Posts Tagged ‘CMS’

Federal Agency Says States Can Expand, Later Reduce Medicaid Under ACA

By Sean Whaley | 12:26 pm August 7th, 2012

CARSON CITY – States do not face any deadline for deciding whether to expand their Medicaid coverage under the Affordable Care Act, and will be able to expand coverage and then later chose to reduce it, federal officials told Governing magazine on Monday.

Cindy Mann, deputy director for the Centers for Medicare and Medicaid Services, made the comments at a National Conference of State Legislatures meeting in Chicago.

Photo by Debora Cartagena/CDC.

The article by Dylan Scott with Governing magazine also had comments from a CMS spokesperson confirming that states can chose to expand eligibility and later choose to reduce it, the first public confirmation that CMS will make such an option available.

Nevada Gov. Brian Sandoval is still assessing whether to expand Nevada’s Medicaid eligibility as a result of the June ruling by the U.S. Supreme Court upholding most of the federal health care law. The court struck down the provision allowing the federal government to penalize states if they did not opt into the Medicaid expansion.

The optional expansion to cover those at 133 percent of the poverty level is set to take effect Jan. 1, 2014.

Sandoval’s initial comment was that the state could not afford to undertake any expansion under the law. But he is awaiting additional information and clarification from the U.S. Department of Health and Human Services before deciding how to proceed.

Federal funding will pay for 100 percent of any Medicaid expansion for the first three calendar years beginning in 2014, with the state required to pick up a percentage of the cost beginning in 2017. The first year state cost is 5 percent, in 2018 the state cost is 6 percent, in 2019 the state cost is 7 percent, and in 2020, the state cost is 10 percent.

The expansion in Nevada would mostly cover childless adults, who are not covered by the state program now. The other expansion will come from parent caretakers of children who are covered at 75 percent of poverty now, according to Mike Willden, director of the Nevada Department of Health and Human Services.

Willden said last month there are also administrative costs to the state that are not fully covered by the expansion but instead are shared between the federal government and the state at a 50-50 match. They include information technology costs and the cost to hire new eligibility workers, for example, he said.

Willden said in May  that as many as 150,000 additional Nevadans would be eligible for Medicaid if the law was upheld by the court, but that estimate was two years old and was made before the court said states could opt out of the expansion.

He estimated that bringing new residents onto the rolls would cost the state general fund an estimated $574 million between now and 2020.

But only $63 million of that cost estimate was due to the Medicaid expansion. The rest was due to those Nevadans who are already eligible for Medicaid but who have not enrolled. This population is expected to enroll in the program as a result of the mandate to obtain insurance.


Federal Agency Names New Accountable Care Organization in Nevada

By Nevada News Bureau Staff | 11:30 am July 9th, 2012

CARSON CITY – The Centers for Medicare & Medicaid Services (CMS) announced today that Nevada is among 40 states where people with Medicare can receive health care from an Accountable Care Organization (ACO).

ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare.

The ACO is called the Nevada Primary Care Network and is based in Las Vegas. The ACO has 89 physicians and will serve Medicare beneficiaries in Nevada.

The new ACOs named today around the country will be serving 1.2 million people with Medicare. All ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care.

“Better coordinated care is good for patients and it saves money,” said HHS Secretary Kathleen Sebelius. “We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

U.S Department of Health and Human Services Secretary Kathleen Sebelius.

Participation in an ACO is purely voluntary for providers. The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the 2010 Affordable Care Act. Federal savings from this initiative could be up to $940 million over four years.

“This new group of ACOs adds to a solid foundation,” said CMS Acting Administrator Marilyn Tavenner. “The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives.”

The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives on July 1 to 154.

The selected ACOs operate in a wide range of areas of the country and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving.

To ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely, an ACO must meet quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

CMS also announced that beginning this year, new ACO applications would be accepted annually. The application period for organizations that wish to participate in the Shared Savings Program beginning in January 2013 is from Aug. 1 through Sept. 6, 2012.

Nevada Among States With Lowest Spending On Health Care And Least Number Of Insured

By Sean Whaley | 2:35 pm December 20th, 2011

CARSON CITY – Nevada ranks 46th among states on spending on health care per capita, according to a report released this month by the Centers for Medicaid & Medicare Services.

Nevada spends $5,735 per person on total personal health care as of 2009, the report says. The national average is $6,815. The highest per capita spending was found in Massachusetts at $9,278.

Larry Matheis, executive director of the Nevada State Medical Association, said Nevada’s low spending on health care is a reflection of the large number of residents who don’t have health insurance.

U.S. Census data released in October shows that Nevada is the third most uninsured state per capita in the U.S as of 2009.

“On first blush it’s good news that we’re not on the high end of spending per person,” Matheis said. “But a more balanced look at the data says we have a lot of warning signs in this pool of data. It renders a number that looks like we’ve got costs under control. It actually just means we have a big access problem.”

The report found that eight of the ten top states for total health care spending per capita, including Massachusetts, Connecticut, and New York, are also ranked in the top third in the nation for annual personal income per capita.

Photo by James Gathany, Centers for Disease Control and Prevention.

“Income appears to have an important and positive relationship with health spending,” the report said.

Matheis said the study provides much-needed information as the country moves forward with full implementation of the national health care law.

“They need much better baseline information about how much they are spending and on what with every population and in every part of the country, because a big part of the reform proposals are aimed at trying to, if not reduce costs, reduce the things that lead to higher costs,” he said.

Report also looks at Medicare and Medicaid spending

The report shows that Nevada is in the middle of the pack in terms of Medicare spending per enrollee at $9,692, and ranks toward the bottom of the states on Medicaid spending per enrollee at $6,003. The national averages are $10,365 and $6,826, respectively.

But in terms of the percentage of health care dollars spent on Medicaid, Nevada is lowest among all states at only 8.6 percent. Nevada is the only state where spending is in the single-digits. The highest is New York, where 29.2 percent of all personal health care spending is via Medicaid.

Medicaid is the health care program for low income seniors, disabled and families, the cost of which is shared by states and the federal government.

Charles Duarte, administrator of the state Division of Health Care Financing and Policy, which oversees the Medicaid program, said Nevada’s spending is low because of the policy decision to restrict eligibility. The program also doesn’t offer many optional services that can increase costs.

“We’ve made decisions as a state that we’re not going to expand the program from an eligibility perspective,” he said. “And so in other states Medicaid makes up 14, 15, 16 percent of coverage for people in the state. In some states it is as high as 30 percent.

“We don’t cover as many people in our public programs, but our employers are kind of right in the middle there, slightly above the national average,” Duarte said. “And what the means is the uninsured group are those that could be covered by Medicaid if our rules allowed it.”

Federal health care law expected to affect Nevada Medicaid spending

This situation is expected to change as the Medicaid program expands beginning in 2014 as part of the implementation of the federal health care law, he said. As many as 100,000 new residents could be eligible for Medicaid. There are residents eligible for Medicaid now who are not participating in the program who will have to be covered as well, Duarte said.

The cost of the newly eligible residents will be covered almost entirely by the federal government, but the state will share in the cost of those who are eligible now but who have not signed up for the program, he said.

This Medicaid expansion is one reason Nevada joined with many other states in challenging the constitutionality of the health care law. The U.S. Supreme Court has agreed to review the law. Former Gov. Jim Gibbons in 2010 estimated the Medicaid mandate will cost Nevada $613 million over six years beginning in 2014. Gibbons initiated Nevada’s participation in the challenge to the law which is being continued by Gov. Brian Sandoval.

Matheis said there is a strong feeling in the Nevada medical community that the state is under-spending on this population, which will have to change with the implementation of the health care law.

“Nevada is going to go from where we are now, which is a very low spending per Medicaid patient; we’re going to jump a huge amount because there are going to be so many people that will be identified for the new Medicaid expansion that is coming under the Affordable Care Act,” he said.

This rapid expansion will create budget challenges for state lawmakers, Matheis said.

Policy-makers need to seriously consider the data and build it into the state’s planning efforts, he said.

“At some point we do have to invest in a health care system that we want,” Matheis said. “Right now we’re doing that in Nevada minimally and that’s what this report really shows.”


Audio clips:

Larry Matheis, executive director of the Nevada State Medical Association, says the report provides much needed baseline information:

122011Matheis1 :24 to higher costs.”

Matheis says Nevada will see a big jump in Medicaid spending because of the new health care law:

122011Matheis2 :25 Affordable Care Act.”

Matheis says the news looks good at first, but it suggests there are concerns:

122011Matheis3 :19 pool of data.”

Charles Duarte, administrator of the state Division of Health Care Financing and Policy, says Nevada’s Medicaid spending is low because eligibility is restricted:

122011Duarte1 :15 high as 30 percent.”

Duarte says the uninsured group in Nevada are those who could be covered by Medicaid if eligibility was expanded:

122011Duarte2 :18 rules allowed it.”