Payer Roundup—Illinois sues for reversal of required $145M in repayments

Illinois suing the federal government for reimbursements on two Chicago hospitals. (Getty/tifonimages)

Illinois sues for reversal of required $145M in repayments

Illinois is suing the federal government over an order to repay $145 million in reimbursements for Medicaid payments at two Chicago hospitals. In 2016, the Centers for Medicare & Medicaid Services CMS required the Illinois Department of Healthcare & Family Services to repay $140 million in reimbursements to the University of Illinois Hospital and $4.5 million to Mount Sinai Hospital. 

The payments happened over a four-year period, 1996 to 2000, and the state is being accused of not following standards for the Illinois Medicaid plan when calculating hospital-specific payments. 

To cover the disputed payments, CMS is collecting $20 million per quarter from the state, plus interest. (Crain’s)


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CMS updates Medicare coverage policy for TAVR

The Centers for Medicare & Medicaid Services announced that it would update its coverage policy for transcatheter aortic valve replacement.

CMS said it would cover the treatment in Medicare beginning in 2012 under its coverage with evidence development (CED) determination, and since then more than 500 hospitals have begun to offer TAVR. In the new guidance, CMS said it will continue to cover TAVR under that designation, but wants to offer greater flexibility to providers that would include it among their service offerings.

Providers that want to offer TAVR must also offer a certain number of heart procedures to receive Medicare payment, CMS said.

“CMS must continually refine our policies and requirements in light of emerging evidence,” Administrator Seema Verma said. (Announcement

Women report greater access to healthcare, prevention with ACA

Since implementation of the Affordable Care Act (ACA), women at all income levels are reporting greater affordability of coverage, access to healthcare and receipt of preventative services, according to a study in the American Journal of Preventative Medicine. 

After looking at the profiles of more than 41 million women, since the enactment of the ACA, those with incomes less than 138% federal poverty level have had less difficulty finding affordable insurance, are more likely to have seen a doctor in the past 12 months, and have had blood pressure screenings, cholesterol screenings and mammograms. 

Prior to the ACA, women faced obstacles such as higher premiums than men, denial of coverage for pre-existing conditions, and lack of coverage for services like maternity care. (American Journal of Preventive Medicine)

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