Finance and Reimbursement
With Medicare and Medicaid providing more than half of most hospitals’ patient revenue, changes in these government-sponsored programs have a significant impact on hospitals. Federal health care reform will change these programs significantly over the next decade, as well as make dramatic modifications to private insurance practices. The Texas Legislature sets the Medicaid program budget for each biennium, and also oversees the regulation of the state’s insurance industry through the Texas Department of Insurance. THA works with the Texas Legislature on legislation that affects health care financing. Through involvement with specific Medicaid advisory committees, the Texas Health and Human Services Commission and the Texas Department of State Health Services, THA helps shape the regulatory environment.
Federal
As part of the comprehensive federal health care reform legislation, reductions in the Medicare market basket begin in federal fiscal year 2010. However, a number of rural hospital reimbursement programs have been extended through Dec. 31, 2010. Other changes will require Medicaid to create a program similar to Medicare that prevents payment for health care-associated conditions, such as infections. Several demonstration projects to reduce costs and improve outcomes are intended to reduce hospitals’ costs over time.
State
Rebasing of Medicaid reimbursement of hospital inpatient services is underway. A Medicaid Correct Coding Initiative will roll out later this year. THHSC has issued a request for proposals for the Medicaid Health Home Pilot Project, and will fund up to eight initiatives for a 24-month period.
