Medicaid Reimbursement

New Medicaid Payment Model Targets Behavioral Health Integration

January 18, 2024 - CMS has announced a new Medicaid payment model that will incent care coordination across physical, behavioral, and social providers to improve the quality of care Medicare and Medicaid beneficiaries receive. The model, called the Innovation in Behavioral Health (IBH) Model, is part of the Biden Administration’s new HHS Roadmap for Behavioral...


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Hospitals Concerned About Medicaid State-Directed Payment Changes

by Jacqueline LaPointe

Eight leading healthcare industry groups are urging CMS to abandon proposed restrictions on provider-based Medicaid funding sources, citing coverage and cost consequences if the proposals are...

States Boosting Medicaid Payment Rates for Home Healthcare Amid Shortages

by Victoria Bailey

Most states have increased Medicaid payment rates for home healthcare providers as the sector grapples with staffing shortages, according to a KFF issue brief. The COVID-19 pandemic exacerbated...

Over 230 House Reps Join Fight Against Medicaid DSH Cuts

by Jacqueline LaPointe

Enacting scheduled cuts to Medicaid Disproportionate Share Hospital (DSH) payments would leave the most vulnerable patients and providers open to more access to care problems, a bipartisan group of...

As Medicaid Unwinds, Hospitals Seek Relief from DSH Payment Cut

by Jacqueline LaPointe

Hospital and health system advocates are calling on lawmakers to stop an $8 billion cut to Medicaid Disproportionate Share (DSH) payments to safety-net hospitals. A letter sent to Congressional...

CMS Proposes to Implement Changes to Medicaid DSH Calculations

by Jacqueline LaPointe

CMS has proposed a rule to update the regulatory requirements of the Disproportionate Share Hospital (DSH) program in response to the Consolidated Appropriations Act of 2021, including implementing...

Higher Spending on Nursing Home Staff is Not Tied to Better Staffing Levels

by Victoria Bailey

Nursing homes with higher shares of Medicaid residents directed more revenue toward workers but had lower staffing levels, indicating that a minimum nursing staff expenditure regulation would not...

Two-Thirds of People Evade Coverage After Medicaid Disenrollment

by Jacqueline LaPointe

In a year after Medicaid disenrollment, about two-thirds of people had a period of uninsurance, according to a recent analysis from Kaiser Family Foundation (KFF). The Families First Coronavirus...

Study: Safety-Net Hospitals Miss Out on Some Medicaid DSH Payments

by Jacqueline LaPointe

Over a third of Medicaid disproportionate share hospital (DSH) payments may have been misallocated, according to a study led by Weill Cornell Medicine and University of Pennsylvania investigators. The...

Improper Payment Rate for Federally Facilitated Exchange Fell Under 1%

by Victoria Bailey

The improper payment rate for the federally facilitated exchange (FFE) program was less than 1 percent in 2020, according to the annual 2022 Agency Financial Report from CMS and HHS. Improper payments...

Medicare, Medicaid DSH Payment Methods Exacerbate Racial Disparities

by Victoria Bailey

Disproportionate share hospital (DSH) payments from Medicare and Medicaid may further racial disparities by basing allocations on patient healthcare use, a study published in JAMA Network Open...

Medicare, Medicaid Payment Policies Inconsistent for Dual Eligibles

by Victoria Bailey

Poor alignment in the Medicare and Medicaid programs leads to higher spending and worse outcomes for dual eligible beneficiaries. Thus, policymakers should develop payment policies that offer a more...

Hospital Reimbursement Boosts Access to Birth Control Postpartum

by Jacqueline LaPointe

A new study recently published in JAMA Network Open indicates that hospital reimbursement for immediate postpartum long-acting reversible contraception (LARC) leads to greater access to birth control...

CMS Urges States to Tie Nursing Home Medicaid Payment to Quality

by Jacqueline LaPointe

CMS is pushing for more value-based reimbursement, this time for nursing home Medicaid payment. The federal agency has sent an informational bulletin to states urging them to tie Medicaid payments for...

Senate Scraps Medicaid DSH Cuts in Latest Build Back Better Act

by Jacqueline LaPointe

An updated Build Back Better Act from the Senate Finance Committee does not include provisions that would reduce Medicaid Disproportionate Share Hospital (DSH) payments. A previous version of the bill...

Medicare FFS Improper Payment Rate Hits Low of 6.26%

by Jacqueline LaPointe

CMS continues to control improper payments in Medicare fee-for-service (FFS). The federal agency recently announced that the 2021 Medicare FFS improper payment rate hit a historic low of 6.26 percent...

MA Reimburses 2X Medicare Rate for Some COVID-19 Vaccinations

by Jacqueline LaPointe

Healthcare providers in Massachusetts are getting twice the standard Medicare rate for COVID-19 vaccinations in an effort to accelerate vaccine rollout, according to a recent provider bulletin from the...

Medicaid Physician Reimbursement Rates Lag Medicare

by Jacqueline LaPointe

Medicaid physician reimbursement is significantly lower than commercial payer and even Medicare payments for the same services despite growing enrollment in the public healthcare program, reveals a new...

Medicare, Medicaid Payments Off Actual Costs By $75.8B in 2019

by Jacqueline LaPointe

Hospitals received just 87 cents for every dollar they spent caring for Medicare patients and 90 cents for every dollar on Medicaid patients in 2019, according to new data from the American Hospital...

Medicaid Expansion Still Boosting Hospital Finances

by Jacqueline LaPointe

A study coming out of the Urban Institute shows that hospitals continue to reap the financial benefits of Medicaid expansion. The study recently published in Health Affairs found that hospitals in...