Literature Review

CMS hears you, hospice providersMcKnights Home Care, by Liza Berger; 3/8/24 Rarely does the Centers for Medicare & Medicaid Services succeed in shocking us. The large bureaucracy, which is not exactly known for its nimbleness, managed to do so this week when it abruptly cancelled the hospice component of the Value-Based Insurance Design Model. ... For those who wonder whether advocacy works, I’d chalk this up to a win for providers — and a clear example of advocacy in action. 

Hospice provider experience underscores urgency of program integrity efforts: Findings reveal current audit process' shortcomings HomeCare News; 3/12/24 Following a series of meetings with the Centers for Medicare & Medicaid Services (CMS) and Members of Congress on efforts to improve and protect hospice program integrity, four national hospice organizations—LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI)—released findings of a hospice provider survey that the organizations say underscores the urgency and need for CMS and Congress to act. 

CMS reportsCMS email; 3/8/24

Nursing homes bury 63 percent of profits in related-party tunnels, but not all play the game: study McKnights Long-Term Care News, by Josh Henreckson; 3/8/24 As much as 63% of nursing home profits in Illinois were hidden from state regulators using related party transactions in 2019, according to the results of a new study from UCLA and Lehigh University researchers. Those results are likely indicative of a nationwide trend that has continued through the pandemic and into 2024, experts told McKnight’s Long-Term Care News Thursday.

CMS to end Hospice MA Carve-In: Insights for home-based care providers Home Health Care News, by Andrew Donlan; 3/7/24Grand opening, grand closing. Hospice providers began to work with Medicare Advantage (MA) via the Value-Based Insurance Design (VBID) demonstration in 2021. At the end of 2024, the “hospice carve-in” model will cease. ... In this week’s exclusive, members-only HHCN+ Update, I dive into what CMS’ ditching of the hospice carve-in means for home health and hospice providers generally. I’ll also get into what it may mean for that space between home-based care providers and MA plans moving forward. 

Wound coding changes bring compliance, legal questions McKnights Long-Term Care News, by Josh Henreckson; 3/5/24 Changes to end-of-life wound classification in a recent Minimum Data Set update should be a positive for long-term care, but regulatory and legal ambiguity still surrounded the new coding procedures at press time. 

CMS offers relief to providers affected by Change Healthcare outageModern Healthcare, by Lauren Berryman; 3/5/24The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.Editor's Note: Access to the full article requires a subscription

Coverage denials in Medicare Advantage—Balancing access and efficiencyJAMA Health Forum; by Suhas Gondi, MD, MBA; Kushal T. Kadakia, MSc; and Thomas C. Tsai, MD, MPH; 3/1/24 Each year, millions of claims for medical services are denied by health insurance plans. Many denials may be justified as a necessary strategy to reduce wasteful spending from low-value care. However, denials may also delay diagnosis and/or treatment for patients, and appealing denials contributes to clinician workload and burnout. This tension is apparent in the Medicare program, where denials affect millions of beneficiaries who enroll in Medicare Advantage (MA). 

Veterans’ care new battleground in nursing home staffing mandate McKnights Long-Term Care News, by Kimberly Marselas; 3/5/24Two senators have introduced a bill to determine exactly what “unintended circumstances” could result for elderly veterans if a federal rule mandating staffing levels at all US nursing homes is allowed to proceed. ... The bill would require the VA to study potential risks associated with the proposed Center for Medicare and Medicaid Services rule — especially as they pertain to rural providers. The senators said the proposal would “unsustainably change staffing ratios at nursing homes.”

Congress floats Medicare physician pay bump: 4 notes Becker's Hospital CFO Report, by Mackenzie Bean; 3/4/24 Physicians are set to receive a 1.7% increase in Medicare pay effective March 9 as part of a $460 billion spending package congressional leaders released this weekend. Four things to know: ... [click on the title's link for more]

The Future of the Hospice Benefit Component of the Value-Based Insurance Design (VBID) ModelCMS website; 3/4/24Beginning in Calendar Year (CY) 2021, the Value-Based Insurance Design (VBID) Model allowed participating Medicare Advantage Organizations (MAOs) to include the Medicare hospice benefit in their Medicare Advantage (MA) benefits package, herein known as the Hospice Benefit Component. After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation among MAOs that may impact a thorough evaluation, CMS has decided to conclude the Hospice Benefit Component as of December 31, 2024, 11:59 PM. CMS will not accept applications to the previously released CY 2025 Request for Applications for the Hospice Benefit Component of the VBID Model.

What the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry Home Health Care News, by Andrew Donlan; 3/1/24 Since the news surfaced Tuesday that the Department of Justice had opened an antitrust investigation into UnitedHealth Group (NYSE: UNH), additional questions have bubbled up. Namely, those questions surround the home health provider Amedisys Inc. (Nasdaq: AMED), which agreed to be acquired by UnitedHealth Group’s Optum in June of last year.

CMS upends Medicare Advantage supplemental benefits data reporting for payers DLA Piper, by Daivd Kopans and Sua Yoon; 2/27/24 On February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued new guidance via a memorandum to Medicare Advantage (MA) organizations, Program of All-Inclusive Care for the Elderly (PACE) organizations, and Demonstration Organizations (collectively, Plans) that upends how these Plans have been reporting (or not reporting) encounter information for their covered supplemental benefits. The guidance in the memorandum is effective retroactively to January 1, 2024. [In this article] is a Q&A explaining the top points of the guidance and highlight its impact on companies across industries.