Medicare & Medicaid
CMS is proposing to apply a permanent 5% cap on decreases in the wage index.
DaVita claims Marietta Memorial Hospital Employee Health Benefit Plan's limited coverage for outpatient dialysis violates the statute.
CMS did not explicitly concur with the OIG's recommendation to develop its own source of race and ethnicity data.
The rule proposes a permanent 5% cap on negative wage index changes, regardless of the underlying reason for the decrease.
The Medicaid managed care organization was accused of submitting inaccurate billing requests to the state in its capacity as PBM.
Without action from Congress, the AHA estimates hospitals will lose at least $3 billion by the end of the year.
The tradeoff is the same cap would increase per capita spending on Medicare by 1,000, or 7.8% on average.
Plus, Medicare and Social Security are facing long-term financing shortfalls under currently scheduled benefits and financing.
Enrollment growth was strong in Medicaid and Medicare Advantage, but was partly offset by increased medical costs.
The hospital lost Medicare and Medicaid funding after a series of compliance issues, but lawmakers call the facility essential.