Medicaid Reimbursement
The ACA makes changes to payments for some Medicaid-covered services that can affect Medicaid beneficiaries’ access to providers and services.
*Milestone details:
*Full name: Update Medicaid payment levels as required by the ACA.
*Relevance to the ACA:
The ACA requires some specific changes to Medicaid payment levels, including the following:
HCERA §1202 – Requires Medicaid agencies to pay at least the same amount that Medicare would pay for primary care services delivered by primary care providers, and provides 100% FMAP for the increased cost from 2013 until 2015.
HCERA §1203 – Sets a formula for reductions in State Medicaid DSH allotments based in part on how states target DSH payments to hospitals. The largest reductions are imposed on states that do not target their DSH payments to hospitals with high volumes of Medicaid inpatients or high levels of uncompensated care.
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District of Columbia
Last week, CMS published this final rule for increased Medicaid reimbursement for primary care providers. The rule takes effect in January 2013 and pays these providers at Medicare rates for calendar years 2013 and 2014. Increased reimbursement will apply to services provided to Medicaid enrollees by physicians practicing family medicine, general internal medicine, pediatric medicine, and related subspecialties.
District of Columbia
The Center for Health Care Strategies (CHCS) has put together a summary of the regulation, highlighting select provisions for states to consider when planning implementation.
New Jersey
On May 9, 2012, CMS released proposed regulations for implementing the Medicaid primary care rate increase under Section 1902(a)(13) of the Affordable Care Act (ACA).
This fact sheet from the Center for Health Care Strategies provides an initial overview of the planned regulatory approach and briefly outlines next steps for states.
District of Columbia
This brief from the Center for Health Care Strategies provides sample performance measures states can use to assess the impact of the Medicaid primary care provider pay increase on access, utilization and quality. Curious about the size of the "bump" in your state? See Table 1.
District of Columbia
CMS recently issued a proposed rule that outlines steps states can take in assessing access to care for Medicaid beneficiaries prior to changing provider reimbursements. The rule includes possible data sources states could use to assess access. Comments on the rule will be accepted until July 5.
District of Columbia
This report by the New York State Health Foundation details the challenges and opportunities NY faces in implementing reform, including Exchange, benefit design and payment issues. Access the report here: http://www.statereforum.org/sites/default/files/nyroadmappaper_aug2010.pdf
District of Columbia
This report discusses progress made by Maryland’s Health Care Workforce Workgroup and options for strengthening workforce capacity and the delivery system. Highlights include discussions on licensing, education, and provider recruitment.
Access the report here:
http://www.statereforum.org/sites/default/files/md_finalreportdeliverysy...