How Do I Rate? – Medicaid Rate Cuts Take Center Stage in Case Before Supreme Court

Providers and advocates know that Medicaid rate setting is recognized for being more art than science. Certain states have made an art out of manipulating rates to meet budget numbers. In this difficult fiscal climate, states have turned to health plans and providers, reducing their rates to save money. Since states are bound to maintain Medicaid eligibility or risk facing financial penalties come 2014, cutting capitation rates and reimbursement is the quickest way to plug leaking state budgets.

No Quick Fix for Doctors’ Incessant Headache – Decrease in Medicare Physician Reimbursement Looming

It’s about that time of year again when Congress starts talking about allocating billions of dollars toward fixing the Medicare physician payment system to prevent doctors from taking a colossal pay cut. Despite the drubbing that politicians take each year on this issue from doctors, the more cynical among us think lawmakers like the attention and the support it gives them in re-elections when they pull the doc-fix out of their hat each year. And with Congress fixated on the budget deficits, debt crisis, and a new Super Committee to reduce spending and curb unsustainable growth, is a permanent fix for Medicare doctors really in the making this year?

I Catch Your Shift – Raising the Medicare Eligibility Age to Contain Federal Spending

While a debt deal has been signed, it is clear that much more work needs to be done to get the U.S. government’s debt crisis under control. A new Super Committee of Congress is now tasked with saving trillions more over time. The Super Committee will likely have to tackle entitlement reform and one proposal calls for increasing the Medicare eligibility age from 65 to 67 years to reduce costs. But new evidence suggests that savings are not all they are cooked up to be and would have far-ranging repercussions in the health-care marketplace.

State Exchange Marketplace Taking Shape – HHS Releases Two Proposed Rules

HHS published two Notices of Proposed Rulemaking (NPRM) a few weeks ago relating to developing a framework for Insurance Exchanges. The first rule serves as a basis for the creation of state-based competitive marketplaces. The second rule addresses standards related to reinsurance, risk corridors, and risk adjustment to ensure stability in the insurance marketplace once the Exchange is offered. The rules are being touted by the administration as promoting state flexibility, while creating a level and transparent playing field driving down costs and ensuring quality.