cmonfils | February 3, 2012
Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby boomers who are retiring and shifting from employer-sponsored health insurance to Medicare.
Category: CMS, Health Insurance, Medicaid, Medicare |
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cmonfils | February 3, 2012
TOPEKA, Kan. (AP) – Republican Gov. Sam Brownback won’t delay an overhaul of Medicaid in Kansas, officials said Thursday, despite bipartisan concern among legislators that his administration is moving too quickly to turn the entire program over to private health insurance companies.
Category: Kansas, Medicaid |
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cmonfils | January 30, 2012
Although more than half of the states are suing to get out of a massive Medicaid expansion under the federal healthcare overhaul, most also are working to overcome a key obstacle to growing their programs.
The Patient Protection and Affordable Care Act relies heavily on broadening eligibility in the joint federal and state program beginning in 2014 in order to extend health coverage to most Americans. The required Medicaid expansion also faces a constitutional challenge by 26 states on which the Supreme Court will decide by the end of its session in June. Those states maintain that the law creates an unconstitutional cost burden on their states beyond the federal government’s initial coverage of the cost of the new Medicaid enrollees.
http://www.modernhealthcare.com/article/20120121/MAGAZINE/301219954/
Category: Health Care Legislation, Medicaid, PPACA |
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cmonfils | January 15, 2012
2013 may be the most significant year in health care policy ever.
But we have to get through 2012 first.
Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.
If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of Congress, we can still expect a serious effort to change the law. Then there is the granddaddy of all problems, the federal debt. The 2012 elections could well prepare the way for entitlement reform—particularly for Medicare and Medicaid. Even if Obama is reelected, the 2013 agenda will include a serious debate about Republican ideas to change Medicare into a premium support system and block grant Medicaid to the states.
Category: Health Care Legislation, Medicaid, Medicare |
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cmonfils | January 13, 2012
To view a PDF version of this article, please click here.
The Centers for Medicare and Medicaid Services (“CMS”) posted Version 3.3 of the User Guide, dated December 16, 2011 (the “Version 3.3”) on its website.
Version 3.3 includes the guidance that CMS has provided in various alerts since the previous User Guide was published as of August 17, 2011. A link to the User Guide is included in footnote 1, below. A summary of all of the changes to Version 3.3 are available on pages 6 and 7 of the User Guide; however, the following summarizes the most significant changes:
Category: CMS, Medicaid, Medicare |
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cmonfils | January 11, 2012
No, it’s not quite going down. But health care spending in 2010 rose at the second-slowest rate in the last half-century.
The Centers for Medicare and Medicaid Services reports that total health spending in the U.S. increased by 3.9 percent in 2010, just a notch above the slowest rate since the government started keeping track — 3.8 percent in 2009.
http://www.npr.org/blogs/health/2012/01/09/144923401/growth-in-u-s-health-spending-stays-slow-experts-cite-lagging-economy?ps=sh_sthdl
Category: CMS, Medicaid, Medicare |
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cmonfils | January 5, 2012
HARTFORD, Conn. – In the past decade, most states have turned Medicaid over to private insurance plans, hoping they could control costs and improve care. Nearly half of the 60 million people in the government program for the poor are in managed-care plans run by insurance giants such as UnitedHealthcare and Aetna.
Category: Connecticut, Medicaid |
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cmonfils | January 3, 2012
Employer’s Guide to Self-Insuring Health Benefits December 2011 | Vol. 19, No.3
The lack of cost transparency stands in the way of health cost control because it makes plan members unable to see prices before services are actually rendered, and harms their ability to budget health spending. Problems include: (1) multiple providers; (2) multiple network-provider contracts; (3) providers that often don’t know how extensive a patient’s treatment needs are until they start treatment; (4) insurers say contractual obligations with providers prohibit the sharing of negotiated rates; and (5) providers afraid of sharing negotiated rates due to their proprietary nature. Leah Binder, CEO of the Leapfrog Group, suggested that most employers can bring more efficient purchasing to their health plan in two ways: (1) change plan documents to reward members for using high-performance providers (for example, by waiving deductibles); and (2) computerize drug ordering and management systems, which would have quality as well as cost and efficiency advantages. (more…)
Category: California, CMS, Florida, Massachusetts, Medicaid, Medicare, New Hampshire, Transparency, Wisconsin |
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cmonfils | December 29, 2011
To view a PDF version of this article, please click here.
Medicare expands resolution options to include a new Medicare repayment program for small settlements or judgments. This program will be available starting in February 2012 and applies to cases settling for $25,000 or less. Under this program, Medicare will provide final conditional payment amounts before settlement under certain circumstances. This program has the potential to revolutionize the settlement process for many Medicare beneficiaries, their counsel, and settling parties. The foundation of that process is to start the verification process early.
Category: CMS, Medicaid, Medicare |
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cmonfils | December 27, 2011
In a surprising move, the Department of Health and Human Services will not impose a uniform definition of “essential health benefits” (EHB) that individual and small group health insurance plans must provide in order to be offered on state exchanges starting in 2014.
Category: CHIP, Health Care Legislation, HHS, Medicaid, PPACA |
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cmonfils | December 27, 2011
www.myhealthguide.com
MyHealthGuide Source: Joanne Wojcik, 12/22/2011, Business Insurance SIIA Article
DETROIT — The Self-Insurance Institute of America Inc. has filed a lawsuit challenging a new Michigan law that is to start assessing a 1% tax on paid health care claims after Jan. 1, 2012.
The tax, which is being used to help fund the state’s Medicaid program, would be paid by insurers offering fully insured plans and by third-party claims administrators and stop-loss insurers in the case of self-funded plans. The assessment would be paid quarterly starting April 15, 2012. (more…)
Category: ERISA, Medicaid, Michigan, Self-Funding |
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cmonfils | December 15, 2011
The CMS said in a proposed rule that it recommends delaying data collection (PDF) in a reform law provision intended to expose financial relationships between drug and device manufacturers, GPOs and providers.
The agency said in the proposed rule that manufacturers and GPOs should not be required to start collecting information about their financial relationships with physicians and teaching hospitals on Jan. 1.
http://www.modernhealthcare.com/article/20111214/NEWS/312149973?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmFWdndGRWxiNUtpQzMyWmFwNW5nWUpidWk
Category: CMS, Health Care Legislation, Medicaid, Medicare |
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cmonfils | December 2, 2011
Now that the deficit-reduction supercommittee has failed to reach agreement, healthcare providers are dealing with the reality that things could get worse before they get worse.
A series of congressional hearings, intense lobbying efforts and countless closed-door meetings were not enough to help the 12-member Joint Select Committee on Deficit Reduction complete its task last week of delivering a proposal to Congress that identified ways to reduce the federal deficit by at least $1.2 trillion over the next 10 years. This summer’s Budget Control Act required that unless Congress could identify such savings, “sequestration” would kick in starting in January 2013, when $1.2 trillion in automatic, across-the-board cuts over 10 years will be split between defense and nondefense programs. The law limits the amount of healthcare savings by capping reductions to Medicare payments at 2%.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289960/cloudy-outlook
Category: Arizona, Health Care Legislation, Medicaid, Medicare, Pennsylvania, South Carolina |
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cmonfils | November 27, 2011
Nine of 10 leaders in health care and health care policy believe it is important for federal and state policymakers to continue to implement the Affordable Care Act, according to a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. Three-quarters of survey respondents think the growth in national health spending per capita can be lowered without harming access to or quality of care. Large majorities support implementation of specific coverage expansion provisions of the health reform law, including insurance market changes, Medicaid expansion, and premium tax credits. Leaders also believe it is important to implement payment and delivery system initiatives such as the Center for Medicare and Medicaid Innovation, Patient-Centered Outcomes Research Institute, and Independent Payment Advisory Board. Large majorities support key elements of President Obama’s recent framework to reduce the federal budget deficit by building on the law and achieving further savings in Medicare and Medicaid.
http://www.commonwealthfund.org/Publications/Data-Briefs/2011/Nov/Views-on-Health-Spending-and-Reform.aspx
Category: Health Care Legislation, Medicaid |
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cmonfils | September 16, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
In testimony before the House Subommittee on Oversight and Investigations on June 22, officials for the Centers for Medicare and Medicaid Services (CMS) defended how the Medicare Secondary Payer (MSP) program works, but GOP congressmen looked at billions of dollars of waste and gave CMS poor grades on tracking improper double payments. (more…)
Category: CMS, GAO, Medicaid, Medicare |
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