Posts Tagged Medicaid

Coalition Pushes for CHIP Reauthorization

Coalition Pushes for CHIP Reauthorization




The Medical Association, the Alabama Chapter of the American Academy of Pediatrics, state lawmakers and a number of organizations advocating for children’s health care are petitioning the Alabama Congressional Delegation to support reauthorization of a bipartisan CHIP funding bill before the Sept. 30 deadline. In a letter to the Alabama Congressional Delegation outlining support for CHIP reauthorization, the coalition cited the great strides made possible through CHIP in ensuring children have access to the care they need. As well, any reductions in federal CHIP funding could cause problems for not only Alabama’s ALL Kids program but also children enrolled in Alabama Medicaid.

Below is the letter, and more signees are expected before the Sept. 30 deadline. Download a copy of the letter here.

We, the undersigned Alabama elected officials and organizations advocating for children and pregnant women in our state, write to urge your support of the Hatch-Wyden bill, Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (S. 1827). This bipartisan legislation ensures stability for vulnerable children by extending funding for the Children’s Health Insurance Program (CHIP) for five years. The bill also provides additional protections for low-income children and increases flexibility for states.

As you know, federal funding for CHIP expires on September 30, 2017. Without certainty from Congress on CHIP funding, states will be forced to make drastic cuts to the program. This could mean slashing enrollment, reducing benefits, and imposing higher costs for families.

CHIP is a bipartisan success story. The program was created in 1997 and has been championed by lawmakers on both sides of the aisle since its very beginning. Together with Medicaid, CHIP has helped to reduce the numbers of uninsured children by a remarkable 68 percent. Now is the time for Congress to stabilize the CHIP funding stream and protect the gains in children’s health coverage that have resulted in more than 95 percent of all children in America being enrolled in some form of insurance coverage.

The program is designed around what children need. It offers benefits that are age-appropriate, including dental coverage and mental health and substance abuse services, which may not be covered by a family’s employer-sponsored insurance.

CHIP plans include networks of pediatricians, pediatric medical and surgical subspecialists, and children’s hospitals, which are especially critical for children with special health care needs.

Families deserve peace of mind knowing that they will be able to access the care and support services their children rely on to be healthy.

Currently in Alabama, 157,000 children are covered by CHIP, known as ALL Kids in our state. With state budgets already set for the coming year, states are counting on CHIP to continue in its current form. Changes to CHIP’s structure – including changes to the Maintenance of Effort or the enhanced CHIP matching rate – would cause significant disruption in children’s coverage and leave states with critical shortfalls in their budgets. Given CHIP’s track record of success, changes to CHIP that would cause harm to children must not be made. In Alabama, we would be forced to use funds originally appropriated for Alabama Medicaid to keep children covered on CHIP. So lack of continued funding at its current level would mean a double hit for Alabama!

Today, we stand united in urging you and your colleagues to work together to enact a five-year extension of CHIP funding.  Securing this critical source of coverage for children and pregnant women into the future is an important opportunity for meaningful, bipartisan action to honor CHIP’s 20 years of success.

Thank you for all you do for our state and the children of Alabama.



Representative Steve Clouse, Chair, House Ways and Means General Fund Committee

Representative Anthony Daniels, House Minority Leader

Representative Nathaniel Ledbetter, House Majority Leader

Representative Mac McCutcheon, Speaker of the House

Representative April Weaver, Chair, House Health Committee

Senator Del Marsh, Senate President Pro Tempore

Senator Jim McClendon, Chair, Senate Health & Human Services Committee

Senator Greg Reed, Senate Majority Leader

Alabama Academy of Family Physicians

Alabama Arise

Alabama Chapter-American Academy of Pediatrics

Alabama Children First

Alabama Hospital Association

Children’s of Alabama

Medical Association of the State of Alabama

UAB Health System

University of South Alabama Health System

VOICES for Alabama’s Children


Posted in: CHIP

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CMS Reveals New Medicare Card Design; Strengthens Fraud Protections

CMS Reveals New Medicare Card Design; Strengthens Fraud Protections

The Centers for Medicare & Medicaid Services has redesigned its Medicare card to remove Social Security numbers and use a unique, randomly-assigned number in an effort to better protect users from identity theft and fraud.

CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. People with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September.

“The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.”

CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive.

Health care providers and people with Medicare will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, health care providers, and suppliers will be able to use either their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition.

This initiative takes important steps towards protecting the identities of people with Medicare. CMS is also working with healthcare providers to answer their questions and ensure that they have the information they need to make a successful transition to the new Medicare number. For more information, please visit:

How can providers get ready for the changes?

  • Ask your billing and office staff if your system can accept the new 11-digit alphanumeric Medicare Beneficiary Identifier or
  • If your system cannot accept the new number, system changes should be made by April 2018
  • If providers use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change
  • Verify your patients’ addresses: If the address you have on file is different than the address you get in electronic eligibility transaction responses, ask your patients to contact Social Security and update their Medicare records. This may require coordination between your billing and office staff.

For more information go to

Posted in: Medicare

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U.S. Senate Announces 5-Year CHIP Funding Program

U.S. Senate Announces 5-Year CHIP Funding Program

The U.S. Senate Finance Committee reached an estimated $8 billion bipartisan agreement that renews funding for the Children’s Health Insurance Program for five years and phases out the 23 percent Obamacare funding bump. States would have to maintain eligibility through 2019, and after that there would be no so-called maintenance of effort for children of parents with incomes more than 300 percent of the federal poverty level.

While the deal does not include details of how the Congress would pay for the funding extension, the proposed legislation would maintain Obamacare’s 23 percent increase in the federal matching rate to states for 2018 and 2019 and begin to ratchet it down in 2020, according to GOP and Democratic aides. The bump is set at 11.5 percent in 2020 and would be totally eliminated starting in 2021. Amendments to the proposed legislation are expected.

“The Medical Association began working with Alabama’s Congressional Delegation in January when we traveled to Washington, D.C., for the Government Relations Conference,” said Executive Director Mark Jackson. “We wanted to express to them the importance that CHIP funding be renewed and the impact the program has on our residents. We are pleased to see that there is a bi-partisan proposal in the Senate that will keep CHIP funding in place.”

CHIP is authorized through 2019, but funding runs out at the end of September. CHIP covers families with income levels between 138 percent and 405 percent of the federal poverty level. States determine the eligibility levels within those parameters, and the ACA requires that states maintain eligibility levels that were in place as of March 23, 2010. States that reduce eligibility lose federal Medicaid funding. Eligibility levels are capped between 200 percent and 300 percent of poverty in 30 states, and in 19 states eligibility levels are higher than 300 percent of poverty, although those states don’t receive the higher match rate for enrollees above the 300 percent threshold, according to American Action Forum. The Finance deal would let states drop eligibility levels to 300 percent of poverty after 2019.

More than 97 percent of CHIP enrollees have family income of 250 percent of poverty, according to the American Action Forum analysis.

The American Academy of Family Physicians and more than 130 other organizations issued a statement on Sept. 6 calling on legislators to save the CHIP from chaos and families from confusion by extending the program’s funding for five years before it expires on Sept. 30.

“CHIP has a proven track record of providing high-quality, cost-effective coverage for low-income children and pregnant women in working families,” the statement said. “CHIP was a smart, bipartisan solution to a real problem facing American children and families when it was adopted in 1997, and its importance and impact in securing a healthy future for children in low-income families has only increased. As Congress continues to work on larger health system reforms, a primary goal should be to improve health coverage for children, but at a minimum, no child should be left worse off. We urge our nation’s leaders to work together to enact a five-year extension of CHIP funding as an important opportunity for meaningful, bipartisan action.”

Nearly 9 million children whose families could not otherwise afford health insurance have access to health care because of CHIP. The program also enables pregnant women in 19 states to obtain the health care they need to have healthy pregnancies and give birth to healthy infants. Many families covered by the program have incomes too high to qualify for Medicaid.

Posted in: CHIP

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Alabama Medicaid Seeks Public Comments

Alabama Medicaid Seeks Public Comments

Alabama Medicaid is seeking public comment on an amendment to the Alabama Home and Community-Based Intellectual Disabilities Waiver.

Medicaid Intellectual Disabilities Waiver Amendment | Comments Submitted by October 8, 2017

The Alabama Medicaid Agency is seeking public comment on its proposal to amend the Alabama Home and Community-Based Intellectual Disabilities Waiver (ID Waiver).

The waiver supports Alabama citizens who have a diagnosis of Intellectual Disabilities and who would otherwise require the level of care offered in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) institution to remain in the community. The waiver provides services such as day services and in-home supports. The amendment proposes changes to the sections pertaining to Individual Directed Goods and Services and self-directed services.

A copy of the proposed application can be found on the Alabama Medicaid Agency website. Click here to view waiver documents.

The comment period is open until October 8, 2017. Written comment regarding the proposed waiver amendment are welcome and should be mailed to Samantha McLeod, Associate Director via mail to: Alabama Medicaid Agency, Long Term Care Division, P.O. Box 5624, Montgomery, AL 36103-5624 or via email to

Posted in: Medicaid

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What If No One Was On Call…2017 Legislative Review

What If No One Was On Call…2017 Legislative Review

In times of illness, injury and emergency, patients depend on their physicians. But what if no one was on call? Public health would be in jeopardy. However, the same holds true during a legislative session. What would happen if the Medical Association was not on call, advocating for you and your patients at the Alabama Legislature? Keep reading to find out.

Moving Medicine Forward

Patients and their physicians want assurances about not only the quality of care provided, but also its continued availability, accessibility, and affordability. Patients want to make health decisions with their doctors, free from third-party interference. Continued progress toward these objectives requires constant vigilance in the legislative arena, where special interest groups seek to undermine physician autonomy, commoditize medicine and place barriers between physicians, their patients and the care their patients need.

If no one was on call… Alabama wouldn’t be the 20th state to enact Direct Primary Care legislation. DPC puts patients and their doctors back in control of patients’ health and helps the uninsured, the under-insured and those with high-deductible health plans. SB 94 was sponsored by Sen. Arthur Orr (R-Decatur) and Rep. Nathaniel Ledbetter (R-Rainsville).

If no one was on call… the Board of Medical Scholarship Awards could have seen its funding slashed but instead, the program retained its funding level of $1.4 million for 2018. The BMSA grants medical school loans to medical students and accepts as payment for the loan that student’s locating to a rural area to practice medicine. The BMSA is a critical tool to recruiting medical students to commit to practice in rural areas. As well, the economic footprint of every physician is at least $1 million, which improves both community health and local economies.

If no one was on call… Medicaid cuts could have been severe, possibly reducing access for patients within an already fragile system in which less than 20 percent of Alabama physicians participate. Due to work done during the 2016 second special session and the 2017 session, sufficient funds were made available for Medicaid without any scheduled cuts to physicians for 2018. Increasing Medicaid reimbursements to Medicare levels – a continued Medical Association priority – could further increase access to care for Medicaid patients.

Beating Back the Lawsuit Industry

Personal injury lawyers are constantly seeking new opportunities to sue doctors. While Alabama’s medical liability laws have fostered fairness in the courtroom and improved the legal climate, each year personal injury attorneys seek to undo parts of the very law that helps keep “jackpot justice” and frivolous suits in check.

If no one was on call… an $80 million tax increase on physicians to fund a new government-administered malpractice claims payout system called the Patients Compensation System could have passed. The PCS would administer damage claims for physical injury and death of patients allegedly sustained at the hands of physicians. Complaints against individual physicians would begin with a call to a state-run 1-800 line and would go before panels composed of trial lawyers, citizens and physicians to determine an outcome. In addition, any determinations of fault would be reported to the National Practitioner Databank. The Patient Compensation System would undo decades of medical tort reforms, which the Medical Association championed and is forced to defend from plaintiff lawyer attacks each session. The PCS deprives both patients and doctors of their legal rights.

If no one was on call… physicians could have been exposed to triple-damage lawsuits for honest Medicaid billing mistakes. The legislation would create new causes of civil action in state court for Medicaid “false claims.” The legislation would incentivize personal injury lawyers to seek out “whistleblowers” in medical clinics, hospitals and the like to pursue civil actions against physicians and others for alleged Medicaid fraud, with damages being tripled the actual loss to Medicaid. The standard in the bill would have allowed even honest billing mistakes to qualify as “Medicaid fraud,” creating new opportunities for lawsuits where honest mistakes could be penalized.

If no one was on call… physicians would have been held liable for the actions or inactions of midwives attending home births. While a lay midwife bill did pass this session establishing a State Board of Midwifery, the bill contains liability protections for physicians and also prohibitions on non-nurse midwives’ scope of practice, the types of pregnancies they may attend, and a requirement for midwives to report outcomes.

If no one was on call… the right to trial by jury, including jury selection and jury size, could have been manipulated in personal injury lawyers’ favor.

If no one was on call… physicians could have been held legally responsible for others’ mistakes, including home caregivers, medical device manufacturers and for individuals following or failing to follow DNR orders.

Protecting Public Health and Access to Quality Care

Every session, various pieces of legislation aimed at improving the health of Alabamians are proposed. At the same time however, many bills are also introduced that endanger public health and safety, like those where the legislature attempts to set standards for medical care, which force physicians and their staffs to adhere to non-medically established criteria, wasting health care dollars, wasting patients’ and physicians’ time and exposing physicians to new liability concerns.

If no one was on call… legislation could have passed to lower biologic pharmaceutical standards in state law below those set by the FDA, withhold critical health information from patients and their doctors, and significantly increase administrative burdens on physicians.

If no one was on call… allergists and other physicians who compound medications within their offices could have been shut down, limiting access to critical care for patients.

If no one was on call… numerous scope of practice expansions that endanger public health could have become law, including removing all physician oversight of clinical nurse specialists; lay midwives seeking allowance of their attending home births without restriction or regulation; podiatrists seeking to amputate, do surgery and administer anesthesia up the distal third of the tibia; and marriage and family therapists seeking to be allowed to diagnose and treat mental disorders as well as removing the prohibition on their prescribing drugs.

If no one was on call… state boards and agencies with no authority over medicine could have been allowed to increase medical practice costs through additional licensing and reporting requirements.

If no one was on call… legislation dictating medical standards and guidelines for treatment of pregnant women, the elderly and terminal patients could have been placed into bills covering various topics.

Other Bills of Interest

Rural physician tax credits… legislation to increase rural physician tax credits and thereby increase access to care for rural Alabamians did not pass but will be reintroduced next session.

Infectious Disease Elimination… legislation to establish infectious disease elimination pilot programs to mitigate the spread of certain diseases failed to garner support on the last legislative day.

Constitutional amendment proclaiming the State of Alabama’s stance on the rights of unborn children… legislation passed to allow Alabamians to vote at the November 2018 General Election whether to add an amendment to the state constitution to:

“Declare and affirm that it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, most importantly the right to life in all manners and measures appropriate and lawful…”

If ratified by the people in November 2018, this Amendment could have implications for women’s health physicians.

Coverage of autism spectrum disorder therapies… legislation passed to require health plans to cover ASD therapies, with some restrictions.

Portable DNR for minors… legislation establishing a portable DNR for minors to allow minors with terminal diseases to attend school activities failed to garner enough votes to pass on the last legislative day.

If the Medical Association was not on call at the legislature, countless bills expanding doctors’ liability, increasing physician taxes and setting standards of care into law could have passed. At the same time, positive strides in public health — like passage of the direct primary care legislation — would not have occurred. The Medical Association is Alabama physicians’ greatest resource in advocating for the practice of medicine and the patients they serve.

Posted in: Advocacy

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The Medical Association Supports Replacement of ACA with Workable Health Care System

The Medical Association Supports Replacement of ACA with Workable Health Care System

The Medical Association released its 2017 Legislative Agendas earlier this year, which were developed with guidance from the House of Delegates and great contribution from our physician members who participated in the 2017 Legislative Agenda Survey. The Medical Association has continued to express support for the repeal of the Affordable Care Act and its replacement with an adequate system to protect not only physicians but their patients as well.

The U.S. Senate is engaged in deliberations on legislation to repeal and replace the Affordable Care Act. So far these debates have one thing in common – they fail to meet the basic requirements of a solid health care plan, which does not further damage an already weakened Medicaid program or make it more difficult for low and moderate-income Americans to obtain affordable health insurance.

As from the beginning, Medical Association continues to support the repeal of the Affordable Care Act and replacement with a system that:

  • Includes meaningful tort reforms that maintain existing state protections
  • Preserves employer-based health insurance
  • Protects coverage for patients with pre-existing conditions
  • Protects coverage for dependents under age 26
  • With proper oversight, allows the sale of health insurance across state lines
  • Allows for deducting individual health insurance expenses on tax returns
  • Increases allowed contributions to health savings accounts
  • Ensures access for vulnerable populations
  • Ensures universal, catastrophic coverage
  • Does not increase uncompensated care
  • Does not require adherence with insurance requirements until insurance reimbursement begins
  • Reduces administrative and regulatory burdens

The disproportionate funding model dictated by the ACA has left most states, including Alabama, sorely underfunded. Medicaid is a critical component of our health care system, covering the young and elderly. Medicaid covers more than half of Alabama births and 47 percent of our children, as well as 60 percent of Alabama’s nursing home residents. Without full funding, the Medicaid program will collapse, leaving these individuals without coverage. While uncompensated care is delivered every day in all 67 counties of this state, without Medicaid, charity care needs could skyrocket, crippling the health care delivery system and potentially placing the burden on those with private health insurance through higher premiums and co-pays.

Now’s the time to fix our broken health care system to ensure access to care for our citizens and the ability for physicians to practice medicine without overwhelming federal burdens guiding the way. The Medical Association continues to work with our Congressional Delegation during these negotiations and urges them to work together toward the passage of a viable health care solution for our residents.

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Alabama Medicaid to Pursue an Alternative to RCOs

Alabama Medicaid to Pursue an Alternative to RCOs

MONTGOMERY – Alabama Medicaid Commissioner Stephanie Azar announced Thursday that in light of known federal administration changes and potential congressional adjustments, the Alabama Medicaid Agency will pursue an alternative to the Regional Care Organization initiative to transform the Medicaid delivery system. The state will work with the Centers for Medicare and Medicaid Services to create a flexible program that builds off the Agency’s current case management structure as a more cost-efficient mechanism to improve recipients’ health care outcomes.

Commissioner Azar cited major changes in federal regulations, funding considerations, and the potential for new opportunities for state flexibility regarding Medicaid spending and services under the Trump Administration as key factors in the decision to employ a new strategy for the state Medicaid program. Since the passage of the RCO statute, new managed care regulations have made the RCO program less viable for the state. Additionally, funding uncertainties at the state and federal levels led to the withdrawal of several probationary RCOs.

“It is highly likely that federal health care changes are on the horizon,” Commissioner Azar said. “While the financial implications could be challenging for our state, the new flexibilities and waiver options that the Trump Administration is willing to consider gives our state Medicaid program new options to accomplish similar goals without incurring the same level of increased upfront costs associated with the RCO program. In the coming days, I will work with Gov. Ivey, our stakeholders and CMS to develop an innovative model to accomplish our goal of retooling Medicaid to better serve the needs of Alabamians.”

The Medical Association would like to thank Commissioner Azar for her diligence through the RCO process and willingness to work with Alabama’s physicians.

“Navigating through this process hasn’t been an easy one, and we certainly recognize the work that Commissioner Azar has done on the behalf of Alabama’s physicians to help improve the Medicaid program,” said Medical Association Executive Director Mark Jackson. “We look forward to our continued working relationship with the Commissioner and Gov. Ivey’s administration to solve the challenges on the road ahead.”

Gov. Ivey also supported the shift in strategy adding by statement: “The RCO model didn’t fail; instead the alternative is a recognition that the circumstances surrounding Medicaid have changed, thus our approach must change. Our end goal is clear – to increase the quality of services provided and protect the investment of Alabama taxpayers.”

RCOs were mandated by state law in 2013 to move the Medicaid agency away from its current payment system to one that would incentivize efficient delivery of high-quality healthcare services and improve health outcomes. When the RCOs were first proposed after the Affordable Care Act under the Obama Administration, the plan was appropriate; however, in today’s climate, it is no longer the best use of taxpayer resources, she said. The program was set to launch in 23 north and west Alabama counties on Oct. 1, 2017.

Posted in: Medicaid

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Physician Groups Issue Joint Statement on Better Care Reconciliation Act

Physician Groups Issue Joint Statement on Better Care Reconciliation Act

June 29, 2017: Physicians Express Grave Concerns with the Better Care Reconciliation Act

Click here to see the joint letter to Alabama’s U.S. Senators

MONTGOMERY — We, the undersigned Alabama organizations, representing not just physicians but the thousands of low-income Alabamians served by them, want to express grave concerns with the Better Care Reconciliation Act (BCRA).

The BCRA fundamentally changes how Medicaid is funded, dismantling the program by capping its funding, shifting much of the financial burden to the states and likely leading to enrollment cuts — meaning less coverage for those who need it most. For those who ARE covered, the proposal will have devastating effects on the QUALITY of care provided by removing essential benefits of Medicaid — particularly for children.

Many do not realize that Medicaid is primarily a children’s program, particularly in our state:  71 percent of Alabama Medicaid recipients are CHILDREN, whose care is relatively less expensive and makeup only 20 percent of the state’s Medicaid costs. Children have unique health needs, and access to affordable, high-quality coverage is essential to keep them healthy; they are our future. Currently, Medicaid guarantees children comprehensive, medically necessary services, including EPSDT (early periodic screening, diagnosis, and treatment), which allows problems to be identified early so that children have the ability to thrive. Any efforts that take away these services or increase the number of uninsured would jeopardize children’s health.

Equally important, Alabama’s economic viability lies in the strength of its rural communities. The state’s physicians who practice in these areas depend on Medicaid for infrastructure dollars to keep their doors open. Even relatively small reductions in federal payments will force the closure of our rural hospitals and force physicians to leave these areas and likely, Alabama.

Will states be able to pick up the financial slack by raising taxes or reallocating state dollars from other programs? Will primary care physician payments be cut to the point where they can no longer care for their patients and pay their bills? In some states, survival may be a possibility, but in Alabama, as you know, funding for the current state share for Medicaid is a constant, year-to-year struggle in which there is no appetite for raising new taxes or revenues. With the unique way Alabama funds its Medicaid with Certified Public Expenditures, hospital/nursing home taxes, and the Children’s Hospital tax, Alabama stands to lose even more.

Simply put, the Better Care Reconciliation Act will be disastrous for low-income patients and ALL doctors who practice in Alabama and depend on Medicaid for healthcare system infrastructure.

In addition, we are concerned with other provisions of the legislation that would increase the number of uninsured (or underinsured), possibly eliminating the Essential Health Benefits (EHBs) and the loss of guaranteed coverage for those with pre-existing conditions.

We question the BCRA’s negative impacts on Alabama, oppose the legislation as currently drafted, and urge the Administration and Congress to continue working to fix the problems with the ACA in a way that does not increase the number of (non-voluntarily) uninsured Americans.

For more information, contact:

  • Mark Jackson, Medical Association of the State of Alabama, (334) 954-2500
  • Linda Lee, Alabama Chapter, American Academy of Pediatrics, (334) 954-2543
  • Jeff Arrington, Alabama Academy of Family Physicians, (334) 954-2570

Posted in: Official Statement

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CMS Updates Proposed Rule for MACRA; Eases Burden for Some Physicians

CMS Updates Proposed Rule for MACRA; Eases Burden for Some Physicians

The Centers for Medicare & Medicaid Services has unveiled a 1,058-page proposed rule updating the Medicare physician payment system implemented under the Medicare Access and CHIP Reauthorization Act of 2015 with changes to make it easier for small independent and rural practices to participate.

The proposed rule would make changes in the second year of the Quality Payment Program as required by MACRA. According to a statement from CMS, the goal is to simplify the program, specifically for small, independent and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” said CMS Administrator Seema Verma. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.”

The proposal will allow for the exemption of small providers participating in the program by increasing the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or less Medicare patients annually. The original threshold was $30,000 in Medicare Part B charges or 100 Medicare patients. The agency believes the move will exclude about 134,000 clinicians from MIPS.

American Medical Association President David Barbe released a statement commending the CMS for hearing the concerns of practicing physicians. “Not all physicians and their practices were ready to make the leap, and many faced daunting challenges. This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country,” he wrote.

The news may come as a relief for some clinicians. In March, Healthcare Informatics found 43 percent of more than 2,000 providers stated they needed help with MACRA preparation while 30 percent said that are not prepared at all. However, after exclusions, CMS estimates 36 percent of clinicians will be eligible for participation in 2018.

The American Academy of Family Physicians stated the regulation would help improve family physicians’ ability to participate in payment reforms successfully.

“We’re pleased that, consistent with the Department of Health and Human Services’ directive, CMS has taken steps to reduce administrative and regulatory burden,” John Meigs Jr., M.D., president of AAFP, said in the statement. “We’re equally pleased that CMS agreed with the AAFP recommendations on medical homes. For example, the financial risk borne by medical homes rolls out more slowly, providing more time for family physicians to move toward full participation in the Advanced Payment Model track. Equally important are the significant steps to reduce risk for practices of all sizes in the MIPS program.”


New Quality Payment Program Resources Available

The Centers for Medicare & Medicaid Services revamped the look of the Quality Payment Program website and posted new resources to help you successfully participate in your first year of the Quality Payment Program. READ MORE

Posted in: CMS, MACRA

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AARP: States Lag In Keeping Medicaid Enrollees Out Of Nursing Homes

AARP: States Lag In Keeping Medicaid Enrollees Out Of Nursing Homes

By Phil Galewitz, Kaiser Health News | June 14, 2017

States are making tepid progress helping millions of elderly and disabled people on Medicaid avoid costly nursing home care by arranging home or community services for them instead, according to an AARP report released Wednesday.

“Although most states have experienced modest improvements over time, the pace of change is not keeping up with demographic demands,” said the report, which compared states’ efforts to improve long-term care services over the past several years. AARP’s first two reports on the subject were in 2011 and 2014.

The organization ranked states’ performance on long-term care benchmarks such as a supply of home health aides, nursing home costs, long nursing home stays, the employment rate of people with disabilities and support for working caregivers.

With 10,000 people a day turning 65 and the eldest baby boomers beginning to turn 80 in 2026, the demand for long-term care services is expected to soar in coming years.

AARP officials said the House’s bill to repeal the Affordable Care Act would worsen the situation by capping annual federal revenue for states’ Medicaid programs. That bill is now before the Senate.

“The proposed cuts to Medicaid — the largest public payer of long-term assistance — would result in millions of older adults and people with disabilities losing lifesaving supports,” said Susan Reinhard, senior vice president and director of the AARP Public Policy Institute.

The report found strikingly wide variances in the share of state Medicaid spending for long-term care directed to home- and community-based services for elderly and disabled adults in 2014, the latest year for data covering all states. Minnesota, the top-ranked state, spent about 69 percent, but Alabama, ranked last, spent less than 14 percent.

Nationwide, the average edged up from 39 percent in 2011 to 41 percent in 2014.

Only nine states and the District of Columbia spent more on home- and community-based services than on nursing home care, according to the report. Such services include home health care, caregiver training and adult day care.

People turning 65 this year face about a 50-50 chance of needing long-term care services in their lifetime, AARP officials said.

Trish Riley, executive director of the National Academy for State Health Policy, said states face several obstacles to expand home- and community-based options. They include a strong nursing home lobby that does not want to give up its Medicaid dollars and a shortage of transportation and housing options, particularly in rural areas.

An Alabama Medicaid spokeswoman said the state is working on the issue highlighted by AARP but refused to comment on its report.

John Matson, a spokesman for the Alabama Nursing Home Association, rejected the notion that nursing homes are to blame. “We think it’s a shift that needs to happen in Alabama. We can’t build enough nursing homes to meet [the needs of] everyone that is coming,” he said.

The state’s effort to shift Medicaid patients from long-term care into managed care organizations starting next year will help, because those entities will have a financial incentive to keep people at home for care when possible, Matson said.

Reinhard said many states have struggled to expand home- and community-based options for Medicaid enrollees needing long-term care because that is an optional benefit. Nursing homes are mandatory under federal law. While states focus on Medicaid coverage for children and families — as well as non-disabled adults covered by the Medicaid expansion under the Affordable Care Act — adults with disabilities have received less attention.

“Long-term care is a stepchild of the program and not a top focus for states,” she said.

To view the full report, go to The report was funded by the AARP Foundation, The Commonwealth Fund and The SCAN Foundation.

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. | @philgalewitz

Posted in: Medicaid

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