According to new guidance from the Centers for Medicare and Medicaid Services, Medicaid Recovery Audit Contractors will not replace existing Medicaid program integrity contractors under the terms of a final rule issued in September 2011. The recently released Frequently Asked Questions document also provides a refresher on the Recovery Audit Contractors (RAC) program.
The RAC model was created for Medicare in 2003; it was then expanded to Medicaid under Section 6411(a) of the Affordable Care Act. The ACA requires each state to establish a Medicaid RAC program so as to enable the auditing of claims for services furnished by Medicaid providers. [click to continue…]
What is cost sharing and how will it change under health reform? What are health insurance exchanges and how will they affect me? How will the new law close the coverage gap for people on the Medicare, Part D program? The Robert Wood Johnson Foundation recently created a series of educational videos designed to answer your questions about 5 common terms that are often heard in connection to healthcare reform.
This week, the 26 states who have joined in a Supreme Court challenge to the Affordable Care Act filed a brief outlining their argument that the law’s 2014 Medicaid expansion is an unconstitutional infringement on state power. The states argue that through the Medicaid expansion, the federal government is essentially coercing them into covering new people by threatening to withhold federal Medicaid funds unless they do so.
Many legal experts agree that because states’ participation in Medicaid is voluntary, it does not constitute “coercion” for the federal government to attach requirements about how the funding is used. However, the states argue that participation in Medicaid “[is] not truly voluntary… While some individuals are exempt from the penalties designed to enforce the [ACA’s individual] mandate, no State is exempt from the massive penalty — the loss of the entirety of funding under the single largest grant-in-aid programs for the States — and so Congress did not even contemplate the possibility of a State opting out of Medicaid.” [click to continue…]
The Department of Health and Human Services has awarded more than $296 million to states for ensuring more children have health coverage. The performance bonus payments are funded under the Children’s Health Insurance Program Reauthorization Act, signed into law by President Obama in 2009. To qualify for these bonus payments, states must surpass a specified Medicaid enrollment target. They also must adopt procedures that improve access to Medicaid and the Children’s Health Insurance Program (CHIP), making it easier for eligible children to enroll and retain coverage. [click to continue…]
The Center for Consumer Information & Insurance Oversight (CCIIO) at the Department of Health and Human Services has issued answers to Frequently Asked Questions about the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. The FAQs address such topics as:
After the amendments made by the Affordable Care Act, are small employers still exempt from parity requirements?
Am I entitled to receive a copy of the criteria for medical necessity determinations made by the patient’s plan or health insurance coverage?
I think my plan is applying medical necessity standards more strictly to benefits for mental health and substance use disorder treatment than for medical/surgical benefits. How can I obtain information on the medical necessity criteria used for medical/surgical benefits?
The parity FAQs are part of a series addressing many important aspects of the health reform law. Click here to visit CCIIO’s website and view the other FAQs.
In a recent article, Kaiser Health News (KHN) reported on how healthcare reform and its benefits are already well underway and exceeding expectations. An estimated 2.5 million young adults have already gained health insurance coverage since the health law took effect in 2010 – a number far higher than many predicted. The article discusses a variety of data and results which reflects the large number of young adults who have gained coverage.
According to KHN:
Officials based their number on U.S. Census data and the results of the latest National Health Interview Survey. In September 2010, the survey found 64.4 percent of adults between 19 and 25 were insured. By March, the rate was up to 69.6 percent, and in June it was at 72.7 percent. That month, the uninsured rate for this population reached its lowest point in more than a decade, down to 28.8 percent.
Click here to read the full article and to learn more about the new laws benefits on young adults.
1. Medicare Physician Pay Fix: In the last hours of its 2011 session, Congress enacted a short-term deal that postponed for two months a scheduled 27% reduction to Medicare physician payments. The cut was required under the Sustainable Growth Rate (SGR) formula, which compels Medicare to adjust payment rates each year to align with a predetermined rate of growth in the program. In practice, this has meant that Medicare payments would take an ever-increasing yearly cut – but each year, Congress has passed legislation postponing those cuts.
The newest 2-month “SGR fix” gives Congress until February 28 to reach a longer-term agreement to stave off the cuts. However, the same issues that plagued the December deal will continue to dog negotiators as they seek a permanent solution, with the biggest stumbling block being the question of how to pay for a long-term fix. Fiscal hawks in Congress have insisted on offsetting all costs with spending cuts elsewhere in the budget, but other legislators disagree on whether or where to seek savings. With the 2012 elections putting additional political pressure on an already divided Congress, it is unclear whether the two-month delay will be sufficient time for lawmakers to work out the details of a permanent fix – or whether they will enact another short-term patch. [click to continue…]
Despite what seemed like constant threats to Medicaid and behavioral health funding over the last year, our field was able to fend off the worst cuts – and make strong progress on our other legislative goals. Here’s what your advocacy helped achieve in 2011:
1. Supercommittee Cuts to Medicaid did not Materialize: 2011 brought one after another legislative proposal to revamp Medicaid and cut hundreds of billions of dollars from the program. From bills that would convert Medicaid to a block grant, to a “blended” FMAP proposal, Medicaid was constantly on the chopping block. Nowhere was this more true than in the Supercommittee negotiations, which – had they succeeded – could have had a devastating impact on Medicaid. However, the Supercommittee was unable to reach a spending cut agreement, leaving Medicaid spared for now. The National Council would like to thank the 1,700 individuals and organizations who signed on to our Supercommittee letter in support of Medicaid, along with the thousands of advocates who sent letters to your legislators last year urging them to preserve and protect Medicaid. Your efforts made a difference! [click to continue…]
The Center for Public Integrity is out with a new video that explains the importance of federal funding for behavioral health information technology. The video [...]
According to new guidance from the Centers for Medicare and Medicaid Services, Medicaid Recovery Audit Contractors will not replace existing Medicaid program integrity contractors under the terms of a final rule issued in September 2011. The recently released Frequently Asked Questions document also provides a refresher on the Recovery Audit Contractors (RAC) program.
In a recent article, Kaiser Health News (KHN) reported on how healthcare reform and its benefits are already well underway and exceeding expectations. An estimated 2.5 million young adults have already gained health insurance coverage since the health law took effect in 2010 – a number far higher than many predicted. The article discusses a variety of data and results which reflects the large number of young adults who have gained coverage.
