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September 24, 2014 | Daily News

The American College of Physicians is pushing hard for legislation that would extend the Medicaid pay bump for primary care physicians for at least two years saying it is necessary to ensure the state and federal health care program for low-income individuals and children has enough providers to meet beneficiaries needs. A nonprofit health care policy resource center, however, says that the program has not been in place long enough to assess its effectiveness, and policy fixes are needed if the pay bump is extended.

September 22, 2014 | Daily News

Congressional Medicaid and CHIP advisers questioned the former Arkansas Medicaid director and others about whether more state Medicaid programs should consider a premium assistance model, and one commissioner said that while they were excited about the approach there is concern that a recent Government Accountability Office report slamming the costs of Arkansas' program could dampen enthusiasm for the model.

September 18, 2014 | Daily News

Medicaid-beneficiary advocates filed a lawsuit Wednesday (Sept. 17) in California accusing the state of making hundreds of thousands of Medicaid applicants wait months without coverage that many desperately need and, by law, deserve. A day later, key House and Senate Republicans blamed CMS for the application logjams in many states.

September 18, 2014 | Daily News

As more Medicaid beneficiaries are enrolled in managed care plans, the National Association of Medicaid Directors is urging CMS to focus on four overarching program-integrity areas: provider enrollment; data reporting; compliance; and benefits' coordination. Streamlining processes and offering guidance to states in these areas requires the agency to work closely with state Medicaid programs and highlight some of the most innovative and efficient state practices, NAMD says in a letter to CMS.

September 17, 2014 | Daily News

Sen. Jay Rockefeller (D-WV), the driving force behind the bipartisan Children's Health Insurance Program, is extolling Congress to extend the program's funding through 2019 during the lame duck session following the November elections, warning that failing to do so would cause millions of children to lose their coverage and wreak havoc on states' already strained budgets.

September 12, 2014 | Daily News

States and some lawmakers are pushing for CMS to extend the Multi-Payer Advanced Primary Care Practice demonstration beyond 2014, though one state policy expert says it may be time to move beyond multi-payer demonstrations that focus exclusively on primary care. A CMS official last month told Inside Health Policy the agency was considering demo extension requests from several states, and a key stakeholder says final word on the demo's future likely rests with the White House.

September 12, 2014 | Daily News

Two reports from the Urban Institute and Georgetown University's Center for Children and Families found that the estimated uninsured rate for parents fell by 14.4 percent nationwide but the estimated rate of uninsured children -- which was already low -- has seen no statistically significant movement due to the ACA's coverage expansions.

September 11, 2014 | Daily News

As CMS plans its first major update of Medicaid managed care regulations since 2002, Medicaid Health Plans of America is asking that states and Medicaid managed care organizations (MCO) have the ability to adjust rates when new, higher-priced medications and procedures come into the market place, such as the hepatitis C drug Sovaldi, which costs an average of $84,000 for a treatment regimen.

September 05, 2014 | Daily News

The Center for American Progress is proposing a new multi-payer “Accountable Care States” model under which CMS would offer broad payment reform flexibility to states limiting per-capita spending and in turn share with states the resulting health care savings, which the group estimates could reach $1.7 trillion over 10 years.

Were the Accountable Care State model to take off, CAP says, CMS should create a new Office of Accountable Care States to review and approve one application covering Medicaid waivers, Medicare waivers and changes to state-run health insurance exchanges.

September 04, 2014 | Daily News

Reacting to CMS actuaries' finding that health care spending is creeping back up after an historic slowdown of five consecutive years of spending growth below 4 percent, a well-known health care economist said cuts to physician pay or program benefits likely will be necessary to sustain Medicare unless the country is willing to raise taxes.

August 25, 2014 | Daily News

An insurer participating in Iowa's exchange and enrolling Medicaid beneficiaries into its private plans says the Medicaid premium assistance population is higher cost than the company's baseline exchange business, however state officials could not say if this will result in higher exchange premiums for 2015. Iowa, like Arkansas which pioneered it, has expanded Medicaid using a model in which beneficiaries enroll in exchange plans and their premiums are subsidized using the ACA's higher Medicaid matching funds.

August 21, 2014 | Daily News

Contrary to popular belief, most of the emergency room visits by Medicaid beneficiaries are for urgent symptoms that require quick medical attention, according to the Medicaid and CHIP Payment and Access Commission (MACPAC). According to studies, MACPAC says non-urgent visits to the emergency room make up only 10 percent of Medicaid-covered emergency department visits in its July “MACfacts” report.

August 20, 2014 | Daily News

The Bipartisan Policy Center turned pessimistic about the prospect of Congress comprehensively changing the health care system and is instead focusing on smaller reforms that Congress can make when it next deals with the Medicare physician pay formula and on changes CMS can make administratively. The center released a white paper Tuesday (Aug. 19) that scales back expectations for overhauling the health care system.

The white paper is the first in a series on changes to the fee-for-service Medicare and alternative pay demonstrations.

August 19, 2014 | Daily News

Enroll America doesn't plan to expand the number of states where it placed field staff to get people insured but it will be launching some new tools and doing more active recruitment of assisters going into the forthcoming open enrollment period, the non-profit's president tells Inside Health Policy. Enroll America President Anne Filipic says she doesn't think a dramatically different strategy is needed for the second open enrollment period to get people covered.

August 19, 2014 | Daily News

Just as the country is on the verge of a significant increase in drug spending, brand-drug makers are lobbying for a trade deal that could severely constrain the ability of Medicare to curb drug prices, consumer groups warn.

August 15, 2014 | Daily News

Consumer advocate and broker sources are praising two new special enrollment periods that will let people enroll in subsidized coverage on healthcare.gov if they were denied due to a system error or because they lived in a non-Medicaid expansion state and were below the poverty line but then saw an increase in income.

August 04, 2014 | Daily News

Medicare will pay acute-care hospitals 1.4 percent more next year and long-term care hospitals will receive a 1.1 percent pay bump, according to the final Inpatient Prospective Payment System rule issued Monday (Aug. 4), but CMS expects a nearly $1 billion reduction in Disproportionate Share Hospital pay and programs that penalize hospitals for poor performance will offset their pay increase considerably.

August 04, 2014 | Daily News

Patients infected with hepatitis C are preparing to sue in short order states that restrict Medicaid coverage of Sovaldi, and they're using as a model a lawsuit that cystic fibrosis patients recently filed in Arkansas, where Medicaid uses a prior authorization policy to curb use of the cystic fibrosis drug Kalydeco, according to Donna Cryer, of the Global Liver Institute. National Association of Medicaid Directors Executive Director Matt Salo said he isn't surprised that liver patients plan to sue but he thinks patient groups are using the wrong tactic.

July 30, 2014 | Daily News

In the flood of bills leading up to August recess, Sens. Patty Murray (D-WA) and Sherrod Brown (D-OH) on Wednesday (July 30) introduced legislation to extend by two years an ACA policy that temporarily bumped up Medicaid payments for primary care physician services to match Medicare rates. The bill also would expand the higher pay rates to certain women's services.

July 29, 2014 | Daily News

A bipartisan, bicameral group of lawmakers Tuesday (July 29) asked governors for advice on how to extend or revise the Children's Health Insurance Program, which will lose funding after Sept. 30, 2015. The lawmakers' letter came the same day the National Coalition on Health Care (NCHC) urged Congress to fund CHIP this year, and as children's advocate First Focus released a report showing that CHIP provides less expensive, more comprehensive coverage than exchange policies.