Medicaid and Managed Care–Who Benefits?

Is Medicaid really broke?  If not, who is making money where Managed Care is involved?  According to this, not the providers.  Is this ignored so that attention is focused on allegations of fraud by providers?

Arizona Eliminates SCHIP

Because of budget shortfalls, states are reducing coverage and cutting reimbursement rates for programs like Medicaid. But Arizona became the first state to drop the State Children’s Health Insurance Program (SCHIP) altogether. (Source) Arizona will also reduce Medicaid coverage for childless adults. The state simply doesn’t have enough money to operate SCHIP or continue to [...]

The Political and Bureaucratic "Class" Thrives While YOU Suffer

Your excellence counts for nothing as they line their own pockets: “Pay for performance? Fuggeddaboutit! Congress keeps its automatic pay increase, and taxes, inflation, deficits, and the national debt all rise. Down Independence Avenue, Health and Human Services (HHS) bureaucrats get automatic pay raises and universal “outstanding” performance ratings. (Footnote: take a laptop with you [...]

Texas Governor Ambivalent About Health Care Plan

Governor Rick Perry is straddling the fence on President Barack Obama’s health care reform plan. On the one hand, he criticized it, calling the so-called opt out provision for states “classic Washington bait and switch,” because citizens would still have to pay for it. On the other hand, Perry said he’s unsure whether Texas will [...]

SCHIP Expansion in Health Care Reform

President George Bush twice vetoed versions of a bill that would have expanded the State Children’s Health Insurance Program (SCHIP) amid concerns that parents who could afford private insurance would seek coverage under the program, depriving low-income children of coverage. Republicans who voted against the bill also were concerned the bill would expand coverage to [...]

Proposed 2010-11 ICR/MR Rates – comment through 8/7/09

As a result HHSC’s delay in issuing the proposed rates, the public commet period has been extended through Friday, August 7, 2009 at 5:00 p.m. Take advantage of this opportunity to have your voice heard by emailing Pam McDonald with HHSC at pam.mcdonald@hhsc.state.tx.us by 5:00 p.m. on Friday, August 7, 2009. • The proposed rates [...]

2010 Payment Rate Changes

CMS announced that acute care hospitals will see a 2.1 percent payment rate increase as part of an inflation update. Skilled nursing facilities face a Medicare payment reduction of $360 million as part of a $1.050-billion case-mix adjustment decrease and a $690 million market-basket increase. Alan Rosenbloom of the Alliance for Quality Nursing Home Care [...]

TxHmL & HCS — Elimination of the Monthly Admin & Operations Fee

As you probably know by now, the admin/op fee of approx. $935 per consumer is set to be eliminated and tied directly to individual service rates. This rule will be republished in this Friday’s Texas Register and implemented October (not September) 1, 2009. Today, July 24, 2010, professional rates (RNs, LVNs, OTs, PTs, etc) will [...]

Proposed Changes to §335.723—So long flat rates…hello “weighted methodologies”

ATTENTION HCS & TxHmL Providers: CMS has directed HHSC to eliminate the current monthly Administration and Operations Fee (Adm & Op fee) and replace with a methodology that allocates these expenses across all HCS services. How will this directive impact you? It means that the current monthly “admin& op” fee used to reimburse providers for [...]

Rulings Favor California Providers

California is attempted to solve a budget deficit by cutting programs, and in-home care workers would have received a $2 hourly wage cut beginning July 1. A federal judge blocked the wage cut. In-home care workers in California will maintain their present wage level. (Source) The salary cut would have saved the state $98 million [...]

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