AHA urges CMS to lift Medicaid managed care restriction

Dec 05, 2017 - 10:21 AM

AHA today urged the Centers for Medicare & Medicaid Services to reverse its policy prohibiting pass-through payments to hospitals through the Medicaid managed care system, and work with states and hospitals “to explore how these vital funds can support state payment and delivery reform objectives, such as value-based payment arrangements.” A 2016 final rule effectively ended these supplemental payments for hospitals in a managed care setting. AHA voiced support for many of the rule’s other policy changes, such as standardizing requirements for the state capitation rate setting process and health plan medical loss ratios, provider network adequacy standards and strategies for quality improvement. AHA also supports the provision allowing states to pay a capitated payment to managed care plans for enrollees aged 21 to 64 who are subject to the Medicaid Institutions for Mental Disease exclusion, but urged the agency to consider expanding the 15-day limit on enrollees’ stay. “There is a critical need to improve access to short-term inpatient psychiatric and substance use disorder treatment for the Medicaid population,” wrote Ashley Thompson, AHA senior vice president of public policy analysis and development.

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