Good news for Medicaid facilities

Elizabeth Newman
Elizabeth Newman

Nursing homes that take Medicaid beneficiaries or dual eligibles often know they are admitting low-income, chronically ill seniors. Now there is some good news: The Centers for Medicare & Medicaid Services announced it will increase payments for dual eligibles enrolled in one of 12 state-administered demonstration programs.

CMS said it realized it was underfunding these health plans and originally said a bump in payments wouldn't happen for at least another year. These demonstration programs generally began under the Affordable Care Act and focus on care coordination. Despite long-term providers' feelings about the ACA (... so many feelings ...), most agree care coordination is solely lacking in this population.

As reported by Modern Healthcare, and according to a notice on Nov. 12, health plans under the Financial Alignment Initiative will see higher rates next year, with retroactive enhancement payments going to the beginning of 2016. Other dual plans will see the raise in 2017.

The move isn't because the Obama administration likes skilled nursing facilities, but because it wants to curb the long-standing problem around the cost of more than 9 million dual eligibles. This group makes up more than a third of all the money being spent in Medicare and Medicaid, even though they comprise under 8% of the enrolled population.

The plans need help due to high opt-out rates, with only 25% of beneficiaries eligible to participate enrolling. CMS also said in October it is looking at whether updating Medicaid factors to reflect payment year dual status improves the predictive radios of institutionalized beneficiaries.

In other Medicaid news, the House Energy and Commerce Committee voted to approve two bills Wednesday geared toward improving the program. One (H.R. 3716) is to improve oversight of terminated providers, a long-standing issue that hurts good providers. The bill would require state Medicaid and Children's Health Insurance Programs to report providers terminated for cause to CMS.

The other bill (HR 3821) would make state Medicaid programs with fee-for-service enrollees or primary care case management arrangements to have updated provider directories on websites. This, obviously, would make it significantly easier for beneficiaries to find a provider.

Change in Medicaid, or healthcare for that matter, often seems to come in fits and starts. But both CMS' acknowledgement of providers' lack of reimbursement and lawmakers' focus on small but meaningful changes show change can still come.

Elizabeth Leis Newman is Senior Editor at McKnight's. Follow her @TigerELN.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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