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Showing posts from December 15, 2019


from Ntl FV: House and Senate negotiators have reached a deal on spending for FY 2020, which began on October 1. See  Lawmakers Pile on the Spending In $1.4 Trillion Deal  (The Hill, 12/16/19), and the House has passed the measure. See  Massive Spending, Tax Packages Headed for Senate  (Roll Call, 12/17/19). The legislation will also extend some important health programs for five months, and includes some other significant policy provisions, as explained below.   Significantly, the deal does NOT include any provisions to address  surprise medical billing . See  Surprising Swings In Momentum For Legislation On Surprise Medical Bills  (Kaiser Health News, 12/17/19). Nor does the deal include any major measures to control the cost of  prescription drugs .  The Health 202: Congress Failed to Pass a Drug Pricing Overhaul. So It Set Another Deadline  (Washington Post "Power Post," 12/17/19).   Appropriations:  Some programs of importance to children and youth with spec

CMS good faith exemption extends EVV soft launch

The 21st Century Cures Act directs state Medicaid programs to require personal care service and home health service providers to use an electronic visit verification (EVV) system to document the services rendered. See Indiana Health Cover Programs (IHCP) Bulletins BT201951 and BT201855 for more information. In accordance with this federal requirement, the IHCP worked toward implementing an EVV system by January 1, 2020. However, after receiving input from the provider community, the Indiana Family and Social Services Administration (FSSA) submitted a good faith exemption request to the Centers of Medicare & Medicaid Services (CMS) to extend the soft launch of EVV. This would allow additional collaboration with affected providers and individuals to ensure a successful EVV implementation for Indiana. The CMS approved Indiana’s request, which extends the EVV soft launch through December 31, 2020. While the State has additional time to meet the federal EVV requirement, providers

IHCP to remove age restriction on structured family caregiving waiver services under A&D waiver

IHCP to remove age restriction on structured family caregiving waiver services under the A&D HCBS program, and accept resubmitted claims Effective immediately, the Indiana Health Coverage Programs (IHCP) will remove the age restriction on certain structured family caregiving (SFC) waiver services under the Aged and Disabled (A&D) Home and Community-Based Services (HCBS) program. Services billed for Healthcare Common Procedure Coding System (HCPCS) code S5140 – Adult foster care; per diem, in combination with modifier U7 and modifier U1, U2, or U3, had been restricted to IHCP members ages 18 and older. The age restriction no longer applies. Other existing reimbursement guidelines for code S5140 in combination with these modifiers remain unchanged. Removal of the age restriction applies retroactively to fee-for-service (FFS) claims with dates of service (DOS) on or after January 1, 2019. Claims billed for code S5140 with the modifiers indicated above may have denied for expla

IHCP removes therapy visit limit for Package C – CHIP members

IHCP removes therapy visit limit for Package C – CHIP members The Indiana Health Coverage Programs (IHCP) is removing the 50-visit limit per rolling 12 months for physical, speech, occupational, and respiratory therapy for Package C – Children’s Health Insurance Program (CHIP) members, effective for dates of service on or after January 17, 2020. This change is being made as part of the IHCP federal compliance report with the Centers for Medicare & Medicaid Services (CMS) for the Mental Health Parity and Addiction Equity Act (MHPAEA). This limit is currently being removed from the Indiana Administrative Code 405 IAC 13-7-2 and is being edited out of the managed care entity (MCE) contracts.

Medicaid Block Grants are like “Free” Hot Fudge

By:   Mara Youdelman When my kids were younger and we’d go out for ice cream, they always wanted to go to FroYo instead of Sweet Frog. Why? Because FroYo had free hot fudge (and free caramel sauce)! The “free” fudge was a big draw because they thought it was a great deal. As they got older, I explained how “free” isn’t really free, it’s a marketing pitch to draw them in. As a for-profit company, FroYo wasn’t being beneficent in giving away free hot fudge but likely increased the price of other items to pay for the free hot fudge. It was a good economics lesson that equally applies to Medicaid and Tennessee’s recent proposal to block grant its Medicaid program As set up by Congress, Medicaid is an entitlement for states, in other words: “open-ended” financing for states based on the medical assistance provided to residents of the state. So how is this relevant to block grants? Well, if something seems too good to be true – like free hot fudge (or if you’re of my generation, a c