In the News: Medicaid Managed Care Expansion Tied to Performance in Texas, Legislative Maneuvering on ‘Doc Fix’ Continues

CMS Ties Medicaid Managed Care Expansion to Performance — The increasing trend of states moving toward managed care programs to trim costs associated with their Medicaid budgets received a big shot in the arm yesterday as the Obama Administration approved a Texas plan to add more than 1,000,000 Medicaid patients to managed care plans by 2013.  Many states have begun to apply for and implement managed care programs to deal with ever increasing enrollment and costs associated with Medicaid, but there is a difference between Texas’ and others programs — performance standards.  The plan approved by CMS this week allows the expansion of managed care, but also implements quality performance standards that must be met in order for Texas to receive supplemental federal matching funds known as “upper payment limit” funds, which are designed to help make up for low base payments.  Other states are likely to watch closely whether Texas is able to take advantage of the increased federal funding through their managed care programs, and the performance data associated with them, and look to capitalize on any conclusions that may be gleaned from the recent expansion. MORE

House Passes Doc Fix, Payroll Tax Extension in Spending Bill — Last night the House of Representatives passed a bill to avert a 27% cut to physicians appropriately named, “doc fix”, also known as the sustainable growth rate, a formula used to calculate reimbursement payments to physicians serving Medicare patients. The doc fix, extensions of unemployment insurance and Social Security payroll tax deduction for individuals were all included as part of the must pass, year-end spending bill that both sides have been negotiating for months.  The Democratically-controlled Senate quickly announced their disapproval of the House version of the spending bill, leaving both sides scrambling to blame the other for playing politics with the most recent continuing resolution funding the government scheduled to run out on Friday. At present, the main sticking point seems to be how to pay for these costly additions to the spending bill, orthotics and prosthetics have not been included in any of the offsets discussed publicly by the House or Senate. MORE 

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