CMS proposes reductions in Medicaid allotments to states for hospitals’ uncompensated care

On July 28, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement $43 billion in reductions in federal Medicaid allotments to state Medicaid agencies for payment adjustments to hospitals serving a disproportionate share of low-income persons. The reductions in such allotments under the proposed rule will apply to federal fiscal years 2018-2025. Reductions nationwide will start at $2 billion in FY 2018 and will reach $8 billion per year in FY 2024 and FY 2025. [More]

U.S. District Court in Connecticut certifies nationwide class of Medicare beneficiaries in challenge to “observation status”

On July 31, 2017, the U.S. District Court for the District of Connecticut certified a nationwide class of Medicare beneficiaries who desire to challenge their placement on “observation status” during their hospital stays. Alexander v. Price, No. 3:11-cv-1703 (D. Conn. July 31,2017).

The plaintiffs in this long-running action argue that the decision to categorize Medicare beneficiaries as outpatients on observation status rather than inpatients should be subject to administrative review. Currently, Medicare does not allow beneficiaries to appeal this determination. [More]

Developments in Section 1332 State Innovation Waivers

Halfway through the first year that states are eligible to implement Section 1332 Waivers, and with states seeking to stabilize their markets in the face of uncertainty at the Federal level, the pace is picking up on Section 1332 Waivers. In recent weeks, there have been two major developments on this front with the Federal government approving Alaska’s waiver request and Iowa submitting an unprecedented emergency and abbreviated Section 1332 Waiver request. More details on both of those developments are below. Additionally, the Federal agencies made a preliminary determination on June 20th that Minnesota’s Section 1332 Waiver application is complete starting the clock on review and approval. [More]

The latest news from D.C.

Following the failure in the Senate to pass various legislative proposals – the Better Care Reconciliation Act (the Senate version of repeal and replace), the straight repeal option, or the “skinny repeal” bill – last week, Senate leadership has continued to say that they are moving on to other agenda items for now. However, there still seem to be daily updates from D.C. Several new proposals have come to the forefront in the past week. Senators Cassidy and Graham have proposed block granting Affordable Care Act (ACA) funding (including related to premium tax credits and cost-sharing reductions) to the states, providing them with the [More]

White House issues report on the opioid epidemic

On July 31, 2017, the White House posted the initial findings and recommendations of its Commission on Combatting Drug Abuse and the Opioid Crisis.
The Commission cites evidence that:
• 142 Americans die from drug overdoses per day.
• Only 10 percent of the 21 million persons with a substance use disorder (SUD) are receiving appropriate treatment for it.
• Over 40 percent of persons with an SUD also have a mental health disorder but less than half of them are receiving appropriate treatment for either disorder.
• About 80 percent of new heroin users begin with prescription opioids. [More]

Putting State Innovation Model (SIM) dollars to work

The SIM initiative seeks to advance and accelerate state delivery system and payment reform efforts. Under Section 3021 of the Affordable Care Act (ACA), SIM grants may be awarded to states and territories that demonstrate a comprehensive plan that transforms the delivery system, aligning with the “triple aim” objectives of reducing costs, improving quality, and population health.
To date the Centers for Medicare and Medicaid Innovation (CMMI) has issued a total of 38 SIM awards to 34 states, three territories, and the District of Columbia, for model design and testing. The initiatives underway in SIM grant models touch 61% of the population.
These awards are broken into: [More]