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The final rule related to recovery audit contractors (RACs) for Medicaid was released in mid-September (http://www.gpo.gov/fdsys/pkg/FR-2011-09-16/pdf/2011-23695.pdf), just over three months before it goes into effect. It provides a variety of guidance and opt-outs for states that have many compliance experts scratching their heads.
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Imagine the ongoing dismay of a high school math teacher who year in and year out has to teach students how to do the problems the right way, and year in and year out sees the same mistakes over and over again.
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Grena Porto, a principal consultant with QRS Healthcare Consulting in Delaware, has made a career out of advocating for patient safety and improved quality. It should not have surprised some people, then, when she posted on a patient listserv all the reasons why she believes peer review doesn't work and detailed a number of cases to illustrate why.
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One survey every three years is trying enough. But for Novant Health's Presbyterian Hospital in Charlotte, NC, that would have seemed like a vacation. Between June and August of this year, the hospital had a Joint Commission survey, a CMS survey, and the regular biannual visit from the local health department.
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An estimated 23 million non-elderly Americans will remain uninsured after 2014, including 15 million eligible for Medicaid coverage, according to a March 2011 Congressional Budget Office report.
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California has appealed a 9th U.S. Circuit Court of Appeals decision stopping a 10% provider rate reduction from going forward, with an anticipated decision by the Supreme Court by spring 2012, notes Stan Rosenstein, MPA, principal advisor at Health Management Associates in Sacramento, CA, and former California Medicaid director.
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When Delaware Medicaid attempted to implement co-pays, "we didn't get very far with our legislative branch on that," reports Rita M. Landgraf, secretary of Delaware's Department of Health and Social Services.
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Delaware Medicaid's long-term care population is still primarily fee-for-service, and this population is very high-cost because many individuals are in facility-based care, says Rita M. Landgraf, secretary of Delaware's Department of Health and Social Services. In April 2012, this group will switch to a managed care organization, she reports.
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Budget reductions for the 2011-2013 biennium in Washington state include a legislatively mandated limit on non-emergency visits to hospital ERs, reports Jeffery Thompson, MD, MPH, chief medical officer of Washington's Medicaid program.
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Washington Medicaid's plan to limit non-urgent ER visits to three a year is being watched "with great interest," says Randall Best, MD, JD, chief medical officer for North Carolina's Division of Medical Assistance. "It's a hot topic in pretty much all the states right now."
