White House Mulls Overhaul Of Trump Direct-Contract Medicare Program
The Trump-era program allows private companies to participate in Medicare in an attempt to limit government costs. Progressive Democrats are said to be pressuring the White House to overhaul it. In Montana, federal inspectors placed the state psychiatric facility under serious sanctions.
Politico:
Trump-Era Medicare Program Under Increased Scrutiny
The Biden administration is debating whether to overhaul a major Trump-era program tied to Medicare as soon as this week in the face of rising pressure from prominent progressive Democrats, more than a half-dozen people familiar with the matter told POLITICO. The Trump program — known as a direct contracting model — allows private companies to participate in Medicare as part of a broader health department effort to improve care while limiting the government’s costs. (Levy and Cancryn, 2/16)
In other Medicare news from Montana and Ohio —
Billings Gazette:
Montana State Hospital Placed On 'Immediate Jeopardy' After Federal Inspection
Federal inspectors have placed the state psychiatric facility on "immediate jeopardy" status, the most serious deficiency designation that carries serious sanctions for facilities receiving federal reimbursement dollars. While details of what triggered the designation have not yet been released, the Centers for Medicare and Medicaid Services revisited the Montana State Hospital in Warm Springs last week after the Montana State News Bureau questioned how the federal agency approved an inspection of the facility in September that found staffing numbers were below the level needed to prevent patients from falling. Inspectors found patients had fallen 113 times between June and August 2021, and employees told inspectors staffing documentation had been altered to not list patients whose needs required one-on-one attention from staff. (Larson, 2/16)
Columbus Dispatch:
OrthoNeuro, Others, Improperly Billed For Shoulder Surgeries
Three Columbus-area healthcare companies have agreed to pay about $3.2 million for charging Medicare and the Ohio Bureau of Workers' Compensation for surgeries that may not have happened. According to the U.S. Department of Justice, Mount Carmel Health System, New Albany Surgery Center and Orthopedic & Neurological Consultants (also known as OrthoNeuro), were involved in the improper billing. OrthoNeuro surgeon and partner Robert Nowinski billed for shoulder surgeries that were outside normal standards "or did not occur at all," according to a news release from the Justice Department's Southern District of Ohio office. (Weiker, 2/16)
In Medicaid news from Wisconsin and Georgia —
AP:
Wisconsin Assembly To Vote On Tightening Public Benefits
The Wisconsin Assembly was scheduled to pass a package of Republican-authored bills Thursday designed to force more people into the workforce by tightening eligibility for unemployment benefits and Medicaid coverage. The bills, which are expected to be taken up in the Senate before the session ends next month, are almost certainly headed for vetoes by Democratic Gov. Tony Evers should they pass the full Legislature. (Richmond, 2/17)
Georgia Health News:
House Panel Endorses More Transparency In Health Plans’ Data
A House committee Tuesday approved a bill that would require more public disclosure about Georgia health plans serving Medicaid patients and state employees and teachers. House Bill 1276, if it becomes law, would require the main state health agency to post reports showing how many primary care providers these insurance plans offer in a county, along with data on the insurers’ hospital costs and prescription drug spending. Members of the House Health and Human Services Committee did not voice any objections to the measure, which now goes to the Rules Committee in that chamber. (Miller and Grapevine, 2/15)
Georgia Health News:
Insurance Industry Chief: Not Opposed To Medicaid Spending Requirement
The CEO of an insurance industry trade group said Wednesday that insurer members are not opposed to the medical spending requirements for Medicaid managed care plans contained in a mental health parity bill. Among its provisions, the high-profile House Bill 1013 would set up a minimum level of medical spending of at least 85 percent of the dollars that Medicaid insurers receive from the program. Jesse Weathington, president and CEO of the Georgia Association of Health Plans, told GHN that insurers have met the 85 percent the last two years through a financial reconciliation process with the government. He spoke to a reporter after testifying at a House committee hearing on the mental health bill. (Miller and Grapevine, 2/16)
