Tagged with Medicaid Billing

MGMA, AMA Request Delay in 2015 Edition Certified EHR

In a letter to CMS and the Office of the National Coordinator for Health Information Technology, MGMA, along with 100 medical organizations, requested a deferment for the required use of 2015 Edition CEHRT in the QPP or Medicaid MU Program. The letter recommends that use of 2015 CEHRT remain voluntary until such technology is widely available, no sooner than January 2019.

VT – ACO Pilot Project Announced

Vermont has entered into a one year agreement with OneCare to launch an ACO pilot program serving 30,000 Medicaid beneficiaries.

CMS Issues Non-ACA Compliant Plans Extension

CMS issued an insurance standards bulletin granting another extension to non-ACA-compliant health plans to allow insurers and consumers to extend for an additional year.

CMS Releases Medicaid Spending Report

According to the recently released annual report from CMS, in fiscal year 2016 states and federal government grew 4.3% to $575.9 billion and federal Medicaid spending grew 4.5% to $363.4 billion for the program to cover low income and disabled people. The report states Medicaid spending has increased in recent years and is expected to continue to rise, potentially reaching levels that could “displace spending on other important programs.”

New Final Rule Targets Pass-Through Payments

CMS’ newest Medicaid managed care final rule will prevent increases in pass-through payments as well as the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established.

PA – New Global Capitation Model for Rural Hospitals

CMS has announced a new global capitation model for rural hospitals in Pennsylvania. Under the new model participating critical access hospitals and acute care hospitals will receive all-payer global budgets for a fixed amount of money that is set in advance and funded by all participating insurers, to cover inpatient and outpatient services.

IL – Limited MCO Coverage of ABA Therapy for Individuals with Autism

Effective January 1, Health Alliance Connect, the sole Medicaid managed care plan covering applied behavioral analysis (ABA) services for children with autism in central Illinois, has withdrawn from the state’s Medicaid program increasing barriers to access to ABA.

NJ – DHS Updates Medicaid Fee-for-service Rates for State Plan Services

The New Jersey Department of Human Services’ (DHS) Division of Medical Assistance and Health Services (DMAHS) has posted a public notice of its intent to seek approval from CMS for amendments to the State Plan to reflect updates to state Medicaid fee-for-service rates, effective January 1.

NJ – OIG Report Reveals Improper Medicaid Payments

A report released by the HHS Office of Inspector General (OIG) states, over a four-year span, New Jersey has received an estimated $95 million in improper Medicaid payments. According to the report, “The deficiencies occurred because the state … did not adequately monitor [its] partial care services program to ensure that providers complied with [the program’s] requirements.”