BRG Medicaid Update

Aug 12, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –   MA: MassHealth extends rate increase for eligible inpatient psychiatric facilities –   MD: State reopens Health Benefit Exchange coronavirus emergency special enrollment period –   PA: State maintains EPSDT benefits for beneficiaries turning 21, through end of COVID emergency –   TX: CMS approves FY21 Medicaid incentive payment funding for nursing facilities –   VA: Advocates sue Medicaid agency over budget-related cuts to hospital and ED rates Click to read...

FY 2021 Hospice Final Rule Increases Payments by +2.4%

Aug 11, 2020 | Hospice, Medicare

CMS issued the final rule that updates the FY 2021 Medicare payment rates and wage index for hospice facilities. Overall payments to hospice facilities will increase by +2.4%, or $540M—below the initial proposal, as CMS expects COVID-19 impacts on the economy to drive slower compensation growth and reduce the estimated market basket update. Click to read more.

Managed Care Friday

Aug 7, 2020 | Managed Care Friday

50: The reimbursement rate increase for child psychiatrists agreeing to be in the BCBS of Massachusetts network. This is a big deal - we only see these hikes when traditionally out-of-network service providers perhaps agree to come in-network for a deal, and even then, they can be rare. Child psychiatrists are in high demand throughout the US. Meanwhile, primary care doctors who "integrate" mental health into their practice here will be eligible for incentives. Question is whether integration will include using telepsych platform and whether PCPs will be effective at this, given the length...

CMS Moves Ahead With Medicare Physician Fee Schedule Overhaul

Aug 6, 2020 | Physician Fee Schedule, Physicians

CMS proposed relatively minor changes to its final rule from last year, which broadly overhauled the way evaluation and management (E&M) services are reimbursed by Medicare. The policy change increases payments for primary care services, but requires a significant budget neutrality offset that negatively impacts many physician specialties. Click to read more.

BRG Medicaid Update

Aug 5, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –   GA: State gets CMS approval to make retainer payments for several waiver programs –   MD: +4% rate increase for specific programs, effective July 1, 2020 –   MA: State makes ABA CPT code for parent support permanent –   MO: Voters opt to expand Medicaid, effective July 2021 Click to read more.

CY 2021 Proposed Rule for ESRD

Aug 4, 2020 | ESRD

CMS published the proposed CY 2021 rule for the end-stage renal disease (ESRD) prospective payment system (PPS), which will be finalized at least 60 days before January 1, 2021 – likely the week ending on Friday, October 30, 2020. This brief summarizes the proposed changes to the ESRD PPS, which applies to approximately 7,400 dialysis facilities. Click to read more.

Managed Care Friday

Jul 31, 2020 | Managed Care Friday

61: The percent of college students who will forgo school this year, according to our random poll of 417 incoming freshman and sophomores. Read what they’ll do instead and how it may impact healthcare by clicking here. David Gets a Win vs. Goliath in New Pay Model: BCBS of Massachusetts is launching a new payment model for small practices that will combine value-based care and support payments. The model is designed for practices with 1K-20K members and will incorporate upside risk. The pilot does not launch until 2021, but immediate support payments will go out to any provider participants...

BRG Medicaid Update

Jul 29, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  AZ: State releases its 2020 AMRP to assess the adequacy of FFS rates –  OH: State publishes RFP for a single PBM to process all Medicaid MCO pharmacy claims –  VA: Recently approved demo provides housing and employment services for high-need individuals Click to read more.

Recent Court Decisions Back Trump Administration Regulations

Jul 27, 2020 | Commercial Insurance, Exchanges, Hospitals, Legislation/ Budgets/ Macro

Three recent court decisions ruled in favor of the Trump administration regulations on price transparency, short-term plans, and hospital site-neutrality. While the rulings on short-term plans and site-neutrality uphold current regulations, the hospital price transparency rule will not go into effect until 2021. Trade associations that oppose the regulations intend to appeal these decisions. Click to read more.