There’s More Time To Work Out Kinks In Medicaid Eligibility, Pricing Rules

Modern Healthcare: States Get Deadline Extension To Confirm Medicaid Enrollee Eligibility
CMS is now giving states a full year after the COVID-19 public health emergency ends to finish redetermining eligibility for Medicaid beneficiaries. The agency announced the new guidance in a letter sent to state health officials Friday. The Families First Coronavirus Response Act prohibited Medicaid programs from kicking beneficiaries off the program regardless of changes in eligibility. That's caused Medicaid and Children's Health Insurance Program enrollment to swell to a record high of more than 81 million people this year. (Bannow, 8/13)

Bloomberg Law: Medicare Holds Off On Hospital Price Disclosure Fines For Now
The Medicare agency is giving hospitals time to adjust to its price transparency rule, so far refraining from penalizing providers despite recently proposing to increase sanctions for those that don’t comply. Hospitals have been apprehensive since the Trump administration announced they would be required to disclose standard charges for items and services in a final rule (RIN 0938–AU22) published in November 2019. The vast majority of hospitals—94.4%—haven’t met one or more of the requirements since the rule took effect Jan. 1, 2021, according to a recent sample of 500 hospital websites conducted by Patient Rights Advocate. Right now many hospitals are getting warning letters if they don’t comply. (8/16)

In updates on Medicaid expansion in Missouri —

Missouri Independent: Missouri To Begin Accepting Medicaid Expansion Applications
Missourians who qualify for benefits under Medicaid expansion can begin enrolling, but it may take up to two months until they will find out if their eligibility has been verified and their application has been approved. In a news release last week, Gov. Mike Parson announced that in response to a Cole County judge’s ruling, the Department of Social Services will begin accepting applications from the approximately 275,000 residents who qualify under voter-approved Medicaid expansion. That includes 19- to 64-year-old adults whose household incomes are 138% of the federal poverty guideline or less, which ends up being $17,774 a year for a single person, or $36,570 for a family of four. (Weinberg, 8/14)

The Washington Examiner: No Need For Special Session To Fund Missouri Medicaid Expansion: Lawmakers
Missouri is complying with a court order to enroll an anticipated 275,000 low-income residents into its Medicaid program under last August’s voter-approved Amendment 2. State attorneys sought to delay enrollment until September because, among other reasons, Missouri lawmakers had not allocated the $130 million in state money to garner the $1.65 billion federal match to pay for it. (Haughey, 8/15)

In other Medicare news —

Modern Healthcare: UnitedHealth Loses Appeal Over Medicare Advantage Overpayment Ruling 
An appellate court Friday ruled against UnitedHealthcare insurers, overturning a lower court decision they claimed resulted in underpayment of Medicare Advantage insurers. A federal judge concluded in 2018 that the overpayment rule violated a federal law that required payments to be actuarially equivalent to traditional fee-for-service providers. But the U.S. Court of Appeals for the District of Columbia Circuit threw out the decision after it found that actuarial equivalence did not apply to the overpayment rule. (Brady, 8/13)

Reuters: Private Medicare Plans Must Return Overpayments, Appeals Court Rules
A U.S. appeals court on Friday revived a rule requiring private insurers that administer federally funded Medicare plans to return potentially billions of dollars in overpayments they receive based on incorrect diagnoses. The unanimous ruling by a panel of the D.C. Circuit Court of Appeals in Washington was a setback for UnitedHealth Group Inc , which had successfully challenged the rule in a lower court. UnitedHealth did not immediately respond to a request for comment. Nor did the U.S. Department of Health and Human Services, which oversees Medicare, the federal health insurance program for seniors and certain people with disabilities. (Pierson, 8/13)

CNBC: Democrats Want To Expand Medicare. Here Are The Coverage Gaps To Know
You may know that once you reach age 65, you’re eligible for Medicare. What surprises many people, say experts, is the cost. Even as Democratic lawmakers in Congress want to expand the health insurance program to cover dental, vision and hearing as part of their $3.5 trillion budget plan, those are not the only things excluded by Medicare. And, there are costs built in even when you have coverage for a service, procedure or other medical need. (O'Brien, 8/15)