Medicare and medicaid – Medic Buzz Wed, 29 Jun 2022 18:42:42 +0000 en-US hourly 1 Medicare and medicaid – Medic Buzz 32 32 ADUS and AMED stocks have opposing views to Stifel on Medicare rate cuts (NASDAQ:AMED) Wed, 29 Jun 2022 17:42:00 +0000

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Launch of its cover on Amedisys (NASDAQ: AMED) and Addus HomeCare (ADUS), Stifel had mixed views on the two home health care companies after the Centers for Medicare and Medicaid Services (CMS) proposed Medicare home rate reductions last week.

Issuing a buy rating on Addus (ADUS), analyst Tao Qiu argued that with limited exposure to rate cuts, the company could support stable teenage margin and EBITDA growth as strong state and local reimbursement offset labor inflation.

However, Medicare’s proposed rate cuts, if implemented, could hurt Amedisys (AMED), the analyst pointed out, citing a negative impact on organic growth and margin.

The company highlights the experience of both management teams and argues that both companies are attractive based on their trading multiples to 2023 EBITDA.

However, Qiu, with a Hold on Amedisys (AMED) rating, cited the redemption overrun and limited near-term catalysts for the business, adding “a better buying opportunity can be had when the final rule is released in november”.

The analyst estimates targets of $101 and $128 per share for Addus (ADUS) and Amedisys (AMED), implying a premium of around 22% and a decline of around 8% at the last close, respectively.

Amedisys (AMED) underperformed Addus (ADUS) in 2022, as this chart shows.

MSP Recovery Begins Billing Big Pharma Over $5.6 Billion in Billed Amounts and More… | New Tue, 28 Jun 2022 01:41:29 +0000

CORAL GABLES, Fla., June 27, 2022 (GLOBE NEWSWIRE) — MSP Recovery, Inc. (“MSP Recovery” or “MSPR”), a Medicare, Medicaid, commercial and secondary reimbursement recovery and technology leader, today provided commercial update today.

  • MSP has begun submitting individual claims totaling more than $5.6 billion in billed amounts for payments owed by some of the world’s largest pharmaceutical companies.
  • The total amounts billed to the identified pharmaceutical companies related to more than twenty-five different types of recoveries.

MSPR identifies additional claims held against Big Pharma

MSPR today announced that it has identified more than $5.6 billion in amounts billed and more than $2.8 billion in amounts paid for potentially recoverable single cases on behalf of Medicare Advantage organizations and other payers against large pharmaceutical companies (“Big Pharma”) for various product responsibilities. , consumer protection and antitrust claims.

The announcement follows MSPR’s announcement two weeks ago that it has increased its own claims to $368 billion and identified more than $1.5 billion in billed amounts for potentially recoverable single cases on behalf of Medicare Advantage organizations against P&C insurance companies.

To pursue and maximize these identified claims against Big Pharma, MSPR is sending Individual Claims Requests requesting that these damages for claims held by MSPR be paid within thirty (30) days. MSPR pursues these recoveries against some of the largest pharmaceutical companies in the world, including, but not limited to:

Astra Zeneca
Bristol Meyers Squibb
Eli Lilly and company
AbbVie Inc.
Janssen Pharmaceuticals
Fresenius medical care
Teva Pharmaceuticals
Purdue Pharma
international endo

The types of claims being pursued include those shown in the illustration below:

In addition to these specific collection efforts and any pending litigation, several Private Lien Resolution Programs (“PLRPs”) have been established across the country by Settlement Committees in mass tort litigation against Big Pharma. .

PLRPs are established to resolve health care privileges asserted by private health insurance providers in mass tort settlements. MSPR is actively working with various lien resolution administrators to recover held claims for which manufacturers have already settled other lawsuits and established PLRPs.

MSPR has already entered into PLRP agreements and is collecting these claims. These PLRPs include some of the same big pharma that have already settled claims with MSPR from individuals as opposed to health plans. MSPR is now pursuing these same types of claims over its own claims arising from the same types of settlements already entered into. These PLRPs stem from cases that have already been settled by Big Pharma and agreed to pay plaintiffs.

These PLRPs include:

  • Roundup/Monsanto Product Liability Litigation
  • TRT Androderm – Testosterone Replacement Therapy Product Liability Litigation
  • TRT Androgel – Testosterone Replacement Therapy Product Liability Litigation
  • Invokana Product Liability Litigation
  • Xarelto (Rivaroxaban) Product Liability Litigation
  • Depakote Product Liability Product Liability Litigation
  • Benicar Product Liability
  • Purdue Bankruptcy PLRP
  • Mallinckrodt Bankruptcy PLRP

“Over the past few weeks, we have diversified our strategy and started to add massive individual billing to our recovery efforts. As a result, we have seen a significant increase in the volume of checks received. We believe that with the more than $7.1 billion in billed amounts (including $1.5 billion previously announced on June 13, 2022) that we are sending, we will continue to see an increase in the volume of recoveries. We also continue to grow and identify additional trade-in opportunities for our existing customers. We have also seen a significant increase in the number of entities that have engaged MSPR at many levels. We exceeded our expectations for new business growth well beyond our five (5) year forecast and have now established new protocols to match new business with revenue,” said John H. Ruiz, founder and CEO of MSP Recovery. “Big Pharma is a multi-billion dollar industry against which MSPR is pursuing significant recoveries through data-driven solutions.”

About MSP Recovery

Founded in 2014, MSP Recovery has become a leader in reimbursement recovery from Medicare, Medicaid, commercial and secondary payers, disrupting the antiquated healthcare reimbursement system with data-driven solutions to secure recoveries from responsible parties. MSP Recovery provides the healthcare industry with comprehensive compliance solutions, while innovating technologies to help save lives. For more information visit:

Forward-looking statement

This press release contains forward-looking statements within the meaning of the federal securities laws. Forward-looking statements can generally be identified by the use of words such as “anticipate”, “believe”, “expect”, “intend”, “plan” and “will” or, in each case , their negative or other variations or comparable terminology. These forward-looking statements include all matters that are not historical facts. By their nature, forward-looking statements involve risks and uncertainties because they relate to events and depend on circumstances that may or may not occur in the future. Accordingly, these statements are not guarantees of future performance and actual events may differ materially from those expressed or implied by the forward-looking statements. Any forward-looking statements made by MSPR in this press release, its reports filed with the Securities and Exchange Commission (the “SEC”), and other public statements made from time to time speak only as of the date on which they are made. have been done. New risks and uncertainties arise from time to time, and it is impossible for MSPR to predict or identify all of these events or how they may affect it. MSPR is under no obligation and does not intend to update any forward-looking statements after the date hereof, except as required by federal securities laws. Factors that could cause these differences include, but are not limited to, MSPR’s ability to capitalize on its assignment agreements and recover amounts paid by assignors; the results of litigation; the validity of assignments of receivables to MSPR; the inability to successfully expand the scope of MSPR’s claims or obtain new data and claims from MSPR’s existing assignor base or otherwise; MSPR’s inability to innovate and develop new solutions, or the failure of such solutions to be adopted by existing and potential sellers of MSPR; negative publicity regarding the analysis of health data and the accuracy of payments; the ability of LifeWallet powered by MSPR to implement its health security technology and school security technology, and other factors included in MSPR’s annual reports on Form 10-K, quarterly reports on Form 10-Q and d other reports filed by MSPR with the SEC. These statements constitute the Company’s warnings under the Private Securities Litigation Reform Act of 1995.

A photo accompanying this announcement is available at

For media: ICR, Inc. For investors: ICR, Inc. Marc Griffin

Copyright 2022 GlobeNewswire, Inc.

Social Security is not bankrupt. What we know about future benefits Sat, 25 Jun 2022 12:30:01 +0000

A Social Security Administration office in San Francisco.

Getty Images

A new report from Social Security trustees points to a slightly longer time horizon for the program’s trust funds.

But even with a new exhaust date of 2035 – a year later than expected last year – the program still faces a 75-year shortfall.

A one-year bump is a small change for a huge program that Alicia Munnell, director of Boston College’s Center for Retirement Research, compares to a big ocean liner. And time is running out for Congress to take action to reverse the direction it is currently heading.

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In 2035, only 80% of benefits will be payable, if no action is taken.

“We are entering this area where immediate action will be needed,” Munnell said.

In a new report, the Center for Retirement Research outlines some key program highlights based on this year’s trustee report.

Social Security is not bankrupt

Much of the deficit that social security faces today can be explained by changing demographics that have resulted in a gap between income and cost rates.

In 1964, women had an average of 3.2 children. In 1974, this figure fell to 1.8.

This has led to a reduction in the ratio of workers to retirees, in particular due to the size of the baby boomer population, which is estimated at around 73 million people. About 10,000 baby boomers turn 65 every day; by 2030, all baby boomers will be at least this age.

Also, people are living longer. Taken together, this has contributed to the program’s 75-year deficit.

Social Security trust funds help to mitigate this deficit. Their assets currently have about two years of benefits.

After changes to social security legislation in 1983, these assets had cash surpluses.

But that started to change in 2010, when the program’s cost rate began to exceed its revenue rate. At that time, the program began to draw on interest from trust funds to pay benefits.

In 2021, the government began to draw on trust funds in order to pay benefits, due to tax and interest shortfalls.

These withdrawals will continue until the current projected exhaustion date of 2035.

In the 1980s, the program was expected to last up to age 65 before the trust funds ran out. Today marks 13 years. For each passing year, a new year with a large negative balance is added.

Yet the program is not bankrupt.

Revenue from payroll taxes will continue to cover a significant portion of benefits even after the scheduled exhaustion dates, even if replacement rates are expected to decline.

Some congressional proposals seek to eliminate the 75-year-old deficit, including a bill recently introduced by Sens. 2100 Act proposed by Rep. John Larson, D-Conn., which would extend the solvency of the program into the next century.

Disability outlook is improving, but questions remain

A significant change in this year’s Trustees’ Report was the projections for the Social Security Disability Insurance Fund, which is not expected to be depleted in 75 years. In contrast, last year’s trustees’ report predicted an exhaust date of 2057 for this fund.

The number of disability program participants has skyrocketed over the past 35 years due to a combination of factors. Legislation passed in 1984 made these benefits more accessible by broadening the definition of disability and giving claimants and care providers more influence in the decision-making process. The baby boomer generation and women subsequently had higher incidence rates as a result of these changes.

However, fewer people are receiving disability benefits today than in 2014.

This may be due to several factors, according to the Center for Retirement Research, including the economic expansion of the Great Recession, easier access to medical care after the Affordable Care Act, a shift to less physical jobs and the shutdown certain social security services. field offices.

thurtell | E+ | Getty Images

In addition, new policies and procedures may have played a role in the decline, particularly changes to how administrative judges who adjudicate disability insurance claims process cases beginning in 2009, including included fewer cases per judge.

The percentage of applications approved fell to 49% in 2019 from 57% in 2009.

This lower approval rating may have been further complicated during the Covid-19 pandemic, when Social Security was forced to close its offices primarily in 2020 for in-person appointments. Offices reopened earlier this year.

“People who need benefits may not be getting them,” Munnell said.

Updated projections for the disability fund should help quell complaints that the program is being overwhelmed by recipients, she said.

“The debate hasn’t really been in tune with the facts for a while,” Munnell said.

Annual adjustments provide inflation protection

Retirees are often described as “living on fixed incomes”.

But that description is largely flawed, due to the fact that Social Security is a major source of income for retirees and those benefits see annual cost-of-living adjustments in line with inflation each year, according to Munnell.

A record 5.9% increase in benefits took effect in January. Admittedly, this is well below the consumer price index in the months that followed. This includes a 9.3% increase in May over the previous 12 months for a subset of the data used to calculate Social Security’s COLA each year, known as the Consumer Price Index for urban workers and office workers, or IPC-W.

The COLA for 2023 could be higher than 8%, due to the retrospective method of calculating the annual adjustment, which compares the third quarter of the current year to the third quarter of last year.

“Over the full cycle, this will fully offset inflation,” Munnell said.

Although there is some debate over whether another measure – the Consumer Price Index for the Elderly, or CPI-E – would better reflect the costs faced by retirees, both indices have experienced virtually identical average annual increases from 2002 to 2021, according to the Center for Retirement Research.

Medicare Part B premiums could change in 2023

Medicare Part B premiums, which cover outpatient physician and hospital services, increased 14.5% in 2022 to bring the standard monthly premium to $170.10.

Much of this increase was caused by the Alzheimer’s drug Aduhelm. However, the price of this drug was halved in December to about $28,200. The use of Aduhelm was also subsequently restricted to patients enrolled in clinical trials.

However, the Centers for Medicare and Medicaid Services determined it was too late to adjust premiums for 2022.

As a result, Part B premium increases for 2023 could be “quite small,” according to the Center for Retirement Research.

Notably, even with higher-than-normal premiums in 2022, beneficiaries should still have seen an upside from the above-average COLA. For example, a beneficiary receiving $1,600 per month would have had a COLA of $94. After paying $22 for their health insurance premiums, their net increase would be $72, or 4.5%.

Analysis of the recent OIG advisory opinion on the employment of excluded people | Arnall Golden Gregory LLP Wed, 22 Jun 2022 18:32:52 +0000

The Department of Health and Human Services, Office of the Inspector General (OIG) recently issued a favorable advisory opinion, OIG Advisory Opinion No. 22-11 (the “Opinion”), analyzing the proposed employment of a person excluded from federal health care programs. to perform marketing functions related to workers’ compensation (WC) programs (the “Proposed Arrangement”). Plaintiff, a group medical practice, asked whether the proposed arrangement would be grounds for sanctions under Section 1128A(a)(6) of the Social Security Act (the “Act”), 42 USC § 1320a-7a(a)(6). The OIG concluded that although the proposed use would present a significant risk of non-compliance to the claimant, the OIG would not impose any sanctions under the law in connection with the proposed arrangement.

The advisory opinion. According to the facts presented, the Applicant is a medical group specializing in pain management. While the majority of Plaintiff’s patient treatment is covered by WC programs that are not federal healthcare programs, Plaintiff also processes and submits claims for items and services provided to WC program beneficiaries. federal health.

In 2016, a licensed chiropractor (the “excluded person”) pleaded guilty to conspiracy to receive illegal kickbacks for referring WC patients to a certain hospital for spine surgery. In April 2017, the excluded individual was suspended from participating in the state’s WC system as a doctor, practitioner or provider. In March 2019, the Plaintiff hired the Excluded Person as an administrative employee to provide related services, at least in part, to recipients of the federal health care program. The state’s Medicaid program disqualified the disqualified individual in May 2019, and the OIG disqualified the disqualified individual in March 2021. Plaintiff placed the disqualified individual on unpaid administrative leave in May 2021 and disclosed the employment of the person at BIG.

Under the proposed arrangement, Plaintiff would reinstate the Excluded Person’s employment as a WC Paymaster Relations Representative, marketing Plaintiff’s medical services to WC Payers and attorneys working with WC Payer Covered Persons. . The excluded individual would also develop marketing materials, research potential contacts within the state’s WC industry, participate in WC industry groups, and provide information about the WC to the plaintiff’s management. Applicant has certified that the Excluded Person will not provide marketing, billing, or any other services to Federal Health Care Program recipients or any provider or supplier who refers Federal Health Care Program recipients to Applicant . Further, the individual would have no contact with federal health care program recipients and would not provide any items or services, directly or indirectly, for which payment may be made by a federal health care program. health. Plaintiff also certified that it would create a separate payroll division that would pool revenue from the reimbursement plaintiff receives only from non-federal health care program payers, and that the salary, benefits, and expenses of the excluded person would be paid exclusively from this separate payroll. .

The OIG concluded that the proposed arrangement would not engage its civil authority for monetary penalties under section 1128A(a)(6) of the Act. He relied on the plaintiff’s certifications that the disqualified person would not provide any items or services directly or indirectly to federal health care program recipients and that federal health care programs would not pay, directly or indirectly, the salary of the excluded person. The OIG also noted the plaintiff’s certification that the individual would be paid from separate payroll funds derived solely from reimbursement from non-federal health care program payors, but pointed out that “[a] the provider need not maintain a separate account from which to pay the excluded person, so long as no claim is submitted or payment is received from federal health care programs for items or services that the excluded person provides and that such items or services relate only to non-Federal Health Care Program patients.

The OIG’s advice was not without caveats, however. The OIG cautioned that its opinion: (1) did not address potential liability based on the disqualified person’s prior employment with the claimant; and (2) gave no opinion on whether the proposed arrangement would involve or violate the terms of the disqualified person’s suspension from participation in the state’s WC system. The OIG further cautioned that the proposed arrangement raises compliance concerns, as the claimant proposes to employ a person convicted of receiving illegal bribes in exchange for directing WC patients into a marketing role designed to encourage WC payers and attorneys to refer their clients to the applicant for medical services. Nevertheless, since the excluded person’s employment under the proposed arrangement would not involve the provision of items or services for which payment may be made under a federal health care program health, so it would not involve the civilian monetary penalty authority of the OIG.

Analysis. Pursuant to 42 CFR § 1001.1901, no payment may be made by Medicare, Medicaid, or any other federal health care program for any item or service provided by an excluded person or entity during the exclusion period. Accordingly, federal health care programs do not pay for items or services provided directly or indirectly by an excluded person, regardless of who bills for those items or services. Providing “indirectly” means providing items or services manufactured, distributed, or otherwise provided by persons or entities who do not directly submit claims to Medicare, Medicaid, or other federal health care programs, but who provide items or services to providers, practitioners, or vendors who submit claims to these programs for such items and services. 42 CFR § 1000.10.

Advisory Opinion 22-11 is the latest in the OIG’s analysis regarding the employment of excluded persons by health care providers who submit claims to federal health care programs. See, for example, OIG Advisory Opinion No. 18-011 (finding that an excluded participant could market the company’s services to long-term pharmacies that could submit claims to federal health care programs because the marketing services offered were far removed from the products provided to program beneficiaries ); OIG Advisory Opinion No. 03-012 (finding that the excluded physician could perform some attenuated business development functions for the employer without sanction, although the employer’s products would ultimately be paid for by the Medicare program through inclusion in hospital cost reports ); OIG Advisory Opinion No. 01-163 (concluding that the employment of an excluded physician as a program developer in a health maintenance organization would not be subject to administrative penalties).4 The OIG has also provided guidance relating to prohibitions on employing or contracting with excluded individuals and entities in its “Special Information Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs.” health “.5

Advisory Opinion 22-11 is available at While this notice and others discussed herein apply only to the specific facts and proposed arrangement presented in each particular application and should not be construed as general policy, they do offer informal guidance to care providers. on practices related to the employment of persons excluded from the federal government. health care programs that could result in the imposition of significant monetary penalties.

[1] Available at
[2] Available at
[3] Available at
[4] See also OIG Advisory Opinion No. 19-05 (purchasing real estate from an excluded person would not trigger penalties), available at -19-05.pdf; OIG Advisory Opinion No. 07-17 (finding that an excluded person who assigned to a family-controlled entity the rights to an invention ultimately sold to health care providers who could bill federal programs for this was not subject to sanctions) available at
[5] Available at

Telemedicine Market to Reach Around USD 565.81 Billion by End of 2030, Growing at 26.3% CAGR – Reports and Data Mon, 20 Jun 2022 14:30:00 +0000

According to a new report from Reports and Data, the global telemedicine market is expected to reach USD 565.81 billion by 2030.

NEW YORK CITY, NY, USA, June 20, 2022 / — According to a new report from Reports and Data, the global telemedicine market is expected to reach USD 565.81 billion by 2030. Telemedicine is experiencing potential opportunities in the field such as the growing adoption of informatics in healthcare, increasing geriatric population, increasing prevalence of target diseases and most importantly the advantage of maximum reach in case of different medical crisis such as COVID-19 pandemic outbreak or untapped population target (rural areas or Related Patients). The geriatric population is growing rapidly across the world, and Europe and North America have the highest share of the population aged over sixty-five and older. Telemedicine is becoming a crucial part of the world affected by the pandemic, to remotely treat many common medical conditions that are reflected among the elderly population such as Parkinson’s disease, diabetes, cardiovascular diseases, hypertension high blood pressure and hypercholesterolemia, arthritis and many more. According to the United Nations, in 2050, the geriatric population is expected to represent 35% of the population in Europe, 28% in North America, 25% in Latin America and the Caribbean, 24% in Asia, 23% in Oceania and 9% in Africa. Traveling to hospitals for visits and the unfamiliar environment of hospitals results in patients not complying with follow-ups. Thus, tele-visits and telemedicine help to provide remote services in their familiar environment.

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In 2018, Europe had a total of around 3 million dependent or bedridden patients. In such cases, the movement of patients is difficult as telemedicine or televisiting does not need to move critically ill patients, resulting in an increasing growth of the telemedicine market. Additionally, favorable reimbursement policies for telehealth are one of the major factors driving the growth of the market. Insurance companies such as Medicare, Medicaid cover telehealth reimbursement. Medicare Part B reimburses clinicians for electronic visits, communication, or virtual check-ins. Recently, the Center for Medicare & Medicaid Services released coverage for COVID-19 telehealth, which has led to a growing adoption of telemedicine. To address the untapped market players is to develop a telemedicine solution, which results in an improvement in the market demand. For example, Texas A&M Health recently launched a telemedicine station for rural patients. Additionally, huge ongoing research on the platform solution pipelines is expected to fuel the market growth in the future. For example, the Regional Plastic Surgery and Burns Unit in Canniesburn, UK, is committed to the development of 3D telemedicine to practice effectively in the COVID-19 pandemic.

Other key findings from the report suggest:

To avoid blockage due to the lack of knowledge of the uses of doctors or healthcare providers, market players are developing benchmarks to boost the adoption of technology. For example, the American Medical Association (AMA) launched the AMA Telemedicine Quick Reference Guide, intended to help clinicians determine best practices for implementing technology. The guidelines cover everything from policy and coding to implementation

In April 2020, DrChrono launched a fully integrated telemedicine app and marketplace for patients. Over 10,000 medical providers on the DrChrono platform have access to more telehealth options and are receiving more inbound requests to provide virtual patient care visits, especially during COVID-19

Towards the expansion of the customer base, the field actors are committed to developing a telemedicine solution for different users with personalized plans. For example, in January 2020, Cigna, an American insurer, in partnership with MDLive, launched a telehealth platform that gives its 12 million members of employee-sponsored health plans access to primary care services.

North America led home ovulation testing with revenue of $17.63 billion in 2019. In North America, the increasing prevalence of target diseases, increasing adoption of advanced technologies , high investments in IT solutions for healthcare are the major factors driving the growth of the market.

Software type segment accounted for the highest market share in 2019. Widespread adoption of telemedicine and digital platform in healthcare and several software developments by key players are major factors that are exploding the growth of telemedicine software market.

Based on end use, diagnostic centers are expected to grow at a CAGR of 15.5%. Imaging being the main procedure in the overall healthcare management and the significant growth of teleradiology are the major factors promoting the growth of the telemedicine in diagnostic centers market

The report also focuses on the details of each market player including their global position, financial position, revenue generation, company overview, product and service portfolio. The telemedicine market is extremely competitive and consists of several regionally and globally key players. The major players are focusing on adopting various strategies such as new product launches, mergers and acquisitions, R&D investments, partnerships, joint ventures and collaborations to strengthen their market position and enhance their product portfolio. products.

Major companies operating in the market are:

MDLIVE, Teladoc, SteadyMD, Doctor on Demand, Maven Clinic, AMD Telemedicine, Aerotel Medical Systems Ltd., iCliniq, Polycom, HealthTap, Cardio Net Inc., Amwell, CVS Health, Synapse Medicine, Practo.

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The report also offers detailed information on market segmentation based on type, application and regional bifurcation:

Segmentation of the telemedicine market:

End-Use Outlook (Revenue, USD Billion; 2019-2030)

Hospitals and health facilities
Home Care

Application Outlook (Revenue, USD Billion; 2019-2030)

Remote precision

Regional outlook:

North America
The rest of Europe
Asia Pacific
South Korea
Rest of APAC
Latin America
Rest of Latam
Middle East and Africa
Saudi Arabia
South Africa
Rest of MEA

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Kahle Law extends reimbursement program for county nursing homes Sat, 18 Jun 2022 08:01:07 +0000

Legislation sponsored by State Rep. Bronna Kahle to expand a reimbursement program to county medical care facilities is now law.

Kahle’s bill extends the sunset on a program that reimburses county health care facilities that provide care to many Medicaid patients, according to a news release. The extension allows counties to continue to pay their lower “sustaining effort” rate, which would benefit counties and the state. If the sunset had not been extended, Kahle said it could force some medical facilities to close if they are unable to fund the operation of the facilities and would put the elderly and those with medical coverage at risk. Medicaid.

The maintenance of the effort rate for the county’s medical care facilities was to end in December. It has been extended regularly since the program was first implemented in 1984. Kahle’s plan extends the expiration date by three years or until the state creates a new reimbursement system.