Medicaid Payment and Reimbursement

Supreme Court ruling on Chevron makes regulations in healthcare (and other industries) more vulnerable to legal challenges

The U.S. Supreme Court issued a decision Friday that has dramatic implications for the regulatory infrastructure in healthcare, among many other industries. Since it was established in a 1984 case, Chevron deference has served as guidance to courts that regulatory authorities such as CMS and dozens of others across the federal government have license to…

Nick Hut June 28, 2024

HHS issues regulations to strengthen anti-discriminatory protections in healthcare (updated)

July 3 update A judge with the Southern District of Mississippi federal court granted an injunction preventing the Biden administration from enforcing regulations expanding anti-discrimination protections in the Affordable Care Act (ACA). Issued two days before the new rule was to take effect, the order applies to the provisions concerning gender identity. The move came…

Nick Hut May 14, 2024

Seeking to improve healthcare for Medicaid beneficiaries, CMS issues a flurry of regulations

CMS over the last month published a trio of final rules intended to make the Medicaid program work better for beneficiaries, with implications for healthcare providers. The three rules address eligibility and enrollment, access and Medicaid managed care. Streamlining eligibility and enrollment The first rule addresses administrative barriers in an effort to simplify enrollment processes…

Nick Hut May 1, 2024

The Medicaid unwinding continues to pose issues one year in, but healthcare coverage appears stable

The unwinding of Medicaid continuous-enrollment requirements reached the one-year mark this month amid mixed measures of the effect on overall coverage. In one sense, the impact has exceeded all projections. Since states could begin disenrolling Medicaid beneficiaries on April 1, 2023, coverage for more than 19.6 million beneficiaries had been terminated as of April 4,…

Nick Hut April 12, 2024

BESLER provides thorough Transfer DRG revenue recovery services

Hospitals require clear and simple paths through the challenges posed by changing regulations so they can spend more time and dollars focusing on enhancing patient care.

HFMA April 1, 2024

Highlights of the Administration’s FY 2025 Budget

HFMA presents a summary highlighting healthcare-related proposals included in the President’s Budget for fiscal year 2025, based on materials released by the Biden Administration on March 11, 2024.

HFMA March 22, 2024

Medicaid DSH Third-Party Payer Final Rule Summary

HFMA presents a detailed summary of the final rule issued by CMS addressing legislative changes to the hospital- specific limit on Medicaid disproportionate share hospital payments that took effect on October 1, 2021, as a result of the Consolidated Appropriations Act 2021.

HFMA March 11, 2024

Federal funding legislation would address Medicaid DSH cuts, physician payments and more

March 8 update The Senate passed the appropriations bill by a 75-22 vote, getting it to the White House for President Joe Biden to sign hours before funding for some federal departments would have expired and a big cut to Medicaid disproportionate share hospital payments would have begun. Attention now turns to HHS and other…

Nick Hut March 6, 2024

New rule on Medicaid DSH payments will impose stricter limits on many hospitals

Numerous hospitals that receive Medicaid disproportionate share hospital (DSH) payments face a tighter cap on their payment amounts after the Feb. 23 publication of a CMS final rule. The regulations were spawned by 2020 year-end legislation that made changes to the DSH hospital-specific limit (HSL), including with respect to how third-party payments factor into the…

Nick Hut February 23, 2024

Continued 340B eligibility is at risk for hundreds of hospitals thanks to pandemic-related factors

Hospitals that rely on savings from the 340B Drug Pricing Program should examine the possibility that they’ll soon be rendered ineligible. Several factors are having an industrywide impact on the disproportionate share hospital (DSH) adjustment percentage, and if that tally drops below a certain threshold on a hospital’s Medicare cost report, the hospital cannot receive…

Nick Hut February 2, 2024
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