POLICY BRIEFINGS


CMS Releases Medicaid/CHIP Enrollment Numbers


According to a report released by the Centers for Medicare and Medicaid Services (CMS), enrollment in the Medicaid program has surged across the U.S. since the ACA’s first open enrollment period for the marketplace began in October 2013. 10.75 million people were enrolled in Medicaid or CHIP as of December 2014. This amounts to an 18.6 percent increase over enrollment numbers before the ACA’s marketplaces opened. While enrollment increases surged upwards of 30 percent in states that expanded their Medicaid programs, enrollment only climbed seven percent in states that did not participate in Medicaid expansion.


Medicare Reform Bills Move Through Ways and Means


The House Ways and Means Committee has approved four bills aimed at overhauling the Medicare program. H.R. 1021, the Protecting Integrity in Medicare Act (PIMA), is aimed at improving the integrity of the Medicare program. It would remove Social Security numbers from Medicare cards, combat prescription drug abuse, and allow patients to receive electronic benefit summary notices. H.R. 284 would require Medicare suppliers that bid under a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program to submit binding bids or risk forfeiture of a surety bond. H.R. 876 would require hospitals to notify beneficiaries of their admission status of “inpatient” versus “under observation.” H.R. 887 would prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user.


Legislation Introduced to Address Medicare Fraud


Sen. John Thune (R-S.D.) and Sen. Mark Warner (D-Va.) have introduced S. 584, the Better Efficiency and Administrative Simplification Act, which would permit Medicare beneficiaries to receive electronic benefit notices. This provision was included in the Protecting the Integrity of Medicare Act (PIMA), which moved through the House Ways and Means Committee last week. S. 584 would also change the Medicare contracting process by giving CMS the ability to increase the length of contract years for Medicare Administrative Contractors (MAC). The agency would also be given additional flexibility in awarding new contracts when MACs are not meeting CMS requirements.


ACO White Paper Unveiled by Fix the Debt, Dartmouth-Hitchcock Health, Dartmouth College


The Campaign to Fix the Debt, the Dartmouth Institute, and Dartmouth Hitchcock Health have released a white paper titled Medicare Slowdown at Risk: The Imperative of Fixing ACOs, which outlines the reforms that need to be made to the Accountable Care Organization (ACO) program in order to improve the financial model facing ACOs and increase patient engagement. The white paper follows a summit convened in September of last year to discuss ways to reform Medicare and move away from fee-for-service payments. The paper argues that ACO programs need a better methodology for determining initial benchmarks in order to correct the current perverse incentives that are potentially penalizing successful ACOs with lower subsequent benchmarks. The authors consider policies to incentivize and maintain participation in ACOs from low-cost providers. Additionally, the paper identifies tools to encourage ACOs to accept two-sided risk. To increase patient engagement, the white paper suggests that the existing attribution model be improved and first-dollar supplemental coverage be restricted. The report also argues that CMS should allow beneficiaries to attest that they want to belong to an ACO, for the purposes of patient engagement.



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