Centers for Medicare and Medicaid Services

A showdown between bitter opponents of the Affordable Care Act and Republican Governor Asa Hutchinson has resulted in the state preserving its expansion of Medicaid, AJMC's Mary Caffrey reports. As a result, Medicaid will continue for 267,000 residents who earn up to 138 percent of the federal poverty level. The expansion includes a waiver from the Centers for Medicaid and Medicare Services with provisions to require "more personal responsibility."

The Centers for Medicare and Medicaid Services has proposed a rule that would require long-term care facilities to extend spousal rights to same-sex married couples, McKnight's Tim Mullaney reports. CMS said in the proposed rule "'our goal is to provide equal treatment to spouses, regardless of their sex, whenever the marriage was valid in the jurisdiction in which it was entered into, without regard to whether the marriage is also recognized in the state of residence or the jurisdiction in which the healthcare provider or supplier is located.'"

Even in states that don't recognize same-sex marriage, the stick to make facilities follow the rule would be that their funding from Medicare and Medicaid would be contigent on their obedience to the regulation.

The Centers for Medicare and Medicaid Services has clarified that most of the rules of when liens are asserted by the government to recover the money spent on Medicaid health care for long-term care will apply to people who are getting Medicaid under the Affordable Care Act expansion, The Southern reports. States are entitled to asset recovery for all health care benefits, but CMS hopes that states will only impose liens and try to recover from estates for nursing home cases, The Southern also reports.

Separately, NJ.com reports that the "Affordable Care Act encourages states to expand their Medicaid rolls so single people and childless couples can now qualify if poor enough. That means thousands of newcomers to Medicaid may not realize that ultimately they may have to repay the piper."

The Chicago Tribune reports on how a "little-known" provision in the Medicaid health-insurance expansion is going to increase the practice of the government asserting liens on patients' assets to recoup expenditures on medical costs: "The issue arises because of a provision in the long-standing laws governing Medicaid that compel states to recoup certain medical costs after a person dies, either via liens placed on an individual's home or claims on their assets." Liens are not asserted in private insurance policies bought on state-based insurance exchange.

The Tribune reports that new Medicaid patients could face liens even if they don't seek medical care: "In another twist, all new Medicaid patients in Illinois were placed into so-called managed-care programs, in which the state pays insurers on a per-member per-month basis. That means people like Rosato will be racking up health care costs even if they don't seek any medical care. In theory, that money could all come out of their estates once they die."

Some states, included Oregon and Washington, have tweaked their regulations to apply recovery efforts only to long-term care, The Tribune further reports. However, Illinois has not.

The Centers for Medicaire & Medicaid Services said it will provide guidance to states sometime soon.

Two separate pieces caught my eye today: the adminstrative-law systems for disability claims and Medicare are failing. The Medicare adminstrative-law system is facing a tremendous backlog, while the disablity-claims system could be facing many fake claims.

The Office of Medicare Hearings and Appeals has a backlog of 357,000 claims, which developed because the number of cases grew by 184 percent while the system's resources remained constant, The Washington Post reports. The chief judge has suspended "new requests for hearings filed by hospitals, doctors, nursing homes and other health-care providers," The Post reports.

Meanwhile, D. Randall Frye, administrative law judge for the United States Social Security Administration, wrote in the New York Times today that there are no checks and balances in the system against claimants who might be fraudsters. Frye says other administrative law judges and he want an adversarial system in which there would be an advocate for taxpayers to challenge medical evidence and to review case files and in which social-media evidence could be used to check the credibility of claimants. "Social Security disability courts have millions of claimants and constitute one of the world’s largest judicial systems. But the system is not run by anyone with real judicial experience. Instead, we are at the mercy of unelected bureaucrats whose only concern is how many cases each judge can churn out and how fast we can do it," Frye opined.

An audit by the Department of the Health and Human Services' Office of Inspector General found that most hospitals don't have policies about copying and pasting health information in electronic health records, iHealthBeat reports. That could lead to health care fraud and abuse such as fraudulent billing and incorrect information being entered into patient records. Only 24% of hospitals had a policy regarding the "improper use of copy-and-paste functions within EHR systems," iHealthBeat further reports.

Separately, Government Health IT reports that earlier this month the Centers for Medicare & Medicaid Services decided to propose a delay in the next two stages of its program to incentivize healthcare providers to adopt "meaningful use" of electronic health records in exchange for governmental incentives.

The New York Times reports on why the health-insurance exchanges have been so buggy: one factor was that the biggest contractor wasn't given specifications right away and only started writing software code this spring. Another factor was not rolling out a piece of the portal instead of the whole shebang at once. A third factor was that the Centers for Medicare and Medicaid Services "assumed the role of project quarterback, responsible for making sure each separately designed database and piece of software worked with the others, instead of assigning that task to a lead contractor." Sources told the NYT that CMS did not have the capacity to take on that role.

The result: "Many users of the federal exchange were stuck at square one. A New York Times researcher, for instance, managed to register at 6 a.m. on Oct. 1. But despite more than 40 attempts over the next 11 days, she was never able to log in. Her last attempts led her to a blank screen."