Reforming Medicaid Reimbursement before the Next Pandemic

2020 ◽  
Author(s):  
Charles Blahous ◽  
Elise Amez Droz
Keyword(s):  
Medicaid Reimbursement

Termination of Skilled Nursing Facility Medicaid Provider Agreements: Procedural Due Process Requirements

1981 ◽  
Vol 6 (4) ◽  
pp. 451-493
Author(s):  
Nancy Elizabeth Jones
Keyword(s):  
Due Process ◽  
Skilled Nursing Facility ◽  
Health And Safety ◽  
The State ◽  
Federal Regulations ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Medicaid Reimbursement ◽  
Emergency Situations ◽  
Procedural Due Process

AbstractWhen a state Medicaid agency terminates its provider agreement with a skilled nursing facility, federal regulations give the state the option of providing a pretermination evidentiary hearing; they do not, however, require that a state provide such a hearing. If a state chooses not to grant a pretermination hearing, as a number of states have done, federal regulations require: (1) an informal written reconsideration made by the state and submitted to the skilled nursing facility before the effective date of the termination, and (2) a posttermination evidentiary hearing.This Article argues that a skilled nursing facility has a right under the due process clauses of the fifth and fourteenth amendments of the U. S. Constitution to an evidentiary hearing before termination of its Medicaid provider agreement. The author claims that a skilled nursing facility's interest in continued receipt of Medicaid reimbursement under its provider agreement is a property interest entitled to constitutional due process protections, and not merely an expectation of economic benefit that does not implicate constitutional due process considerations.The Article concludes that, except in emergency situations, state Medicaid agencies are constitutionally required to grant a provider a pretermination, rather than a posttermination, evidentiary hearing. This procedure would protect the provider and its patients from the severe effects of an erroneous termination, while furthering the governmental interest in ensuring the health and safety of skilled nursing facility patients. The format for such a hearing should allow for the participation, with the assistance of counsel, of both the skilled nursing facility and its patients.

Physician Extender Services in Family Planning Agencies: Issues in Medicaid Reimbursement

1986 ◽  
Vol 7 (2) ◽  
pp. 183
Author(s):  
Lewis W. Mondy ◽  
Debra B. Lutz ◽  
Stephen F. Heartwell ◽  
Marion R. Zetzman
Keyword(s):  
Family Planning ◽  
Medicaid Reimbursement ◽  
Physician Extender

scholarly journals Medicaid Reimbursement for Screening and Brief Intervention for Substance Misuse

2011 ◽  
Vol 62 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Holly E. Fussell ◽  
Traci R. Rieckmann ◽  
Mary Beth Quick
Keyword(s):  
Brief Intervention ◽  
Substance Misuse ◽  
Screening And Brief Intervention ◽  
Medicaid Reimbursement

Pediatrician Participation in Medicaid: 1978 to 1989

PEDIATRICS ◽  
1990 ◽  
Vol 85 (4) ◽  
pp. 567-577 ◽  
Author(s):  
Beth K. Yudkowsky ◽  
Jenifer D. C. Cartland ◽  
Samuel S. Flint
Keyword(s):  
Policy Options ◽  
Medicaid Program ◽  
Limited Participation ◽  
Medicaid Reimbursement ◽  
American Academy Of Pediatrics ◽  
Private Market ◽  
Medicaid Beneficiaries ◽  
High Degree ◽  
Medicaid Children

Optimal pediatrician participation in the Medicaid program is essential if the full benefits of recent eligibility expansions are to be realized. A 1989 national survey of the members of the American Academy of Pediatrics (n = 940), designed as a follow-up to similar studies conducted in 1978 and 1983, was an examination of the factors that influence pediatrician participation. Between 1978 and 1989: (1) basic participation (treating any Medicaid beneficiaries) declined to 77% from 85%; (2) limited participation (seeing only some Medicaid beneficiaries who request care) increased from 26% to 39.4%; and (3) extent of participation (the percentage of a pediatrician's patients who are Medicaid beneficiaries) increased from 15.7% to 19.4%. A dichotomous conceptualization of participation (restricted or unrestricted) was developed. By this definition, only 56% of pediatricians allowed comparable access to their practices for both Medicaid and private patients. Low reimbursement and slow payments discouraged participation. Medicaid reimbursement to pediatricians was approximately equal to their overhead costs. However, a high degree of willingness to care for Medicaid children remains if fees are increased to within 11% to 16% of the private market level. Policy options to enhance participation are discussed.

scholarly journals Florida's Model of Nursing Home Medicaid Reimbursement for Disaster-Related Expenses

2009 ◽  
Vol 50 (2) ◽  
pp. 263-270 ◽  
Author(s):  
K. S. Thomas ◽  
K. Hyer ◽  
L. M. Brown ◽  
L. Polivka-West ◽  
L. G. Branch
Keyword(s):  
Nursing Home ◽  
Medicaid Reimbursement
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