The proposed reduction in payments — announced by the Centers for Medicare & Medicaid Services — is set to remedy an unintended 5% increase in payments for fiscal 2020, the agency said. Also in the news, a Montana hospital for psychiatric patients faces a loss of federal funding.
CMS Proposes Pay Decrease For Nursing Homes
Nursing homes may see a $320 million cut to their Medicare Part A payments in fiscal 2023 under a proposed rule the Centers for Medicare and Medicaid Services issued Monday. The proposed rule also seeks feedback on how to establish minimum staffing requirements for nursing homes, as directed by President Joe Biden, and includes a plan to add three measures to the Skilled Nursing Facility Value-Based Purchasing Program. (Goldman, 4/11)
In other news about Medicare —
Will Biogen Sue Medicare Over Its Limits On The Alzheimer’s Drug Aduhelm?
Biogen and other drugmakers have already hinted they might sue Medicare over its decision to limit coverage for the controversial new drug, Aduhelm — a legal challenge that could have massive implications for patients and pharmaceutical companies that extend far beyond those focused on Alzheimer’s disease. Even before Medicare officials made their limits on the drug official last week, Biogen had said it didn’t believe such restrictions would hold up in court. Other drugmakers potentially impacted by the decision, like pharmaceutical giant Eli Lilly, raised similar objections. (Florko, 4/12)
State ‘Evaluating’ Patient Transfers From Mental Hospital Following Loss Of Funding
Patient advocates fear the Montana State Hospital could fall further into a tailspin as the state-run facility is poised to lose federal funding for services starting Tuesday because of repeated failures to maintain health and safety standards. In interviews Monday, mental health professionals gave a grim picture of the availability of beds elsewhere in the state for patients who may have to relocate from the state-run hospital due to the loss of funding. Because of the end of reimbursement for services by the federal Centers for Medicare and Medicaid for people covered by either of those insurance programs, state officials said Monday they are exploring transfers for some patients. CMS will continue making payments for 30 calendar days for patients admitted on or before April 11. (Larson, 4/12)
Becker’s Hospital Review:
US Hospitals With The Highest Share Of Patients On Medicare
Becker’s calculated which U.S. hospitals have the highest share of their patients covered under Medicare. The 2019 data released April 5 is from the coverage, cost and value team at the National Academy for State Health Policy in collaboration with Houston-based Rice University’s Baker Institute for Public Policy. (Emerson, 4/11)
And in news on Medicaid —
Fresh Take Florida:
Deadline Passes For Sunshine State Health Plan To Challenge $9.1 Million Medicaid Fine
The deadline set by Florida lapsed for its largest Medicaid payment vendor to challenge a nearly $9.1 million fine over the company’s failure for nearly three months to pay tens of thousands of health care claims for the state’s sickest and neediest children. Sunshine State Health Plan Inc. of Tampa had until 5 p.m. Thursday to dispute the large fine imposed last month by its government regulator, the Agency for Health Care Administration, leaving the company with only the option to concede to pay. “Sunshine waives any dispute not raised within 21 days,” the government had warned the company March 17. (Bausch, 4/11)
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.