longtermcare

Paragon Proposes Medicaid Reforms The conservative think tank Paragon Institute proposes to phase out the current 90 percent federal matching rate for the Affordable Care Act’s (ACA) Medicaid expansion and begin applying the regular federal match after eight years. It would also reduce the 50% Medicaid reimbursement floor to 40% for the richest states, also phased in over eight years. It says spending would be reduced by $600 billion from 2026 to 2034. Trump is known to pay attention to Paragon. While radical and it threatens to reduce coverage nationally, the proposal is less disruptive than the fundamental remake of the ACA and Medicaid attempted by Republicans during Trump’s first term. #aca #medicaid #coverage #reimbursement https://finance.yahoo.com/news/paragon-proposes-bold-medicaid-funding-100000986.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAJzUe6HiQKz3okVpdso7A0yLeZAIPW1Ub2ostzrg7ZONyQ8z1KWrDGM859gWDHSx-g-178HChmqc40o8i1lMq0Z0f8O1tXErWp6qrflxRiOQ5GwC6iEyxQ2Yhd9fdz-o9EckMhY6Yljg3gA_7GDG6JdxppPhxUpCV_1324WzFyBd CMS May Take A Tougher Oversight Stance On Medicaid Enrollment The Centers for Medicare and Medicaid Services (CMS) says it will adopt greater oversight of the Medicaid enrollment process in states given the major problems

Medicare Advantage Inpatient Days Rising Hospitals cry foul at every pass over Medicare Advantage (MA) plans’ efforts to control inpatient hospital utilization. But a new analysis from the Kaiser Family Foundation (KFF) shows that inpatient days attributable to MA have increased considerably over time. Medicare Advantage’s share of inpatient days grew from 13% to 23% from 2015 to 2022. As of 2022, nearly half (48%) of all Medicare inpatient hospital days were attributable to MA. The MA penetration in that year averaged just short of 46%. There are numerous other great statistics in the analysis. This year, MA plans are required to follow traditional program standards for deciding whether a stay is required and thus the share will increase more. #medicareadvantage #hospitals #priorauthorization https://www.kff.org/medicare/issue-brief/medicare-advantage-enrollees-account-for-a-rising-share-of-inpatient-hospital-days/ 2020 Exchange Risk Adjustment Payment Data Published The Centers for Medicare and Medicaid Services (CMS) published the annual risk adjustment reconciliation data today. Risk adjustment is

House Committee Grills Big 3 PBM Executives On Practices Executives from the Big 3 pharmacy benefits managers (PBMs) got grilled today before the House Oversight Committee. The committee just released a report on its over year-long investigation of the Big 3 that found that they are anticompetitive, imperil independent pharmacies, overcharge payers and patients using spread pricing, and enter into brand drug rebate deals that tie to the drugs’ preferential placement on formularies. The report concluded the Big 3 not only don’t save on or control costs but steer patients toward higher-priced drugs and their own pharmacies. The committee argued that the PBMs have created multiple ways to advantage themselves in the vertically integrated world the Big 3 live, including the use of group purchasing organization (GPOs). The executives tried to refute the findings and often were silent in response to questioning. The committee also criticized prior authorization and step

Probable Democratic Presidential Candidate Harris To Left Of Biden On Healthcare With endorsements stacking up, Vice President Kamala Harris looks to be the probable presidential nominee of the Democratic Party after President Biden bowed out this weekend. Thus, the media is looking at her positions, including on healthcare.  In general, Harris appears to be to the left of President Biden on a number of healthcare issues.  Harris will of course take credit for the Medicare drug price negotiations and Exchange premium enhancements. She would want to expand and extend each. She agrees with Biden’s anti-trust platform and was active on the issue as California’s attorney general. She may be to the left of Biden on abortion rights, universal access, and drug pricing.  Harris once backed Bernie Sanders’ Medicare for All, although she stepped it down later and advocated for a lighter form — a decade-long transition with private plans playing