Illinois lawmakers approve sweeping changes to nursing home funding meant to increase staffing and improve care
Responding to long-standing problems that were made worse by the COVID-19 pandemic, a bill approved late Thursday would increase payments to nursing homes and tie much of the increase to staffing levels and quality of care.chicagotribune.com
The end of the pandemic could usher in a spike in the uninsured rate
Democrats who hoped they'd have transformational new health legislation in place by next year could instead be facing one of the largest increases in the U.S. uninsured rate in recent history.Why it matters: Temporary pandemic-era reforms to Medicaid and the Affordable Care Act marketplaces caused enrollment in each to swell, but these policy changes are due to end soon, and millions of people could lose their health coverage.Stay on top of the latest market trends and economic insights with Axinews.yahoo.com
Federal government approves California's Medicaid overhaul
The U.S. government has approved California's overhaul of the nation's largest insurance program for low-income and disabled residents, officials said Wednesday, a decision that among other things allows Medicaid money to be spent on housing-related services as the most populous state struggles with homelessness and a lack of affordable housing. CalAIM — California Advancing and Innovating Medi-Cal — intends a more comprehensive approach that improves the "entire continuum of care” across the program that California calls Medi-Cal, according to the California Department of Health Care Services. Starting with the new year Saturday, California will among other things expand what had been a limited “whole person care pilot program" to eligible Medi-Cal members statewide.news.yahoo.com
Flower Mound Hospital to Pay $18.2 Million to Settle Federal and State False Claims Act Allegations Arising from Improper Inducements to Referring Physicians
Both the Stark Law and the Anti-Kickback Statute are intended to ensure that medical judgments are not compromised by improper financial inducements. In connection with the settlement, Flower Mound Hospital entered into a five-year Corporate Integrity Agreement (CIA) with the HHS-OIG. The CIA requires, among other things, that Flower Mound Hospital maintain a compliance program and hire an Independent Review Organization to review arrangements entered into by or on behalf of the hospital. The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Leslie Jennings, M.D., a physician-owner at Flower Mound Hospital. Jennings v. Flower Mound Hospital Partners, LLC, et al., Civil Action No.justice.gov
Texas Pain Management Physicians Agree to Pay $3.9 Million to Resolve Allegations Relating to Unnecessary Urine Drug Testing
Two Texas physicians, Robert Wills and Brannon Frank, have agreed to pay $3.9 million to resolve allegations that they violated the False Claims Act by knowingly billing Medicare, Medicaid and TRICARE for medically unnecessary urine drug testing. Starting in 2011, all urine drug tests ordered by Austin Pain Associates’ physicians, including Wills and Frank, were performed at Austin Pain Associates’ in-house laboratory. Pursuant to their respective settlement agreements, Wills has agreed to pay $2,100,000 to settle these allegations and Frank has agreed to pay $1,800,000. The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Jennifer Nuessner and Robert Hoffman, former employees of Austin Pain Associates. v. Austin Pain Associates, LLC, et al., 5:16-CV-1125-FB (W.D.justice.gov
Court sides with Texas in dispute with Biden administration over Medicaid funding
U.S. District Judge J. Campbell Barker handed Texas another win against the Biden administration Friday, this time over Medicaid funding, granting Attorney General Ken Paxton’s request for an injunction and denying the administration’s motion to dismiss.news.yahoo.com
Reports points to more jobs, other benefits from Medicaid expansion
Florida could add 134,700 jobs, lower the number of uninsured residents by 852,000 and pump billions of additional federal dollars into the economy if it would expand Medicaid to low-income adults without children, according to a report released Thursday.
Florida House eyes cuts for nursing homes, hospitals
The House on Thursday rolled out a health care spending proposal that includes deep cuts, including slicing Medicaid reimbursements to nursing homes by 2 percent, or $80.4 million in state and federal funding. Florida Health Care Association President Emmett Reed said the proposed Medicaid cuts to nursing homes would translate to about a $125,000 reduction in payments per facility per year. In all, the House proposed spending roughly $42.1 billion across the state’s six health care-related agencies. Unlike the House, the Senate proposal wouldn’t cut funding for nursing homes. The House has proposed increasing the rates by $12.1 million in overall funds, while the Senate has proposed a $36.6 million increase.
COVID-19 law sparks dialogue on nursing home alternatives
Now, the COVID-19 relief bill is offering states a generous funding boost for home- and community-based care as an alternative to institutionalizing disabled people. (AP Photo/Charles Krupa)WASHINGTON – With the memory of the pandemic's toll in nursing homes still raw, the COVID-19 relief law is offering states a generous funding boost for home- and community-based care as an alternative to institutionalizing disabled people. As it has grown to cover about 1 in 5 Americans, it's also become the nation's default long-term care program, although qualifying is often an arduous process. While the federal government requires state Medicaid programs to cover nursing home care for low-income people, that's not the case for home- and community-based support services. For now, states and advocates for the disabled are awaiting guidance from the federal Centers for Medicare and Medicaid Services on how the money in the COVID-19 law can be spent.
House unveils plan to extend postpartum Medicaid coverage to tackle minority disparities
Florida’s House Speaker has vowed to tackle the disparities and he’s now backing legislation that would extend Medicaid eligibility for postpartum care. In Florida, nearly half of all births are covered by Medicaid, but recipients are only eligible for two months of postpartum care. “One-third to one-half of maternal deaths occur in the postpartum period,” said House Speaker Chris Sprowls. Sprowls is backing legislation that would extend coverage for the first time since 1976. Under the $240 million plan, Medicaid would cover mothers up to a year after delivery.
Medicaid incentive so far not enough to sway holdout states
Henry McMaster remains firmly opposed to the Medicaid expansion. The bump in federal funding would last two years for the states that join the Medicaid expansion. Laura Kelley this year called for legalizing medical use of marijuana and using the tax revenue to pay for expanding Medicaid. "It’s a nonstarter, and we will continue to oppose the liberal wish list item of Medicaid expansion,” he said. Kay Ivey left open the possibility of expanding Medicaid at some point in the future, but there are no plans to do so.
Medicaid offers free transportation for COVID-19 shots
Florida’s Medicaid program will provide free transportation for people enrolled in the program who want to get COVID-19 vaccinations. The Agency for Health Care Administration announced Wednesday that members of Medicaid managed-care plans should let their health plans know they need rides when they are scheduling vaccinations. Medicaid enrollees who aren’t in managed-care plans can call a Medicaid helpline at 1-877-254-1055 to get the names and phone numbers of transportation services. Rides should be scheduled, according to an AHCA memo, at least three days in advance of the vaccination appointments.
Lawmakers mull how to spend $10B in federal COVID relief funds
TALLAHASSEE – Now that President Joe Biden has signed the American Rescue Plan, Florida lawmakers must decide how to spend $10 billion in federal COVID relief funds. “A lot of our ongoing budget challenges are non-recurring,” said Senate Budget Chair Kelli Stargel. These are recurring expenses and that influx of money is non-recurring funds. The governor has suggested lawmakers set the state budget at $96.6 billion, more than $4 billion higher than the current budget. Even with the new federal funds, lawmakers have remained skeptical of such a large increase.
Justices call off arguments over Medicaid work requirements
WASHINGTON – The Supreme Court said Thursday it has called off upcoming arguments over a Trump administration plan to remake Medicaid by requiring recipients to work, agreeing to a request from the Biden administration. But the Biden administration already has decided preliminarily that work requirements do not fit with Medicaid's goal of providing health care to lower-income people. AdOther cases involved Trump administration immigration policies and a fight over unreleased portions of grand jury documents from special counsel Robert Mueller’s investigation of Russian interference in the 2016 elections. The high court had in December agreed to review lower-court decisions involving Arkansas and New Hampshire that found that the Trump administration’s support for work requirements went beyond what’s allowed by law. Arkansas had opposed the Biden administration’s request that the cases be dropped.
COVID-19 bill gives states pathway to reduce maternal deaths
Labor and delivery are thought of as the riskiest times for new mothers, but many women die in the months after giving birth. The legislation gives states the option of extending Medicaid coverage to women with low to modest incomes for a full year after childbirth. Maternal health advisory groups in 19 states, from Texas to Massachusetts, and Washington to Tennessee, have recommended such an extension. AdSome Republicans who disdain the $1.9 trillion coronavirus relief package say they would like to see the maternal health provisions made permanent. “We must strive to improve maternal health outcomes and reduce maternal mortality,” said Rep. Michael Burgess, R-Texas, who cosponsored legislation with Kelly, the Chicago Democrat, in the last Congress.
Georgia House passes budget as GOP rejects Democrat Medicaid expansion
The state would spend $27.2 billion in state tax money, plus billions more in federal money and money raised in fees and tuition. That’s up from $26.6 billion in state money this year. Brian Kemp had already proposed spending $22 million more on mental health, but House members want an overall increase of $58 million. The House would spend more on service providers, including $12.3 million for a 5% rate increase for providers of adult intellectual and developmental disability services. Ad“This House of Representatives recognizes the need for these services and is prioritizing them accordingly,’' said Ralston, a Blue Ridge Republican.
Biden asks high court to drop 2 Trump-era Medicaid cases
WASHINGTON – The Biden administration is asking the Supreme Court not to hear arguments in two cases on its March calendar about the Trump administration's plan to remake Medicaid by requiring recipients to work. The Biden administration has been moving to roll back those Trump-era plans and cited “greatly changed circumstances” in asking Monday that the cases be dropped from the court's argument calendar. The high court had in December agreed to review lower-court decisions involving Arkansas and New Hampshire that found that the Trump administration’s support for work requirements went beyond what’s allowed by law. Medicaid is a $600 billion federal-state program that covers about 70 million people, from pregnant women and newborns to disabled people and nursing home residents. Under the Obama-era Affordable Care Act, states gained the option of expanding the program to many low-income adults previously ineligible.
Biden administration to undo Medicaid work requirements
(AP Photo/Evan Vucci)WASHINGTON – The Biden administration is moving to roll back Medicaid work requirements in its latest effort to undo a controversial Trump-era policy. Federal health officials planned Friday to inform 10 states that they would revoke permissions granted by the Trump administration to impose such requirements, according to a Biden official who spoke on condition of anonymity to discuss internal plans. Officials were also set to withdraw the past administration’s invitation for states to apply for approval for work requirements. AdThe Trump administration allowed states to require “able-bodied” adults drawing Medicaid benefits to work, volunteer or study. Before the pandemic, nearly 20 states had tried to implement requirements after the administration invited them in 2018 to submit such proposals.
Kansas governor: Medical pot should fund Medicaid expansion
Kelly championed Medicaid expansion in her first race in 2018 and promised to sign legislation legalizing medical marijuana, though she has not pushed that issue aggressively so far. But University of Kansas political scientist Patrick Miller said he wonders why any Kansas politician still opposes medical marijuana. The Legislature has taken only relatively small steps toward legalizing medical marijuana even as most other states have done it. She said legalizing medical marijuana could raise up to $50 million a year and her proposal “eliminates the argument” that Kansas can't afford Medicaid expansion. AdBut Republican lawmakers remained skeptical that medical marijuana could raise much money or cover Medicaid expansion costs.
Biden opens 'Obamacare' window for uninsured as COVID rages
AdThe Biden administration has ample resources for marketing, said Karen Pollitz, a health insurance expert with the nonpartisan Kaiser Family Foundation. “The reason it wasn’t spent is the Trump administration spent its time in office cutting services that support consumer enrollment,” Pollitz said. He cited a Trump policy that allows employers to provide tax-free money for workers to buy individual plans. AdThe idea of reopening Obamacare's health insurance markets in the pandemic has had broad support from consumer, medical, and business organizations. As the number of uninsured Americans grew because of job losses in the pandemic, the Trump administration resisted calls to reopen HealthCare.gov.
Biden to reopen 'Obamacare' markets for COVID-19 relief
President Joe Biden holds his face mask as he delivers remarks on COVID-19, in the State Dining Room of the White House, Tuesday, Jan. 26, 2021, in Washington. (AP Photo/Evan Vucci)WASHINGTON – Fulfilling a campaign promise, President Joe Biden plans to reopen the HealthCare.gov insurance markets for a special sign-up opportunity geared to people needing coverage in the coronavirus pandemic. Biden is expected to sign an executive order Thursday, said two people familiar with the plan, whose details were still being finalized. Coverage is available to people who don't have job-based health insurance, with the Medicaid expansion geared to those with low incomes. “President Biden does not believe, as a principle, it should be difficult ... for people to gain access to health care,” she said.
Florida lawmakers face $2.1 billion budget shortfall
TALLAHASSEE, Fla. – State lawmakers are facing a $2.1 billion pandemic-induced budget shortfall for the budget starting in July, and that’s the best-case scenario, according to state economists. The revenue shortfall means lawmakers will face tough decisions crafting next year’s state budget. While state economists project a $2.1 billion shortfall, the number is heavily dependent on how the economy recovers, something difficult to project in a once in a lifetime pandemic. State economists predict it could take between one and two years. State economists’ latest projections are largely based on data from November and September.
Stimulus money intended for nursing home residents, not the facility, FTC reiterates
That new round of stimulus money going out right now for those who qualify is $600. And if you or a loved one lives in a nursing home or assisted living facility, that money is not for the facility. The Federal Trade Commission says when the first round of stimulus money was sent out last year, certain facilities tried to keep that money from residents particularly those on Medicaid. The FTC says a facility cannot require somebody to sign it over to them even if that somebody is on Medicaid. If that money is taken by a facility, the FTC says to report it right away to the state attorney general and the FTC.
Medicaid costs, enrollment spiral in pandemic
The COVID-19 pandemic, which has played a major role in increased enrollment, hit the state several months into the 2019-2020 fiscal year. Despite the tremendous increase in enrollment and costs, the economists say Medicaid will have a $342.8 million surplus in general revenue funds this fiscal year. The increased costs are driven primarily by a surge in enrollment as the COVID-19 pandemic has caused widespread job losses and new demands on the health-care system. Florida’s Medicaid enrollment was around 3.9 million people before the pandemic. Because Medicaid enrollment increases come during recessions when there is less tax revenue to pay for the program, it puts strains on state budgets.
Medicaid enrollment surge means major workload for state
The department generally reviews Medicaid beneficiaries’ eligibility each year. The federal Centers for Medicare & Medicaid Services has indicated it will issue guidance in the coming weeks about how state Medicaid officials should proceed with the annual reviews. Florida’s Medicaid program, which provides services to poor, elderly and disabled beneficiaries, had 4.417 million people enrolled as of Oct. 30, according to Agency for Health Care Administration data. AHCA runs much of the Medicaid program, but the Department of Children and Families handles issues such as eligibility determinations. They also are applying for the Temporary Assistance to Needy Families program, which provides financial assistance to unemployed families, and a federal food-assistance program.
Feds fine Jacksonville radiology practice $1.4 million after fraud allegations
JACKSONVILLE, Fla – A Jacksonville radiology practice has agreed to pay the United States $1.4 million after allegations that it knowingly submitted false claims to Medicare and Medicaid for radiological images that were ineligible for reimbursement, the Department of Justice announced Friday. (MBB) billed healthcare programs for radiological images that were interpreted outside the United States. “Today’s announcement demonstrates the Justice Department’s commitment to protect public funds and our healthcare beneficiaries,” said United States Attorney Chapa Lopez in a press release. Heyck sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the United States for false claims and to share in the recovery. “Knowingly submitting false claims for financial gain is unacceptable,” said Special Agent in Charge Omar Perez Aybar of the U.S. Health and Human Services, Office of Inspector General.
Feds approve Georgia health insurance changes sought by Kemp
ATLANTA – Georgia will become the first state to offer federally subsidized health insurance to its residents only through private brokers under a plan being approved by President Donald Trump’s administration. Medicaid expansion, as originally envisioned under President Barack Obama’s federal health overhaul, planned for Georgia to offer state-federal Medicaid coverage to all able-bodied adults making up to 133% of the federal poverty level. The governor again dismissed full Medicaid expansion as too expensive, saying it would cost $547 million yearly. Democrats, aiming to gain seats in the state House and Senate, have made full Medicaid expansion a central issue. “I would love to have full Medicaid expansion, but this is what we have right now,” Bentley said, saying she was in favor of anything that would increase access.
Pandemic takes toll on employer-sponsored insurance
TALLAHASSEE, Fla. – The coronavirus-induced recession nationally has displaced 7.7 million workers who had employer-sponsored health insurance, a study released Wednesday shows. Upjohn Institute for Employment Research and the Commonwealth Fund, the analysis also found that 6.9 million dependents were covered, bringing the potential number of people losing employer-sponsored insurance to more than 14 million. If a job loss was temporary, an employer could continue to provide health insurance coverage, the report said. Manufacturing workers have been most impacted by losing jobs with employer-sponsored insurance. But because 66% of manufacturing jobs offered employer-sponsored insurance; the industry accounted for 18% of the loss of jobs with employer-sponsored insurance.
UF researcher gets sickle cell therapy grant
TALLAHASSEE, Fla. – A researcher at the University of Florida College of Nursing has been awarded a $2.6 million grant to determine whether relaxation therapy can help reduce pain and manage stress for patients with sickle cell disease, negating the need for opioids. “Historical and contemporary prejudices and stereotypes are associated with those who suffer from sickle cell disease because of their racial background,” Ezenwa said in a prepared statement. “Stress from sickle cell disease symptoms and social factors have been magnified by the public health crisis related to the opioid overdose epidemic in the United States.”Studies indicate as many as 100,000 people could be living with sickle cell disease in the United States. According to a June 2019 report from the federal Centers for Medicare & Medicaid Services Office of Minority Health, 55,349 Medicaid beneficiaries nationwide had sickle cell disease in 2012, the latest available data. With 5,395 Medicaid beneficiaries with the once-fatal disease, Florida had the second-largest sickle cell Medicaid population behind New York.
Telehealth use jumped in Medicaid system as pandemic swept Florida
TALLAHASSEE, Fla. – Florida Medicaid providers, once reticent to use telehealth, turned to the technology to care for patients as COVID-19 swept the state. Medicaid director Beth Kidder told members of the Medical Care Advisory Committee on Wednesday that the number of providers using telehealth increased from 657 at the end of 2019 to 15,945 as of June amid the pandemic. The number of beneficiaries using telehealth increased from 23,616 at the end of 2019 to 192,038 as of June, according to Kidder’s data. And the same thing for patients.”The Medical Care Advisory Committee reviews issues in the state Medicaid system. Federal regulations require each state’s Medicaid program to have such an advisory committee.
Virus shutdown took a toll on routine health care for kids
Federal officials say a sharp decline in routine medical care for low-income children during the coronavirus shutdown will cause long-term harm if not reversed. (AP Photo/Alex Brandon, File)WASHINGTON – A sharp decline in routine medical care for low-income children during the coronavirus shutdown could cause long-term harm if not reversed, federal officials warned Wednesday. Among the findings:— Early childhood vaccinations declined by 22%, or 1.7 million fewer immunizations for kids up to age 2. — Even after accounting for increased use of telehealth, there were 6.9 million fewer mental health visits. The changes mirror what happened with everyday health care services for adults.
Deadline to fill out US Census fast approaching
JACKSONVILLE, Fla. – The deadline to complete the once-a-decade 10 minute survey is September 30. The programs include, among many others: Medicaid, direct student loans, highway construction grants, low income tax credits and loans, and even adoption assistance programs. News4Jax asked Marilyn Stephens with the U.S. Census Bureau what happens if the country doesn’t hit 100%. Head to Jacksonville Main Library at 303 N. Laura St. on Friday from 10 a.m. to 1 p.m. The Jacksonville chapter of Delta Sigma Theta Sorority will be on hand if you need any assistance.
While income in the US rose in 2019, so did the uninsured
Median household income in 2019 was $68,703, an increase of 6.8% from the previous year. That figure surpassed past boom-before-the bust years in 2007, when it was $62,090 in 2019 dollars and in 1999, when it was $62,641 in 2019 dollars, according to the Census Bureau. It was the fifth consecutive annual decline in the national poverty rate, according to the Census Bureau. Hispanics saw the greatest jump in the uninsured of any racial or ethnic group, going from 17.9% in 2018 to 18.7% in 2019. But even taking into consideration that bias, median household income in 2019 would have been 4.1% higher than it was in 2018, showing that the median household income last year was the highest on record, the Census Bureau concluded.
Obama's Medicaid expansion keeps gaining ground under Trump
President Donald Trump is still trying to overturn Obamacare, but his predecessor's health care law keeps gaining ground in places where it was once unwelcome. Missouri voters this week approved Medicaid expansion by a 53% to 47% margin, making the conservative state the seventh to do so under Trump. The six states where voters have approved Medicaid expansion in the Trump years are Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah. In Virginia, the legislature passed a Medicaid expansion after Democrats made political gains. In Missouri, support for Medicaid expansion in cities and suburbs overcame opposition in rural communities.
Florida hits medicaid plans with $2M in contract breach sanctions
TALLAHASSEE, Fla. Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services -- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions -- and contracts with three managed dental-care companies.
Stimulus money could pose dilemmas in nursing homes
The situation underscores the vulnerability of many elderly residents and potential confusion about what homes can and cant do with residents money. One worry is that nursing homes could pressure residents to use the checks to pay outstanding balances. Its not yet known whether there are widespread problems with nursing homes taking residents' checks, said Lois Greisman of the Federal Trade Commission. Cole, the southwest Ohio nursing home resident, said he still has some stimulus money left after buying a 55-inch television and gaming device. Hell said he'll likely wait until his nursing homes lockdown ends to spend the rest.