In an effort to provide low-cost prescription drugs to the state’s uninsured, Maryland proposed to offer them prescription drugs at Medicaid prices, but the Centers for Medicare and Medicaid Services (CMS) rejected the plan. (Kaiser Network) The state sought to finance the plan through various sources, including through pharmaceutical company rebates. This is not a legitimate source for matching funds, says CMS spokesperson Mary Kahn. The federal government matches state Medicaid … [Read more...] about CMS Says No to Maryland Drug Plan Proposal for Uninsured
New Hampshire Nursing Homes Sue DHHS
On occasion, I’ve blogged about nursing homes and the “burden†of Medicare Part D. In July, I told you that pharmaceutical representatives testified on Capitol Hill that nursing homes are losing money under the program. Nursing homes are also concerned about Medicaid under-reimbursements. Sixty nursing homes in New Hampshire are suing the Department of Health and Human Services for $4.4 million for care given to Medicaid beneficiaries since 2002. From the Kaiser Network: The … [Read more...] about New Hampshire Nursing Homes Sue DHHS
Texas Register Updates: Transfer of Assets, Provider Payments
Texas Health and Human Services Commission (HHSC) has adopted new rules that affect various provisions of Chapter 358, Medicaid Eligibility. The following are new sections: (from the September 22 Texas Register): §358.431 Transfer of Assets §358.432, Home Equity Treatment §358.433, Treatment of Entrance Fees for Individuals Residing in Continuing Care Retirement Communities HHSC adopted the changes to incorporate mandatory provisions of the Social Security Act. In related … [Read more...] about Texas Register Updates: Transfer of Assets, Provider Payments
Texas Register Updates: Medicaid Payment Limits; Patients Rights
The Texas Health and Human Services Commission (HHSC) will submit Amendment Number 747 to the Texas State Plan for Medical Assistance. From the September 8 Texas Register: Amendment 747 revises the methodology used by the State to estimate the Medicaid Upper Payment Limit (UPL) for hospital inpatient services. The UPL is the federal limit on Medicaid payments to a group of hospitals and is determined under Federal regulations as a reasonable estimate of the amount that would be paid for the … [Read more...] about Texas Register Updates: Medicaid Payment Limits; Patients Rights
CMS Chief to Resign
Mark McClellan, Administrator of the Centers for Medicare and Medicaid Services (CMS), is resigning. McClellen had been CMS chief since March 2004. According to Medical News Today, McClellan is headed to the conservative think tank, American Enterprise Institute. McClellan, born right here in Austin, Texas, oversaw the launch of Medicare's new prescription drug program, Medicare Part D. He is a medical doctor who's served in the federal government since the late 1990s. He is the brother … [Read more...] about CMS Chief to Resign
Texas Register Publishes Changes to Medicaid Managed Care and Other Services
Texas Health and Human Services Commission (HHSC) has adopted new rules that affect various provisions of Chapter 353 Medicaid Managed Care. The following rules are amended (from the August 25 Texas Register): §353.2, Definitions; §353.3, Experience Rebate in the Managed Care Program; §353.403, Enrollment; §353.405, Marketing; §353.407, Requirements of Health Maintenance Organizations; §353.409, Scope of Services; §353.411, Accessibility of Services; §353.413, Managed Care Benefits and … [Read more...] about Texas Register Publishes Changes to Medicaid Managed Care and Other Services
Georgia’s $100,000 Medicaid Estate Exemption Fails
Citing the figure as "somewhat excessive," the Centers for Medicare and Medicaid Services rejected Georgia's attempt to raise the state's Medicaid estate recovery exemption from $25,000 to $100,000. (Medical News Today) To offset the costs of nursing home care, states are required by federal law to recover money from a beneficiary's estate. Current Georgia law exempts the first $25,000. For more information, visit on Medicaid estate recovery in Texas, visit the estate recovery program … [Read more...] about Georgia’s $100,000 Medicaid Estate Exemption Fails
Former HHS Chief Says Feds Should Be Responsible for Medicaid Long Term Care
The federal government and the states currently share responsibility for Medicaid long term care. Tommy Thompson, former U.S. Health and Human Services secretary, says that should change in light of the approaching retirement of the baby boomers. Medicaid is already burdening the states, and it will get worse in the next few years. Thompson believes the federal government should be responsible for long term care of the elderly, while the states focus on "acute care for those under 65." … [Read more...] about Former HHS Chief Says Feds Should Be Responsible for Medicaid Long Term Care
New Policy Changes for Dual Eligibles; Physician Groups to Lobby Congress
The Long Term Care Partnership Program (which encourages people to buy private long term care insurance) will be extended from five states to 50, according to the Centers for Medicare and Medicaid Services (CMS). That is one example of CMS's new policy changes for Medicaid coverage of dual eligible beneficiaries. Apparently, some recipients who wouldn't ordinarily qualify for Medicaid (created for people with low incomes) hide assets in order to qualify for the federal insurance program. … [Read more...] about New Policy Changes for Dual Eligibles; Physician Groups to Lobby Congress
Texas Register Updates; New OIG Report
The Texas Health and Human Services Commission (HHSC) recently adopted amendments to §371.204 and §371.208, relating the Hospital Screening Criteria for Texas Medical Review Program (TMRP), Tax Equity and Fiscal Responsibility Act (TEFRA), and LoneSTAR Select II Contract Reviews and Appeals Related to Utilization Review Department Review Decisions. For more information, see this section of the July 14 Texas Register. The Board of Nurse Examiners will review and consider whether to re-adopt, … [Read more...] about Texas Register Updates; New OIG Report