May 19, 2017

States Consider Medicaid Policy Adjustments

Medicaid reform is central to President Donald Trump’s health care reform agenda. If implemented as proposed in the House-approved American Health Care Act (AHCA), Medicaid patient eligibility requirements would be tightened, federal Medicaid grants to the states would be capped and the states’ options for managing their Medicaid programs would be greatly expanded.

While the U.S. Senate formulates its own approach to repeal and replace the Patient Protection and Accountable Care Act (Obamacare), California is considering legislation to liberalize provider reporting requirements for Medicaid laboratory services. Other state legislative proposals would adjust Medicaid reimbursement rates to ensure an adequate pool of providers in Connecticut and more accurately reflect the cost of care in Nevada.

California AB 659 would modify existing Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law restricts the Medi-Cal reimbursement rate for clinical laboratory or laboratory services and requires that laboratory service providers submit annual data reports to the department for the purpose of establishing reimbursement rates based on the lowest amounts other payers are paying providers for similar services. This bill would change the frequency for submitting those reports to every 3 years beginning in 2019, and would require the data in those reports to be based on the previous calendar year.

Connecticut HB 6885 seeks to amend Title 17b of the general statutes to require the Commissioner of Social Services to allocate available funding so that provider reimbursement rates are sufficient to ensure an adequate pool of providers to meet the needs of Medicaid recipients.

Nevada AB 108 calls for periodic review of Medicaid rate of reimbursement for each service or item provided under the State Plan for Medicaid to determine whether the rate of reimbursement accurately reflects the actual cost of providing the service or item. If the Division determines that the rate of reimbursement for a service or item does not accurately reflect the actual cost of providing the service or item, calculate the rate of reimbursement that accurately reflects the actual cost of providing the service or item and recommend that rate to the Director for possible inclusion in the State Plan for Medicaid.

See Statescape – State Legislation Summary in this issue of ACR Advocacy in Action for an up-to-date compendium of medical imaging and other health care legislation under consideration in each of the 50 states and U.S. territories.