All posts by Thomas Entrikin

CMS Issues New Regulations to Enhance Program Integrity

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), published a final rule in the September 10, 2019 Federal Register to implement program integrity enhancements to the provider enrollment process under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  The CMS rule will be effective November 4, ...

Hearings Begin on “Medicare for All” Legislation

On June 12, 2019, the U.S. House of Representatives’ Ways and Means Committee conducted its initial hearings on H.R. 1384, the Medicare for All Act of 2019. Introduced by U.S. Representative Pramila Jayapal (D-WA) in February, H.R. 1384 would: Provide health coverage for all U.S. residents. Authorize automatic enrollment upon birth or establishment of U.S. ...

CDC issues new report on the growing opioid crisis

On March 6, 2018, the Centers for Disease Control and Prevention (CDC) released a report which shows that from July 2016 – September 2017, hospital emergency department visits for opioid overdoses rose about 30 percent in 52 reporting jurisdictions in 45 states. They rose 54 percent in large cities, and 70 percent in mid-western states. ...

President Signs Bipartisan Budget Act

On February 9, 2018, President Trump signed H.R. 1892, the Bipartisan Budget Act of 2018.  The new law reauthorizes federal funding for many health programs, modifies scheduled reductions in Medicaid disproportionate share hospital (DSH) allotments to states, tightens third party liability (TPL) billing requirements, and updates requirements affecting Medicare Advantage plans, accountable care organizations (ACOs), ...

Congress reauthorizes the Children’s Health Insurance Program

On January 22, 2018, Congress reauthorized funding for the Children’s Health Insurance Program (CHIP) through Federal fiscal year (FFY) 2023. The CHIP provisions are included as the Healthy Kids Act under H.R. 195, Division C.  Division B extends a short-term continuing resolution (CR), which was necessary to reverse a three-day federal government shut-down. Division D ...

CMS finalizes rules on episode payment models

On January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published final rules on new Medicare episode payment models (EPMs) to be implemented on July 1, 2017. The EPMs are designed to encourage participating hospitals to devise strategies to improve discharge planning, adherence to treatment and medication regimens, and coordination among all providers ...

CHIP funding crisis remains unresolved

Congressional authorization of Federal funds for CHIP expired on September 30, 2017.  Nine million children depend on this program.  States are now operating CHIP on carryover and redistribution payments from prior years.  CMS estimates that at least one state will exhaust such funding in this month.  Most states could exhaust such funding by March 2018. ...

White House releases report on opioid crisis

On November 1, 2017, the White House released a report drafted by the President’s Commission on Combating Drug Addiction and the Opioid Crisis.  The report offers 56 recommendations for action by Congress, federal agencies, state governments, health care provider organizations, and health care payers. Those include: New training programs on screening patients for substance use ...

Senators introduce ACA repeal legislation

On September 13, 2017, U.S. Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson introduced legislation to scrap many provisions of the Affordable Care Act (ACA) while imposing funding caps on the traditional Medicaid program. The bill could become law under budget reconciliation rules that block a Senate filibuster. The bill could pass the ...

White House issues report on the opioid epidemic

On July 31, 2017, the White House posted the initial findings and recommendations of its Commission on Combatting Drug Abuse and the Opioid Crisis. The Commission cites evidence that: 142 Americans die from drug overdoses per day. Only 10 percent of the 21 million persons with a substance use disorder (SUD) are receiving appropriate treatment ...