CMS Reduces Federal Matching Rates for External Quality Review

CMS will reduce the federal matching rate for external quality review (EQR) activities from 75% to 50% for several plan types, according to CMS guidance. The EQR activities of prepaid inpatient health plans (PIHPs), prepaid ambulatory health plans (PAHPs), and certain primary care case management (PCCM) entities will receive the standard 50% administrative federal matching rate. Managed care organizations (MCOs) may still receive the enhanced matching rate if the EQR meets certain criteria and the State secures CMS approval of the EQR contract. A Medicaid and CHIP Managed Care final rule released in April extended annual EQR requirements to CHIP plans, PAHPs, and certain PCCM entities; MCOs and PIHPs were already subject to the requirements.

Medicaid Expansion Positively Impacts Safety Net Providers, Report Finds

States that expanded Medicaid report significant reductions in uncompensated care provided by safety net institutions, and budget savings for hospitals and community health clinics, according to a report by the Georgetown University Center for Children and Families. The report’s findings are based on telephone interviews with hospital systems and federally qualified health centers in three non-expansion states (Missouri, Tennessee, and Utah) and four expansion states (Arkansas, Colorado, Kentucky, and Nevada). While leadership in non-expansion states reported continued financial constraints, those in expansion states reported opening new clinics, buying equipment, hiring additional staff, and undertaking efforts to integrate and improve care delivery.