Federal Legal Developments HSFO Conference Philip Peisch - - PowerPoint PPT Presentation
Federal Legal Developments HSFO Conference Philip Peisch Scottsdale, AZ Brown & Peisch PLLC October 7, 2019 Washington, DC ACA DSH Reductions Legislative update Methodology for calculating reductions CMS final rule issued
Philip Peisch Brown & Peisch PLLC Washington, DC
HSFO Conference Scottsdale, AZ October 7, 2019
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party payors in calculating the hospital-specific DSH limit
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compliant with special conditions of participation?
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Arkansas, Indiana, Kentucky, Michigan, New Hampshire, Ohio, Utah, Wisconsin
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“with respect to coverage of the Medicaid adult expansion group . . . and for other expenditures that are claimed at the enhanced federal matching rate”
to be eligible between regularly scheduled redeterminations” and recommends “the use of periodic data matching to identify beneficiaries who may have had a change in circumstance that affects their eligibility”
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substance use disorder, for up to 30 total days of care in an “eligible IMD” during a 12-month period
available for items or services provided outside of the IMD
to MCOs for individuals during an inpatient stay in an IMD that is no more than 15 days during the month
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with 90% federal match for first 8 quarters
health homes targeted to Medicaid enrollees with SUD
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85% MLR and a State’s MLR must be at least 85%, if it has an MLR
based on the State’s regular FMAP, even if it is partially attributable to cap payments at the ACA’s increased match for newly eligible adults
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“directing” a managed care entity’s payments to providers
directed payments
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improved reporting of Medicaid payments”
transparency and oversight of Medicaid supplemental payments” by issuing a regulation requiring “more complete and timely provider-level data on supplemental payments, including the financing of such payments”
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Medicaid program is the primary service revenue”
practitioner for benefits such as health insurance, skills training and other benefits customary for employees”
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“directly related” to either the safety, permanence, or well-being of the child or to prevent the child from entering foster care
not yet reviewed and approved by the ACF Clearinghouse
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placements in “child-care institutions”, effective October 1, 2019
specializing in providing prenatal, post-partum, or parenting supports for youth; supervised independent living setting for children 18 and
services to children who are at risk of or who have been victims of sex trafficking.
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Title IV-A (TANF, SSI)
“substantial” and “ongoing” TANF benefits (cash or non-cash); (2) for non-cash TANF, receiving benefits that focus on subsidized employment, work supports, and childcare
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