protected from COVID-19 transmission at work, the ETS does not require employers to provide or pay for tests. Employers may be required to pay for testing because of other laws or collective bargaining agreements.
     
  • Pay Employees for the Time it Takes to Get Vaccinated: All covered employers are required to provide paid-time for their employees to get vaccinated and, if needed, sick leave to recover from side effects experienced that keep them from working.
     
  • Ensure All Unvaccinated Employees are Masked: All covered employers must ensure that unvaccinated employees wear a face mask while in the workplace.
     
  • Other Requirements and Compliance Date: Employers are subject to requirements for reporting and recordkeeping that are spelled out in the detailed OSHA materials available here. While the testing requirement for unvaccinated workers will begin after January 4th, employers must be in compliance with all other requirements – such as providing paid-time for employees to get vaccinated and masking for unvaccinated workers – on December 5th. The Administration is calling on all employers to step up and make these changes as quickly as possible.

New Vaccination Requirements for Health Care Workers: CMS is requiring workers at health care facilities participating in Medicare or Medicaid to have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna, or one dose of Johnson & Johnson – by January 4th. The rule covers approximately 76,000 health care facilities and more than 17 million health care workers – the majority of health care workers in America – and will enhance patient safety in health care settings. The rule applies to employees regardless of whether their positions are clinical or non-clinical and includes employees, students, trainees, and volunteers who work at a covered facility that receives federal funding from Medicare or Medicaid. It also includes individuals who provide treatment or other services for the facility under contract or other arrangements. Among the facility types covered by the rule are hospitals, ambulatory surgery centers, dialysis facilities, home health agencies, and long-term care facilities. Today’s action will help provide patients assurance about the vaccination status of those delivering care, create a level playing field across health care facilities, and help to address challenges facilities have faced with staff sickness and quarantines impacting delivery of care.

Streamlining Implementation and Setting One Deadline Across Different Vaccination Requirements: The rules released today ensure employers know which requirements apply to which workplaces. Federal contractors may have some workplaces subject to requirements for federal contractors and other workplaces subject to the newly-released COVID-19 Vaccination and Testing ETS. To make it easy for all employers to comply with the requirements, the deadline for the federal contractor vaccination requirement will be aligned with those for the CMS rule and the ETS. Employees falling under the ETS, CMS, or federal contractor rules will need to have their final vaccination dose – either their second dose of Pfizer or Moderna, or single dose of Johnson & Johnson – by January 4, 2022. This will make it easier for employers to ensure their workforce is vaccinated, safe, and healthy, and ensure that federal contractors implement their requirements on the same timeline as other employers in their industries. And, the newly-released ETS will not be applied to workplaces subject to the federal contractor requirement or CMS rule, so employers will not have to track multiple vaccination requirements for the same employees.

 
 

Clipped from: https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/04/fact-sheet-biden-administration-announces-details-of-two-major-vaccination-policies/

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South Dakotans will vote on Medicaid expansion in 2022, pending petition validation

MM Curator summary

The state hospital association has gathered enough signatures for its version of the voter Medicaid expansion ballot initiative.

 
 

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.

 
 

PBS NewsHour

Voters will decide whether to expand Medicaid to more low-income South Dakotans as long as the secretary of state verifies enough petition signatures were turned in on Monday.

South Dakotans Decide Healthcare said it turned in 46,119 signatures from registered South Dakota voters. That’s more than the 33,921-signature threshold needed for initiated constitutional amendments to be placed on the November 2022 ballot.

The number “really shows the grassroots energy and excitement around this,” said spokesman Zach Marcus.

South Dakotans Decide Healthcare was the only group to turn in its proposed ballot question ahead of Monday’s deadline for initiated constitutional amendments. Initiated measures have a later deadline.

Medicaid is a federal-state health insurance program for low-income people. South Dakota is one of 12 states that has not accepted federal incentives to expand Medicaid eligibility, according to the Kaiser Family Foundation.

Medicaid expansion has only failed once when put before voters, according to Health Affairs. Voters in Maine, Idaho, Utah, Nebraska, Oklahoma and Missouri approved expansion. Montanans rejected expansion — which would have been covered through a tobacco tax increase — but lawmakers later approved it.

 
 

The South Dakota amendment would expand Medicaid to people between 18 and 65 who earn 133% or less of the federal poverty level.

Expansion would make Medicaid available to 42,500 additional South Dakotans in its first year, according to the non-partisan Legislative Research Council.

Studies show Medicaid expansion improves healthcare outcomes while producing economic benefits for recipients, healthcare systems and the overall economy.

Medicaid expansion faces a challenge after the Legislature voted in 2020 to refer a constitutional amendment to the voters during the June 2022 election — before the Medicaid vote in November 2022.

The proposed amendment says any ballot question that raises taxes or spends at least $10 million — such as the Medicaid expansion question — must be approved by 60%, not 50%, of the voters.

Sen. Lee Schoenbeck, R-Watertown, supports the amendment.

 
 

Schoenbeck “acknowledged that his expedited push was motivated by the Medicaid expansion campaign, but argued the vote threshold should apply to all ballot initiatives that levy taxes or spend significant state funds,” according to the Associated Press.

Expansion supporters are concerned about voter turnout in the June election since it’s a primary election without a presidential race. Just 26% of South Dakota voters participated in the June 2018 election compared to 65% in November.

“When we educate voters on why this is going to be helpful for South Dakota, when we educate voters on why this matters and will help them and their families, South Dakota voters respond to this,” Marcus said. “So if we need to get 60% of the vote for this to pass, that’s what we’ll do.”

South Dakotans Decide Healthcare is a statewide ballot question committee that raised $21,639 by the start of 2021, records show. Donors include the AARP, Farmers Union, healthcare organizations and the Fairness Project, a D.C.-based social and economic justice nonprofit.

Proposed initiated amendments that won’t be on the ballot addressed redistricting and elections. Those groups did not turn in petitions Monday, according to the secretary of state. A proposed initiated measure for recreational marijuana and an initiated measure that also addresses Medicaid expansion have a May 3 deadline.

 
 

Clipped from: https://listen.sdpb.org/healthcare/2021-11-08/sd-medicaid-expansion-to-appear-on-2022-election-ballot-pending-validation