November 20, 2017
White House opens door to keeping individual mandate repeal out of tax bill
Senator Susan Collins (R-ME), a key vote in the Senate, opposes a repeal of the ACA’s individual mandate in the tax bill. In a turn of events, the White House announced they are open to the idea of removing the individual mandate provision from the bill if it would thwart the Senate’s ability to pass the legislation. Repeal of the ACA mandate would create about $338 billion in revenue over 10 years, which would be used to offset additional tax cuts.
Higher premiums for outpatient coverage await Medicare beneficiaries in 2018
A bump in Social Security benefits will cause some beneficiaries’ premiums for outpatient coverage under Medicare Part B to increase next year. The standard premium for Part B is $134 a month, but many beneficiaries currently pay only $109 a month due to a hold harmless provision that prevents Medicare Part B costs from increasing more than a beneficiary’s Social Security cost-of-living adjustment. An increase in Social Security benefits will raise the cost-of-living adjustment high enough to account for the difference.
IlliniCare cuts rates to Medicaid suppliers
IlliniCare, a private insurer that is part of the Illinois Medicaid managed-care overhaul, will cut reimbursement rates to medical suppliers by half. The lower rate, which begins in 2018, effects suppliers that manufacture durable medical equipment like wheelchairs, oxygen tanks and ventilators for low-income residents enrolled in Medicaid. There is concern the decision could cause suppliers to stop accepting IlliCare payments, which could limit patient access to critical medical supplies.
Arizona’s Supreme Court upholds state’s Medicaid expansion
The Arizona Supreme Court on Friday upheld a critical component to maintaining the state’s Medicaid expansion, which provides coverage to nearly 400,000 Arizonans. Opponents of the expansion argued a hospital assessment fee included in the Medicaid program constituted a tax, which requires two-thirds of the state legislature to enact. However, the high court unanimously ruled that the hospital assessment used to help pay for Medicaid expansion was not a tax, leaving the provision in place. The assessment helps the state pay for its portion of the Medicaid, program which is mostly—but not entirely—funded by the federal government.
UnitedHealth and Advisory Board Company finalize deal
Shareholders and executives at Advisory Board have approved a deal that will split and sell the Advisory Board’s consulting and education wings to UnitedHealth Group and a private equity firm, respectively. Under the $2.6 billion deal, UnitedHealth’s Optum will acquire the healthcare consulting business, which provides research, advisory service and analytics for more than 4,400 health care organizations. Some are concerned the merger could compromise the integrity of the Advisory Board by skewing its research in favor of Optum.
Value-based models are spreading, but challenges remain
Increased discussion around value-based payment models has coincided with increased use of such programs. Although most providers remain on a fee-for-service pay structure, nearly 25 percent of payments to doctors and hospitals are in alternative payment models, and around 40 percent of physicians report at least some of their pay is linked to quality. CMS has played a strong role in helping drive value-based programs, with nearly 30 percent of all reimbursements linked to alternative payment models, a number the agency hopes to bump to 50 percent by the end of 2018. While value-based models have spread, there are still significant hurdles to switching most providers to value-based payment, as many are unaware or unprepared to adapt to such structures.
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