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PubMed2003

Medicaid and indigent care issue brief: Medicaid: eligibility: year end report-2003.

Medicaid provides health insurance coverage to low-income children, parents meeting specific income thresholds, pregnant women, the elderly and people with disabilities. In 1999, Medicaid provided health care insurance to approximately 32 million low-income Americans. However, in that same year, 42 million Americans had no health insurance at all. In order to reduce the number of people without health insurance, states have expanded or clarified their eligibility standards to allow more people to enroll in Medicaid and other medical assistance programs.

Aged↗
PubMed1991

Nursing home costs, Medicaid rates, and profits under alternative Medicaid payment systems.

This analysis compares nursing home costs, Medicaid payment rates, and profits under three Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate systems. Data used were collected from 135 nursing homes in seven states. The association of case mix with costs, rates, and profits under the three payment systems was of particular interest. Case mix was more strongly associated (positively) with patient care cost and the Medicaid rate for the case-mix systems than for the other systems, particularly the class-rate systems. In contrast, case mix and profits were not associated in the case-mix or facility-specific systems, but were negatively associated in the class rate systems. Overall, the results suggest that case-mix systems have some important advantages over other payment systems, but further research is needed on larger samples and involving the newer case-mix systems.

Aged↗
PubMedDate not supplied

Mid-1990s review of Medicaid and Medicaid dentistry.

In light of a federal report on the extremely limited availability of preventive dental services for children under the Medicaid program, a review is provided of the evolving comparative share of general health expenditures and Medicaid funds that are spent on dental services. The findings indicate that during the 1990s, dentistry in general and within the Medicaid program occupies a continuing decreasing share of expenditures.

Adult↗
PubMed2002

Medicaid program; Medicaid managed care: new provisions. Final rule.

This final rule amends the Medicaid regulations to implement provisions of the Balanced Budget Act of 1997 (BBA) that allow the States greater flexibility by permitting them to amend their State plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without obtaining waivers if beneficiary choice is provided; establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services; and eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as, the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Medicaid program; model Medicaid application form--HCFA. Notice.

This notice publishes a model Medicaid application form that States have the option of using in full, in part, with modification or not at all. It would be used for noninstitutionalized individuals applying for benefits under title XIX of the Social Security Act who are not receiving cash assistance under the Aid to Families with Dependent Children (AFDC) program, Part A of title IV of the Social Security Act. This notice is published in accordance with section 6506(b) of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239), which requires the Secretary to develop a model Medicaid application form for publication in the Federal Register.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Medicaid program; Medicaid Management Information System (MMIS) performance review; notification procedures for changes in requirements, performance standards, and reapproval conditions--HCFA. Final rule.

This rule eliminates the requirement in the Medicaid regulations that HCFA meet certain Federal Register notification requirements for any changes in performance standards and other conditions for reapproval of State Medicaid Management Information Systems (MMISs), even if such Federal Register notice would not otherwise be required. An independent Federal Register publication requirement will remain in place with respect to changes in system requirements and other conditions for approval of MMISs. We believe that a revised process for notifying States and other concerned parties of changes in performance standards and other conditions of reapproval is appropriate and will facilitate the efficient issuance of revised MMIS review requirements and methodologies each year.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Medicaid program; elimination of certain written documentation pertaining to Medicaid long-term care facilities--HCFA. Final rule.

This final rule deletes a requirement in Medicaid regulations pertaining to State survey agencies, which certify facilities as meeting the requirements for participation in the Medicaid program. Specifically, we are deleting the requirement that State survey agencies, when certifying facilities with deficiencies, must provide written documentation that the deficiencies do not jeopardize resident health and safety or seriously limit the facility's capacity to furnish adequate care. Because there are already other written requirements for documentation of these deficiencies, this revision eliminates an unnecessary administrative burden, while ensuring resident health and safety.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Medicare and Medicaid programs; Medicare-Medicaid coverage data bank requirements: preliminary guidance--HCFA. Notice.

This notice informs the public about section 1144 of the Social Security Act, which is self-implementing, and provides preliminary guidance to employers who are required to report information about all individuals covered by group health plans to a newly established Medicare-Medicaid Coverage Data Bank. Information in the data bank will be used to help identify situations where employer group health plans are responsible for making primary payments for services received by Medicare or Medicaid beneficiaries. This notice provides: information on the background and legislative authority for the data bank; definitions of key terms; reporting requirements; the identity of entities that are required to, or may, report; reporting dates; penalties for noncompliance; and methods of reporting.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Medicaid program: redeterminations of Medicaid eligibility due to welfare reform--HCFA. Final rule with comment period.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the Contract with America Advancement Act of 1996 created changes in Federal law affecting the eligibility of large numbers of Medicaid recipients. These changes include revisions to the definition of disability for children and to the eligibility requirements of non-U.S. citizens and individuals receiving disability cash assistance based on a finding of alcoholism and drug addiction. This final rule with comment period protects Federal financial participation (FFP) in State Medicaid expenditures for states with unusual volumes of eligibility redeterminations caused by these recent changes in the law. We are making changes to the regulations to provide for additional time for States to process these redeterminations and provide services pending the redeterminations.

Alcoholism↗
PubMed1998

Medicaid program; Medicaid managed care--HCFA. Proposed rule.

This proposed rule would amend the Medicaid regulations to allow the States greater flexibility by giving them the option to require Medicaid recipients to enroll in managed care entities without obtaining waivers. These revisions, which are authorized by the Balanced Budget Act of 1997, would establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services. They would eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing. They would also permit State agencies to amend their State plans to require enrollment in managed care organizations subject to certain conditions, including limits on whose enrollment can be mandated, and a requirement for beneficiary choice. In addition, this rule would extend most of these new requirements to prepaid health plans.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1983

Medicaid program; Medicaid Management Information System proposed system requirements--HCFA. Proposed notice.

In this notice, we are proposing five new system requirements for Medicaid Management Information Systems. We propose that the systems be required to accept and use exclusively: (a) A uniform diagnostic coding system (the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)), wherever diagnostic coding is used; (b) A common claim form for hospital billing (HCFA-1450); (c) A uniform electronic billing format for institutional billing; (d) A common claim form for noninstitutional providers (the revised version of the Health Insurance Claim Form, HCFA-1500); and (e) A uniform procedure coding system (HCFA Common Procedure Coding System (HCPCS)). These requirements would improve the efficiency and effectiveness of the Medicaid program.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1982

Medicaid program; interest on disputed Medicaid claims--HCFA. Proposed rule.

This proposal would clarify HCFA policies relating to disallowances of State claims for Federal matching of State Medicaid expenditures. Before the enactment of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499). States were permitted to retain, interest-free, the Federal matching funds for State Medicaid expenditures that had been disallowed, until there was a final Federal determination under the administrative appeals process. If the determination upheld part or all of the disallowance, the State returned only that amount and did not pay the Federal government any interest. Section 961(a) of the Omnibus Reconciliation Act of 1980 changed these procedures by giving the State the options, if it appeals a disallowance, of returning the disallowed funds to HCFA, or of retaining the disallowed funds held by the State until there is a final determination but paying interest on any portion of the disallowance that is sustained on appeal. The statute is self-implementing, and the proposed regulations are intended simply to specify the procedures to be followed when a State chooses to retain the funds.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1983

Medicaid program; reduction in error rate tolerance; Medicaid quality control program--HCFA. Interim final rule with comment period.

This interim final rule implements the provisions of section 133 of the Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248). These regulations provide for disallowance of Federal financial participation to States whose eligibility payment error rate for Medicaid, as measured by the Medicaid quality control system, exceeds 3 percent for the period April 1 through September 30, 1983, and for each fiscal year thereafter. The regulations further provide for HCFA to project a payment error rate for each State and to reduce the State's quarterly estimate of expenditures if the anticipated error rate exceeds the 3-percent national standard.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1983

Medicaid program; interest on disputed Medicaid claims--HCFA. Final rule.

These regulations clarify HCFA policies relating to disallowances of State claims for Federal matching of State Medicaid expenditures. Before the enactment of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499), States were permitted to retain, interest-free, the Federal matching funds for State Medicaid expenditures that had been disallowed until there was a final Federal determination under the administrative appeals process. If the determination upheld part or all of the disallowance, the State returned only that amount and did not pay the Federal government any interest on the disallowed amounts. Section 961(a) of the Omnibus Reconciliation Act of 1980 changed these procedures by giving the State the option of either returning the disallowed funds immediately to HCFA or of retaining the disallowed funds held by the State until there is a final determination. If the State chooses to retain the disallowed funds, it will be required to pay interest on any portion of the disallowance that is sustained on appeal. The statute is self-implementing and these regulations simply specify the procedures to be followed when a State chooses to retain the funds.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1984

Medicaid program; reduction in error rate tolerance; Medicaid quality control program--HCFA. Final rule.

This final rule implements the provisions of section 133 of the Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248). Under these regulations, Federal financing participation will be disallowed to the extent that a State has a Medicaid eligibility payment error rate (as measured by the Medicaid quality control system) that exceeds the statutorily mandated three-percent national standard for any of the three quarters beginning April 1, 1983 and ending December 31, 1983. The regulations further provide that we will project a payment error rate for each State for each of these three quarters and will reduce the State's quarterly grant award (based on its estimated expenditures) to the extent that the anticipated error rate exceeds the three-percent national standard.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

Medicaid program; imposition of cost sharing charges under Medicaid--HCFA. Final rule.

This final rule responds to the comments we received on a final rule with comment period published on February 8, 1983 (48 FR 5730). That rule set forth revised requirements concerning the imposition of cost sharing charges on Medicaid recipients when they receive medical services covered by Medicaid.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

Medicare and Medicaid programs; Deficit Reduction Act of 1984; information notice on Medicare and Medicaid amendments--HCFA.

This notice describes briefly some of the provisions of Title III of Division B of the Deficit Reduction Act of 1984 (Pub. L. 98-369, enacted July 18, 1984). These provisions, referred to as the Medicare and Medicaid Budget Reconciliation Amendments of 1984, affect eligibility benefits, reimbursement, and administration of the Medicare and Medicaid programs. The provisions in this notice are, in whole or in large part, self-explanatory and are now or will soon be effective. These provisions are so clear and explicit that regulations are not required for their implementation.

Centers for Medicare and Medicaid Services, U.S.↗