Right now, Medicare's payments to federally qualified health centers are based on reasonable costs, but are subject to established payment limits. However, under rules set out by the Patient Protection and Affordable Care Act, the new Medicare prospective payment system for the centers will use type, intensity and duration of services to help determine reimbursements, without regard to payment limits.
Federally qualified health centers, which are generally required to provide primary care and preventive-care services to all patients regardless of their ability to pay, have been struggling with what the National Association of Community Health Centers has called “an outdated Medicare payment methodology.” A statement issued by the organization references a 2010 report by the Government Accountability Office that found that health centers lost money with each Medicare beneficiary they served. Across the country, these centers treat more than 22 million people, including 1.7 million Medicare beneficiaries.
“While we need to take a closer look and further analyze the effect and impact of these proposed rules, NACHC appreciates CMS' effort to develop what appears to be a comprehensive, yet administratively simple, Medicare reimbursement methodology for health centers,” Dan Hawkins, senior vice president of policy at NACHC, said in an e-mailed statement. “We look forward to providing comment on the proposed rule and its finalization in preparation for implementation in 2014, thus improving health centers' ability to treat growing numbers of Medicare patients.”
The CMS will accept comments on the proposed rule from Sept. 23 through Nov. 18. Though a final rule will not be issued until next year, the CMS plans to start implementing the proposed system on Oct. 1, 2014, and to transition centers to the new system throughout 2015. The proposed rule was developed through a collaborative relationship with the Health Resources and Services Administration, which manages the health center program.
Strong Medicare Advantage enrollment expected
The Obama administration is projecting strong enrollment in the Medicare Advantage program in 2014. Enrollment in the private Medicare plans increased to 14.4 million in 2013 from 11.1 million in 2010, according to the Kaiser Family Foundation, countering some predictions that enrollment would drop significantly as a result of payment cuts to Advantage carriers in the Patient Protection and Affordable Care Act. HHS said Thursday that the average number of plan choices will be about the same in 2014 as in 2013, with 99% of Medicare beneficiaries having access to at least one plan. While reducing Advantage payments under the healthcare reform law, the administration also expanded a program awarding bonus payments for plans receiving high quality ratings. For 2014, more than a third of the plans will receive four or more stars, up from 28% in 2013. Open enrollment for Advantage plans begins Oct. 15.
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