MedPAC Mulls Time Limits on Some Telehealth Payments

Telehealth services for Medicare beneficiaries that have been expanded during the COVID-19 pandemic should be continued — but with an expiration date until a long-term telehealth strategy is established, a member of the Medicare Payment Advisory Commission (MedPAC) said Monday at the panel’s virtual meeting.

CMS Signs off on Medicaid Managed-Care Changes

CMS on Monday wrapped up its long-awaited changes to how states can run their Medicaid and Children’s Health Insurance Program plans. The final rule gives states more flexibility to set rates for their managed-care plans and ensure plans have adequate provider networks. The Trump administration hopes the changes will encourage private health plans within Medicaid and CHIP, slash regulations and cut federal exposure to healthcare costs.

CMMI’s Flexible Medicare Hospice Option Shows Promising Results

The Center for Medicare & Medicaid Innovation’s Medicare Care Choices Model (MCCM) demonstration led to a 25 percent decrease in total Medicare expenditures, according to a new report. The model, which started in 2016 and runs through 2021, is designed to allow beneficiaries who qualify for Medicare hospice benefit (MHB) to continue to receive care from other Medicare providers for their terminal condition. (Normally, Medicare beneficiaries who elect to receive hospice care cannot also receive curative treatment for their life-limiting condition. Fewer than half of beneficiaries choose MBH and those that do elect MBH do so less than a week before death.)

MGMA Voices Displeasure with CMS’ Talk of Mandated APMs

More than three-fourths (76 percent) of healthcare leaders voiced opposition to the government requiring participation in alternative payment models (APMs), according to a new MGMA Stat Poll. The research, conducted by the Colorado-based Medical Group Management Association, was conducted this month and included more than 800 applicable responses. Healthcare leaders were asked, “Should the government mandate participation in Medicare alternative payment models?” Only 10 percent responded “yes,” showing that the vast majority (76 percent) of respondents prefer flexibility and choice in value-based payment reform. The other 14 percent responded “unsure.”

How Many Physicians Have Opted-Out of the Medicare Program?

As U.S health care spending continues to grow faster than the economy, several health care reform proposals would leverage Medicare’s payment structure in order to help control health care costs while also improving consumers’ access to health coverage. Amidst the debate on health care reform, some have expressed concerns that an approach that adopts Medicare payment rates, or a multiplier of Medicare rates, would jeopardize providers’ financial viability, leading physicians to “opt out” of the Medicare program, potentially leading to a shortage of physicians willing to treat Medicare beneficiaries and compromising patients’ access to care. This analysis examines the extent to which non-pediatric physicians are opting out of Medicare, by specialty, and by state.

Medicare and Home Health: Taking Stock in the COVID-19 Era

Home health care is well positioned to provide services to Medicare beneficiaries. However, the current design of the Medicare home health benefit is not sufficient to meet the needs of postacute beneficiaries. Policy changes could potentially increase the value of the Medicare home health benefit in the COVID-19 era. Questions also remain about the relative quality of services, particularly among home health agencies working with Medicare Advantage plans.

Medicaid Enrollment & Spending Growth: FY 2020 & 2021

This brief analyzes Medicaid enrollment and spending trends for FY 2020 and FY 2021 based on data provided by state Medicaid directors as part of the 20th annual survey of Medicaid directors in all 50 states and the District of Columbia. Overall, 43 states responded to the survey by mid-August 2020, although response rates for specific questions varied.

CareFirst Takes over Management of Medicaid Plans from University of Maryland Medical System

The University of Maryland Medical System has sold its health plans that provide insurance coverage to tens of thousand of Medicaid beneficiaries in the state. UMMS and the buyer, CareFirst BlueCross Blue Shield, declined to disclose terms of the deal. But the move, approved by regulators and closed this week, expands CareFirst’s reach into management of Medicaid plans. Medicaid is a government-funded health program for low-income people that is managed by private carriers in Maryland.

Where the States Stand on Medicaid Expansion

The Supreme Court’s 2012 ruling on the Affordable Care Act (ACA) allowed states to opt out of the law’s Medicaid expansion, leaving each state’s decision to participate in the hands of the nation’s governors and state leaders. Now, amid perennial debate over whether to repeal and replace the Affordable Care Act, the fate of Medicaid expansion remains uncertain. The Advisory Board’s Daily Briefing editorial team has been tracking where each state stands on Medicaid expansion, combing through lawmakers’ statements, press releases, and media coverage. In this latest iteration of its Medicaid map, they’ve determined each state’s position and outlined any possible expansion efforts.

Citing COVID-19, Providers Push Back on CMS Payment Rule Rate Cuts, Telehealth Rollback in 2021

Providers are fiercely opposing changes in two CMS payment rules for 2021, decrying physician rate cuts amid the COVID-19 pandemic, pushing for more telehealth flexibility and urging a stop to a controversial plan to eliminate the list of procedures that can be done on an inpatient-only basis. CMS released its annual proposals for the Physician Fee Schedule and Outpatient Prospective Payment System in August and official comments were due Monday. In their comments, doctor and hospital groups largely focused on what they think is needed — and what should be avoided — as the nation continues to battle the novel coronavirus, which could bring new challenges this winter.