State Telehealth Laws & Reimbursement Policies

The Center for Connected Health Policy, the National Telehealth Policy Resource Center, has released its latest biannual update on state telehealth laws, regulations, and policies, with a primary focus on Medicaid fee-for-service programs. However, managed care/private payer laws are also covered when available.

Telehealth policy trends are briefly summarized from a national perspective, followed by detailed state profiles. Each state profile on telehealth reimbursement includes:

• Key state agencies/organizations
• State policy overview
• Definitions
• Live video, store-and-forward, and remote patient monitoring
• Eligible providers, sites, geographic limits, facility/transmission fees, services/specialties
• Consent
• Professional regulation/health and safety, including cross-state licensing and online prescribing

States vary considerably on telehealth policies. Overall, the report noted live video Medicaid reimbursement is far more prevalent than reimbursement for store-and-forward and remote patient monitoring. Other trends noted for some states are specific documentation and/or privacy and security guidelines; the addition of home and schools as eligible originating sites; and the inclusion of teledentristy and substance abuse services as qualifying specialties.

State telehealth laws & reimbursement policies; a comprehensive scan of the 50 states & the District of Columbia. Center for Connected Health Policy, Spring 2019. https://www.cchpca.org/sites/default/files/2019-05/cchp_report_MASTER_spring_2019_FINAL.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITALS: How many DSH hospitals are there?

Hospitals that serve a higher proportion of low-income patients are eligible to receive disproportionate share payments from state Medicaid programs.

DSH hospital: A hospital that receives disproportionate share hospital (DSH) payments and meets the minimum statutory requirements to be eligible for DSH payments: a Medicaid inpatient utilization rate of at least 1 percent and at least two obstetricians with staff privileges that treat Medicaid enrollees (with certain exceptions” (page 57)

In this report from the Medicaid and CHIP Payment and Access Commission (MACPAC), there is a table that quantifies the number of disproportionate share hospitals (DSH) in the United States as of 2012.

DSH Hospitals: Counts by Type of Hospital

• 1,865 (55 percent) of Short-term acute care hospitals
•    565 (42 percent) of Critical access hospitals
•    129 (26 percent) of Psychiatric hospitals
•      47 (58 percent) of Children’s hospitals
•      32 (  7 percent) of Long-term hospitals
•      32 (13 percent) of Rehabilitation hospitals

Counts by Location

• 1,681 (40 percent) of urban hospitals
•    989 (54 percent) of rural hospitals

Counts by Teaching Status

• 1,921 (39 percent) of non-teaching hospitals
•    392 (59 percent) of “low-teaching” hospitals
•    357 (79 percent) of “high-teaching” hospitals

Source: Medicaid and CHIP Payment and Access Commission. (2017, March). Report to Congress on Medicaid and CHIP (pp. 57, 59). Washington, D.C.: MACPAC.  Click here for access: https://www.macpac.gov/wp-content/uploads/2017/03/March-2017-Report-to-Congress-on-Medicaid-and-CHIP.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

Health Innovations State Law Database

The Health Innovations State Law Database created by the National Conference on State Legislatures is  a resource for identifying over 800 recently enacted state laws and regulations that address health policy innovations related to access, Medicaid, private and commercial insurance markets, the Accountable Care Act and social determinants of health.. The database supports searching by keyword, state, legislative status, bill number, sponsor, and/or these topics:

• Exchanges and Health Marketplaces
• Free Market; Challenges and Alternatives
• Market-Cost Containment
• Market-Coverage
• Market-Delivery Reform [includes accountable care]
• Market-Health Insurance Reforms
• Market-Mandates and Essential Health Benefits
• Market-Network Adequacy
• Market-Other
• Market-Payment Reforms
• Market-Price Transparency
• Medicaid Expansion and Waivers
• Medicaid Payment Reform
• Medicaid-General
• PPACA – ACA-Health Reforms
• State-Run Programs
• Telehealth Programs

However, the full-text of the legislation located is restricted to NCLS members.

Source: Health innovations state law database: tracking state laws for health care transformation, 2015-2016. National Conference of State Legislatures, accessed Jan. 27, 2017. http://www.ncsl.org/research/health/health-innovations-database.aspx

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Medicaid and CHIP Data: Findings from a 50-State Survey

The Kaiser Family Foundation has just released its 15th annual 50-state survey on Medicaid and the Children’s Health Insurance Program [CHIP].

The report provides and discusses state data on eligibility, enrollment, renewal and cost-sharing policies and identifies changes over the past year. It also documents the key health coverage role the Medicaid and CHIP programs play for low-income families.

As health coverage policy direction gets debated, this report will provide helpful background information.

Source: Brooks T and others. Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies as of January 2017; findings from a 50-state survey. Kaiser Family Foundation, Jan. 2017. http://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-as-of-Jan-2017

Related:

Rosenbaum S and others. Medicaid’s future: what might ACA repeal mean? Commonwealth Fund Issue Brief, Jan. 2017. http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal

State health facts: Medicaid and CHIP. Kaiser Family Foundation, accessed Jan. 12, 2017 at http://kff.org/state-category/medicaid-chip/

State Medicaid fact sheets. Kaiser Family Foundation, Jan. 26, 2017. http://kff.org/interactive/medicaid-state-fact-sheets/?utm_campaign=KFF-2017-January-Medicaid-State-Fact-Sheets

Blumberg LJ and others. Implications of partial repeal of the ACA through reconciliation. Urban Institute, Dec. 2016. http://www.urban.org/sites/default/files/publication/86236/2001013-the-implications-of-partial-repeal-of-the-aca-through-reconciliation_0.pdf

Cunningham P and others. Understanding Medicaid hospital payments and the impact of recent policy changes. Kaiser Commission on Medicaid and the Uninsured Issue Brief, June 2016. http://files.kff.org/attachment/issue-brief-understanding-medicaid-hospital-payments-and-the-impact-of-recent-policy-changes

Guy J and others. Repeal of the ACA Medicaid expansion: critical questions for states. State Health Reform Assistance Network, Robert Wood Johnson Foundation Issue Brief, Dec. 2016. http://statenetwork.org/wp-content/uploads/2016/12/State-Network-Manatt-Repeal-of-the-ACA-Medicaid-Expansion-Critical-Questions-for-States-December-2016.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

MEDICARE: CMS fast facts provides US national statistics

This is a nice two-page summary of current statistics related to the Medicare and Medicaid programs. It provides official federal government counts of people and money – the number of beneficiaries and persons served and a recap of national health expenditures.  But WAIT!  There’s more!  I am excited to let you know of a count of the total number of providers by type in the U.S.  How many total hospitals?  How many hospitals of different types?  How many skilled nursing facilities?  Ambulatory surgery centers?  Labs?  And other types of providers.  These are useful totals for business planners who are sizing the market for a new product, for example.

Source:

U.S. Centers for Medicare & Medicaid Services. (2016, July 7). Fast Facts.  Click here for free full text: https://www.cms.gov/fastfacts/

For more indepth information: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

FORECASTING: Hospital payer mix 2014 and 2024, U.S.

What are the projections for U.S. hospitals’ Medicare margins over the next 10 years?  This brief article by a staff specialist at the Healthcare Financial Management Association takes a look at data from the Congressional Budget Office and the Medicare Payment Advisory Commission to address this issue.  I especially like the inclusion of payer mix statistics for the two endpoint years.  Here they are:

RECENT HOSPITAL PAYER MIX: 2014

• 37.8 percent  Commercial
• 35.1 percent Medicare
• 18.2 percent Medicaid
•   5.8 percent Other governmental
•   3.1 percent Self-pay

FUTURE HOSPITAL PAYER MIX: 2024 projections

• 40.0 percent Medicare
• 33.0 percent Commercial
• 18.4 percent Medicaid
•   5.7 percent Other governmental
•   2.9 percent Self-pay

Source: Mulvany, C. (2016, Apr.). Margins under pressure. HFM. Healthcare Financial Management, 70(4), 30-33. Click here: https://www.hfma.org/Content.aspx?id=47230 Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MEDICAID: Trends in enrollees and spending 1966 to 2014

These are authoritative national data from the MACPAC, the Medicaid and CHIP Payment and Access Commission.

Medicaid Enrollment (in millions)

•   4.0  1966
• 14.0  1970
• 20.2  1975
• 19.6  1980
• 19.8  1985
• 22.9  1990
• 33.4  1995
• 34.5  2000
• 46.3  2005
• 54.6  2010
• 64.8  2014

Medicaid Spending (in billions)

 

• $    1  1966
• $    5 1970
• $  13  1975
• $  25  1980
• $  41  1985
• $  73  1990
• $157  1995
• $203  2000
• $310  2005
• $388  2010
• $473  2014

Source: Medicaid and CHIP Payment and Access Commission. (2015, Dec.). MACStats: Medicaid and CHIP data book. Washington, D.C.: MACPAC. https://www.macpac.gov/wp-content/uploads/2015/12/MACStats-Medicaid-and-CHIP-Data-Book-December-2015.pdf  Posted by AHA Resource Center (312) 422-2050.

 

Chart Book: 21st Century Rural Hospitals

Is there a typical rural hospital? A new report  from the Sheps Center for Health Services Research, a rural health research and policy center based at the University of North Carolina, provides a statistical profile, including these medians:

• It has 25 beds
• It has 7 inpatients every day
• It employs 321 full-time equivalent workers
• It serves a median population of 27,930 with 36 residents per square mile
• Typical inpatient care includes surgical, obstetric, and swing bed services
• Typical outpatient care includes surgical, cardiac rehab, breast cancer screening/mammography, and health fair services
• Outpatient care represents 69.3% of total revenue

The report provides more data on hospitals, inpatient and outpatient services, the rural population, and hospital finances. In some cases, its contrasts rural hospitals with urban hospitals.

Freeman VA and others. The 21st century rural hospital: a chart book. Cecil G. Sheps Center for Health Services Research, University of North Carolina, March 2015. http://www.shepscenter.unc.edu/wp-content/uploads/2015/02/21stCenturyRuralHospitalsChartBook.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Percent of Office-Based Primary Care Physicians Not Accepting New Patients

The Centers for Disease Control and Prevention reports that 8.4% of office-based primary care physicians were not accepting new patients in 2013. New patient acceptance differed by insurance type, however. Over a third of the physicians were not accepting new Medicaid patients. Here’s the CDC infographic:

 

 

Source: Hing E and others. Quick stats: Percentage of office-based primary care physicians not accepting new patients by source of payment – United States, 2013. Morbidity and Mortality Weekly Report, Aug. 14, 2015. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6431a10.htm

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ACA Insurance Expansion and Uncompensated Hospital Care Costs

Hospital uncompensated care costs were $7.4 billion less in 2014 than they would have been if insurance coverage had remained at 2013 levels. That’s according to an updated analysis by HHS, based on estimated 2014 growth in insurance coverage due to the Affordable Care Act. It’s a 21% decrease in hospital uncompensated care between 2013 and 2014.

Medicaid expansion accounted for a significant portion of the uncompensated cost savings in states that expanded Medicaid versus those states that didn’t. An additional $1.4 billion in uncompensated costs might have been saved if the the non-expansion states had increased Medicaid coverage.

Here are the numbers from the report:

Furthermore, HHS analyzed hospital financial reports and found the volume of uninsured/self-pay admissions has fallen in major hospital systems, with a significant drop in states with Medicaid expansion.

 

Source: Insurance expansion, hospital uncompensated care, and the Affordable Care Act. US Dept. of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, March 23, 2015. http://aspe.hhs.gov/health/reports/2015/MedicaidExpansion/ib_UncompensatedCare.pdf

Related resources:

Economic impact of the Medicaid expansion. US Dept. of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, March 23, 2015. http://aspe.hhs.gov/health/reports/2015/MedicaidExpansion/ib_MedicaidExpansion.pdf

Uncompensated hospital care cost fact sheet. American Hospital Association, Jan. 2015. http://www.aha.org/content/15/uncompensatedcarefactsheet.pdf

See also earlier post: https://aharesourcecenter.wordpress.com/2014/09/26/impact-of-insurance-expansion-on-hospital-uncompensated-costs-in-2014/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org