Hospitals girding for an influx of Medicaid patients in 2014 under the healthcare reform law's Medicaid coverage expansion recently were given some new regulatory tools to deal with the financial fallout.
A final HHS rule (PDF) issued the morning after Independence Day implemented provisions of the Patient Protection and Affordable Care Act that allow hospitals to presume some uninsured patients are eligible for Medicaid and then bill their state program for the cost of their care. The rule specified that states cannot hold hospitals liable for the cost of care for patients they incorrectly assumed were Medicaid-eligible.
“This provision is vitally important for covering the uninsured, because it ensures that if any person who is uninsured but eligible for Medicaid shows up at a hospital needing care, he or she can immediately be enrolled in Medicaid,” Tim Jost, a law professor at Washington and Lee University, recently wrote about the new regulation in a Health Affairs blog post.
The rule will allow hospital to make presumptive eligibility decisions for Medicaid categories where eligibility is income-based. In addition, states have the option of authorizing hospitals to make eligibility determinations based on other qualifying characteristics, such as eligibility stemming from a disability.