State Health Watch Archives Medical Newsletter

WA attempt to limit non-urgent ER visits is being challenged

Budget reductions for the 2011-2013 biennium in Washington state include a legislatively mandated limit on non-emergency visits to hospital ERs, reports Jeffery Thompson, MD, MPH, chief medical officer of Washington's Medicaid program.

Oregon expects cost savings from primary care investment

The Affordable Care Act (ACA) requires that state Medicaid agencies reimburse primary care providers at 100% of the Medicare fee schedule for two years, notes Donald Ross, manager of the policy and planning section at the Oregon Health Authority's Division of Medical Assistance Programs.

North Carolina targets high utilization of ERs

Washington Medicaid's plan to limit non-urgent ER visits to three a year is being watched "with great interest," says Randall Best, MD, JD, chief medical officer for North Carolina's Division of Medical Assistance. "It's a hot topic in pretty much all the states right now."

Is it legal for Medicaid to limit non-urgent ER visits?

As a general rule, courts have upheld limitations on Medicaid reimbursements for services, as long as the services are "sufficient in amount, duration, and scope to reasonably achieve their purpose," according to Laura Hermer, JD, LLM, an assistant professor of health policy and bioethics at the University of Texas Medical Branch in Galveston.

Medicaid mental health spending uneven even within single state

Would you expect a New York Medicaid client to be able to access mental health service equally well, regardless of where he or she lived within the state?

Staffing shortages present obstacle to new access regs

Under a proposed rule published in May 2011 from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies would have to review access to a subset of Medicaid-covered services every year, and review access to every Medicaid-covered service at least once every five years.

Resources are issue with CMS' Medicaid claims audit program

A new Medicaid recovery audit contractor (RAC) program will help strengthen the integrity of the Medicaid program, according to Xiaoyi Huang, JD, assistant vice president for policy at the National Association of Public Hospitals and Health Systems in Washington, DC. "That being said, we need to be cognizant of program integrity efforts that places undue burden on providers," she cautions.

Volume of referrals, appeals are concern with RACs

A state plan amendment submitted by North Carolina Medicaid to the Centers for Medicare & Medicaid Services (CMS) to participate with the Medicaid recovery audit contractor (RAC) program has already been approved, and a request for proposal will be released shortly, reports Brad Deen, a spokesperson for North Carolina Division of Medical Assistance (NCDMA).

Medicaid savings visible in real time via website

New York state's Medicaid Visual Data Mining System allows state officials and policy makers to track the results of savings initiatives in real time, via a spending tracking website, according to Morris Peters, a spokesperson for the Division of Budget. (To view the site, go to http://www.health.state.ny.us/health_care/medicaid/regulations/global_cap/.)