Shutdown
No progress this past week on ending the shutdown. A few news notes related to the shutdown
- EPTC – Politico reported that there are some conversations among Republicans around a compromise on extending enhanced subsidies. This would include changes such as an income cap, a minimum payment requirement, or having the enhanced subsidies only applicable to those currently receiving the subsidies.
- It’s important to note that the delay in ePTCs is already starting to have a negative impact on the individual market. A recent article from Jason Levitis, Sabrina Corelette, and Claire O’Brien outline some timing implications to the delay in ePTC extension.
- CMS announced it would be holding claims related to programs that expired October 1st. Initially CMS announced that it would be pausing all Medicare provider payments but reversed that decision.
- Some health care policies that have not been extended are beginning to affect the industry. For example, Medicaid DSH payment cuts are starting to go into effect and having negative effects on hospitals (h/t modern health care $). The expiration of the home health program is also leading some facilities to move patients back to hospitals, straining hospital capacities.
Oz on Medicare Advantage
CMS Administrator Mehmet Oz recently told insurer executives that MA plans needed to improve prior authorization practices. He also outlined what he perceived as problems for the MA program, namely issues with home health risk assessment and upcoding. CMS did not respond to questions if they we plan on releasing a risk adjustment audit rule.
