Literature Review

A $400M incentive drives hospitals to meet health equity goalsModern Healthcare, by Kara Hartnett; 3/21/24 Hospitals across Massachusetts are building infrastructure to examine health disparities and address social needs, driven by new incentives within the state's Medicaid program. The program is authorized to pay out $400 million annually to private acute-care hospitals, divided among those that comply with an evolving set of operational and quality standards related to health equity. Eventually, healthcare organizations will receive distributions based on their ability to close gaps in care.

New legislation proposes national expansion of integrated care modelsHealth Affairs, by Laura M. Keohane; 3/20, 24 This article is the latest in the Health Affairs Forefront major series, Medicare and Medicaid Integration. The series features analysis, proposals, and commentary that will inform policies on the state and federal levels to advance integrated care for those dually eligible for Medicare and Medicaid.  ... On March 14, a bipartisan group of senators—members of the Senate Duals Working Group—released legislation (The DUALS Act: Delivering Unified Access to Lifesaving Services Act of 2024) that commits to ambitious goals for aligning Medicare and Medicaid coverage ... Would the integration measures proposed in this bill be more successful [than previous programs] in achieving these goals? This Forefront article highlights the key components of the legislation and assesses its ability to advance better outcomes for dual-eligible beneficiaries.

When Medicaid comes after the family home The New York Times, by Paula Span; 3/16/24Federal law requires states to seek reimbursement from the assets, usally home, of people who died after receiving benefits for long-term care. ... The letter came from the state department of human services ... It expressed condolences for the loss of the recipient's mother, who had died a few weeks earlier at 88. ... Medicaid estate recovery means surviving family members may have to sell the home of a loved one to repay Medicaid, or the state may seize the property. Editor's Note: Please share this article with your hospice bereavement counselors. (Access might be limited, per NYT subscriptions.)

Medicaid Fraud Control Units Fiscal Year 2023 Annual ReportU.S. Department of Health and Human Services, Office of Inspector General; 3/14/2024Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. [This 32 page, downloadable document includes:]

Providers meet with OMB to prevent ‘devastating’ effect of 80/20 provision McKnights Home Care, by Adam Healy; 3/4/24Home care stakeholders have been busy on Capitol Hill voicing concerns about a controversial provision of the proposed Medicaid Access Rule. The National Association for Home Care & Hospice and Home Care Association of America met with the Office of Management and Budget last week to discuss the Access Rule’s so-called 80/20 provision. The provision, if finalized, would require that 80% of Medicaid payments for personal care, home health and homemaker services be spent on workers’ compensation. “If that one provision is finalized as proposed, it would be so detrimental that we’d likely lose a significant portion of our service delivery base and people would go without care,” Damon Terzaghi, NAHC’s director of Medicaid HCBS (home- and community-based services) said in an interview with McKnight’s Home Care Daily Pulse. “It would truly be devastating.”

[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says McKnights Product Theater, by Adam Healy; 2/22/24In recent years, unscrupulous hospice providers have cropped up in California and other states. In response, the Centers for Medicare & Medicaid Services has prepared a slew of tools to curtail the fraud. States continue to feel the effects. As an example, a California hospice operator last week was convicted in a Medicare fraud scheme for billing nearly $3 million for services that patients did not need, according to the Department of Justice. 

How one hospice owner got convicted of healthcare fraud and how you can avoid that fateHospice Insights: The Law and Beyond, by Husch Blackwell; 2/21/24The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this [podcast] episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate.

Reduced federal share may force state Medicaid programs to cut services, HCBS expert saysMcKnights Home Care, by Adam Healy; 2/15/24The Congressional Budget Office this month released its “Budget and Economic Outlook” report for the coming decade. In its report, CBO predicted a roughly $58 billion drop in federal Medicaid outlays for 2024 compared to 2023 — a 9% decrease in federal Medicaid spending, due in part to fewer beneficiaries on states’ Medicaid rolls. 

NC Medicaid rolls grow by 1,000 people a day as smooth expansion rollout continues its third monthNC Health News, by Jamie Baxley; 2/15/24When North Carolina launched Medicaid expansion on Dec. 1, state officials said the measure would provide health insurance to an estimated 600,000 low-income adults over a span of two years. It took just two months to reach 58 percent of that goal. More than 346,400 newly eligible beneficiaries have been approved for coverage as of Feb. 1, according to data from the N.C. Department of Health and Human Services.

Part 2, Latest updates from CMS Office of Minority Health: Advancing health equity in rural, tribal, and geographically isolated communities FY2023 year in review

Concurrent Medicare hospice & curative care improves quality & reduces costs 13%Open Minds; 2/7/24Medicare beneficiaries with terminal health conditions who participated in the Medicare Care Choices Model (MCCM), received high quality care at a 13% lower cost compared to similar beneficiaries who did not receive the MCCM services. The Centers for Medicare & Medicaid Services (CMS) tested this new model as an option for Medicare beneficiaries to receive supportive care services while continuing to receive services for their terminal condition.

Patient-centered focus is key to reducing hospitalizations, value-based success, experts sayMcKnights Home Care, by Adam Healy; 2/6/24To keep hospitalization rates low — and thereby produce better results within the Home Health Value-Based Purchasing (HHVBP) model — providers need a good understanding of patients’ goals to tailor care to meet their unique wants and needs. ... Keeping these goals at the forefront of care can reduce their chances of being hospitalized, according to Cindy Campbell, senior director of advisory services at healthcare technology firm WellSky. But defining patients’ goals is not just a recommendation, she noted: It’s mandated by the Centers for Medicare & Medicaid Services.

Cancer facts & figures 2024American Cancer Society; 2024Cancer Facts & Figures 2024 is an educational companion for Cancer Statistics 2024, a scientific paper published in the American Cancer Society journal, CA: A Cancer Journal for Clinicians. These annual reports provide: