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All posts tagged with “Regulatory News | Medicaid.”
Leveraging sales strategies in hospice payment cap management
10/23/24 at 02:00 AMLeveraging sales strategies in hospice payment cap management Hospice News; by Jim Parker; 10/22/24 Errors or other inconsistencies with the payment cap can have significant consequences for providers, and sales and marketing staff can help hospices achieve a healthy balance. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. If a hospice has a cap liability, they will have to repay that amount to Medicare. In some situations, a hospice might face additional monetary penalties, interest charges or referrals to the U.S. Treasury Department in severe cases.
Gentiva reaches $19.4 million False Claims Act Settlement
10/18/24 at 03:00 AMGentiva reaches $19.4 million False Claims Act Settlement Policy & Medicine; by Thomas Sullivan; 10/15/24 Gentiva – formerly known as Kindred at Home – reached a $19.4 million settlement with the United States, resolving allegations that it violated the False Claims Act by holding on to overpayments for hospice services provided to patients who were ineligible to receive hospice benefits under various federal health care programs. Kindred is made up of entities that were previously part of an enterprise that did business through various subsidiaries as Kindred at Home. Kindred provided health care services, including hospice services, using various business names during the time periods relevant to the settlement. The settlement resolves allegations brought by the United States and the State of Tennessee against certain Kindred entities alleging that from 2010 until February 2020, the entities knowingly submitted (or caused to be submitted) false claims for hospice services to hospice patients in Tennessee and other states who were ineligible for Medicare or Medicaid hospice benefit because they were not terminally ill. The settlement further resolved allegations that the defendants improperly concealed or otherwise avoided the obligation to repay the hospice claims at issue. The settlement also resolves allegations that SouthernCare New Beacon – a subsidiary – allegedly violated the Anti-Kickback Statute by willfully paying remuneration to a consulting physician to induce Medicare beneficiary hospice referrals.
CMS grants temporary relief for home health, hospice agencies affected by hurricane
10/18/24 at 02:00 AMCMS grants temporary relief for home health, hospice agencies affected by hurricane McKnights Home Care; by Adam Healy; 10/15/24 The Centers for Medicare & Medicaid Services has issued several temporary flexibilities intended to help hospices and home health agencies affected by Hurricane Helene continue to provide care amid the emergency. During the emergency period, home health providers may take advantage of extended deadlines for quality reporting and patient assessment requirements, according to CMS. The agency communicated last week that it would permit delayed Outcome and Assessment Information Set submissions, and it also extended the five-day completion requirement for patients’ comprehensive assessments to 30 days. These patients assessments may also be conducted remotely or by record view — a departure from the typical in-person requirement — during the temporary emergency period. CMS said that this change will allow patients to be cared for in the environment of their choice, reduce impacts on acute care and long-term care facilities, and maximize clinicians’ ability to care for patients with the greatest acuity.
Care utilization for neurodegenerative diseases compared to patients with cancer
10/16/24 at 03:00 AMCare utilization for neurodegenerative diseases compared to patients with cancer Physician's Weekly; 10/14/24 Neurodegenerative diseases are a leading cause of death, yet healthcare utilization and costs during the end-of-life (EoL) period are poorly understood. Researchers conducted a retrospective study to describe and compare resource utilization among U.S. Medicare decedents with neurodegenerative diseases and cancer. ... The results showed 1,126,799 Medicare beneficiaries, of which 357,926 had a qualifying diagnosis. Individuals with neurodegenerative diseases were older and more frequently received Medicaid assistance than those with brain or pancreatic cancer. ... The study concluded that individuals with neurodegenerative diseases were more likely to visit ED and less likely to utilize inpatient and hospice services at the EoL compared to those with brain or pancreatic cancer.
New CMS Medicaid, CHIP Guidance could help clarify pediatric palliative care payment
10/16/24 at 03:00 AMNew CMS Medicaid, CHIP Guidance could help clarify pediatric palliative care payment Hospice News; by Holly Vossel; 10/15/24 The Centers for Medicare & Medicaid Services (CMS) recently released new guidelines intended to better support state-based pediatric reimbursement systems and help improve equitable health access among youth populations. The new guidance includes best practices for state Medicaid programs and the Children’s Health Insurance Program (CHIP) to implement and comply with early and periodic screening, diagnostic and treatment (EPSDT) coverage requirements. One of the most significant challenges confronting children living with serious illness and their families is the heterogeneity of policies and programs across the country, said Allison Silvers, chief health care transformation officer at the Center to Advance Palliative Care (CAPC). ...
Managing the hospice payment cap by balancing Length of Stay
10/16/24 at 03:00 AMManaging the hospice payment cap by balancing Length of Stay Hospice News; by Jim Parker; 10/15/24 Careful management of the hospice aggregate cap is key to providers’ sustainability as regulatory scrutiny continues to heat up. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. “While the cap is a beneficiary driven cap, meaning the reimbursement allowed per Medicare beneficiary, it is not assessed at the beneficiary level, but rather in the aggregate at the agency provider number level for all beneficiaries served by the agency in the cap,” Rochelle Salinas, vice president of operations for CommonSpirit Health at Home, said. “This allows for greater flexibility in providing care to those in need.” ... [Click on the title's link to continue reading.]
Millions of aging Americans are facing dementia by themselves
10/16/24 at 02:00 AMMillions of aging Americans are facing dementia by themselves California Healthline; by Judith Graham; 10/15/24 Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet they were living alone. Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? ... Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. ... Imagine what this means. ...
Why recent outages are a wake-up call for healthcare and regulators
10/14/24 at 03:00 AMWhy recent outages are a wake-up call for healthcare and regulators Forbes; by Chris Bowen; 10/11/24 When the CrowdStrike outage first started to show itself in the early hours of that hazy July morning, it was hard to believe that this wasn’t a hack or cyberattack. I was driving in my car that morning and looked up to see a digital billboard glitch into the "blue screen of death" before my eyes. Flights were grounded, travel was delayed, and nearly every Windows machine in the world was unusable. It was total mayhem. Clearly, this was an outage of major proportions, as millions of Windows systems worldwide essentially cratered. Caused by a faulty misconfiguration, we saw firsthand how the very digital advancements that have helped transform and modernize our world also expose us to more vulnerabilities than ever. ... In healthcare, this event laid bare the vulnerabilities we cannot overlook—the gaps that directly threaten patient care and safety. It’s a clear reminder of our industry’s utmost responsibility to patient privacy and well-being. ...
Hospice care home provides peaceful place for low-income or homeless to die
10/11/24 at 03:00 AMHospice care home provides peaceful place for low-income or homeless to die Indiana Capital Chronicle; by Elise Shrock; 10/10/24 My neighborhood is full of wonderful places. Lovely places where people go to worship, to meet for meals, to do their errands, and, a lovely place to die. Let me explain. Tucked behind the busy near-north Keystone corridor is the Abbie Hunt Bryce Home, a no-cost home for terminally ill individuals who are low-income or homeless and would have no other home to go to during their last days or months of life. Operated by Morning Light, LLC, Abbie Hunt Bryce Home offers critical and compassionate services to Hoosiers in their final days. As the second largest residential hospice in the nation, our state is positioned to be a leader in providing compassionate end-of-life care. Not only is the Home a leader in size and scope, but all hospice residents stay free of charge, with no payment or insurance required. The Home is supported solely by community support and qualifies for Medicaid Waiver. ... [A case study follows with "Systemic challenges in Indiana." ...]
Concurrent/simultaneous services from Hospice and a Home and Community Based Services waiver
10/10/24 at 03:00 AMConcurrent/simultaneous services from Hospice and a Home and Community Based Services waiver Media.Alabama.gov; State of Alabama Press Release - Medicaid; 10/8/24 The Alabama Medicaid Agency (Medicaid) updated the policy to allow concurrent services from hospice and a Home and Community-Based Services (HCBS) Waiver. However, it is vital that the hospice and HCBS waiver case manager coordinate to avoid duplication of services. The HCBS waiver person-centered care plan (PCCP) and hospice plan of care (POC) of the recipient should be coordinated between the hospice, HCBS waiver case manager, and the recipient and his/her caregiver. A conference that includes these parties must be held before concurrent services can start. The PCCP/POC conference shall be documented in both the recipient’s hospice and waiver record. The PCCP/POC should specify all concurrent services, the frequency of services, and which entity will provide the service. Each HCBS Waiver service included in the PCCP/POC should have an explanation as to why the service is not covered under hospice. [Click on the title's link for more information.]
CMS finalizes rule to curtail major DME fraud concerns
10/02/24 at 03:00 AMCMS finalizes rule to curtail major DME fraud concernsMcKnight's Home Care; by Adam Healy; 9/26/24The Centers for Medicare & Medicaid Services finalized a rule this week that will help it better track anomalous and highly suspicious billing activity for durable medical equipment. The rule allows CMS to more closely monitor two Healthcare Common Procedure Coding System (HCPCS) billing codes for urinary catheters: A4352, an intermittent urinary catheter with a curved tip, and A4353, an intermittent urinary catheter with insertion supplies. These two billing codes were behind what may be the largest case of Medicare fraud in the program’s history. In February, the National Association of ACOs (NAACOS) uncovered evidence that fraudsters had used the two codes to loot as much as $3 billion or more from government health programs.
New revised Medicaid Fraud Control Unit performance standards
09/24/24 at 03:00 AMNew revised Medicaid Fraud Control Unit performance standardsOIG press release on X; 9/19/24HHS-OIG published revised Medicaid Fraud Control Unit (MFCU) performance standards. The standards provide helpful guidance to MFCUs in their operations and assist HHS-OIG in overseeing MFCUs. Read the performance standards here: https://direc.to/fj2o.
Maryland to drop Kaiser as Medicaid administrator
09/24/24 at 03:00 AMMaryland to drop Kaiser as Medicaid administrator Becker's Hospital CFO Report; by Jakob Emerson; 9/23/24 Maryland will drop Kaiser Permanente as a Medicaid managed care organization in 2025. "After some lengthy contract negotiations, the [Maryland] Department of Health has elected not to enter into a contract with Kaiser and we are working to ensure a seamless transition of those enrollees to other health plans," MDH's deputy secretary of healthcare finance, told local radio station WYPR on Sept. 20. ... "If we are not able to participate in Medicaid, it would interrupt the highest-rated care and coverage of our more than 113,000 Medicaid members in Maryland in 2025," a spokesperson for Kaiser told Becker's. "We will continue to work with the Maryland Department of Health so we can continue serving this community for decades to come." According to WYPR, the state will renew its existing managed care contracts, which includes Aetna, CareFirst BCBS, UnitedHealthcare, Elevance Health's Wellpoint, Jai Medical Systems, Maryland Physicians Care, MedStar Family Choice and Priority Partners.
Wisconsin DHS to create an HCBS minimum fee schedule
08/20/24 at 03:30 AMWisconsin DHS to create an HCBS minimum fee schedule Open Minds, Gettysburg, PA; 8/15/24 The Wisconsin Department of Health Services (DHS) is developing a minimum fee schedule for a subset of Medicaid home- and community-based services (HCBS) for which no specific rates exist in fee-for-service Medicaid. The minimum fee schedule will apply to adult family homes, community-based residential facilities, residential apartment complexes, supportive home care (SHC) agencies, and self-directed SHC. The affected programs include Family Care, Family Care Partnership, and Program of All-Inclusive Care for the Elderly (PACE), which together serve nearly 57,000 older adults and adults with disabilities.
Heart disease, cancer remain leading causes of death in US
08/14/24 at 03:00 AMHeart disease, cancer remain leading causes of death in US Becker's Hospital Review; by Elizabeth Gregerson; 8/9/24 Heart disease and cancer remained the leading causes of death in 2023, according to provisional data released Aug. 8 by the CDC. Mortality data is collected by the National Center for Health Statistics National Vital Statistics System from U.S. death certificates, according to an analysis published Aug. 8 in JAMA. After a sharp increase in the rate of deaths from heart disease during the pandemic, the 2023 rate (162.1) reportedly was closer to pre-pandemic levels (161.5). The rate of deaths from cancer decreased from 146.2 in 2019 to 141.8 in 2023. Cause of death data is based on the underlying cause of events leading to death. Death rate is recorded as the age adjusted death rate per 100,000 deaths, authors of the JAMA analysis said.
Hospice advocate Judi Lund Person ... featured on Close Up Radio
08/07/24 at 02:00 AMHospice advocate Judi Lund Person ... featured on Close Up Radio Western Slope Now, Ashburn, VA; by EIN Presswire; 7/26/24 (article) and 7/29/24 (recording)... Talking about where you’d like to be, who you’d like to be, and what you’d like to do is essential to entering this life-stage with confidence and grace. As the former Vice President of Regulatory and Compliance at the National Hospice and Palliative Care Organization (NHPCO) and a longtime advocate for hospice services under Medicare, Judi Lund Person has been working hard for more than 40 years to protect the definition of hospice care and to provide resources and guides for hospice providers to meet the Medicare requirements and provide high quality hospice care. ... Her passion for supporting patients and families during and after death began as a child. “When I was 12, my dad had a heart attack at night and passed when he was only 42. With two younger sisters, ages eight and ten, I was stunned that no one seemed to know what to do with us concerning our grief as children. We were left to try and figure it out on our own. I always thought that wasn’t quite right. Deep down, that experience was a driver for my career. I always knew families deserved more support during the grieving process,” shares Ms. Person. Editor's Note: Click here for the session's description. Click here for the recording.
HHS unveils major revamp to shift health data, AI strategy and policy under ONC
07/31/24 at 03:00 AMHHS unveils major revamp to shift health data, AI strategy and policy under ONC Fierce Healthcare; by Emma Beavins; 7/25/24 The Office of the National Coordinator for Health Information Technology (ONC) has been renamed and restructured, the Department of Health and Human Services (HHS) announced [July 25]. The restructuring will affect technology, cybersecurity, data and artificial intelligence strategy and policy functions. The agency will be renamed the Office of the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC). Head of ONC, Micky Tripathi, will hold the new title of assistant secretary for technology policy in addition to his title of national coordinator for health IT. ... Under ASTP, there will be an Office of Policy, an Office of Technology, an Office of Standards, Certification and Analysis and an Office of the Chief Operating Officer.
New proposed federal legislation takes aim at concerns regarding perceived “looting” of health care systems by private equity investors
07/30/24 at 03:00 AMNew proposed federal legislation takes aim at concerns regarding perceived “looting” of health care systems by private equity investors JDSupra - Epstein Becker Green; by Melissa Jampol, Enrique Miranda, Kathleen Premo; 7/26/24On June 11, 2024, U.S. Senators Ed Markey and Elizabeth Warren from Massachusetts, introduced proposed legislation titled The Corporate Crimes Against Health Care Act (“CCAHCA”), aimed at addressing a perceived “looting” of health care systems by for profit private equity investors. According to Sen. Warren, the bill was introduced to “root out corporate greed and private equity abuse in the health care system,” “prevent exploitative private equity practices,” and to specifically ensure that actions such as “looting” do not happen again by addressing trigger events and targeting real estate investment trusts. ... Finally, the CCAHCA would require health care entities, including, but not limited to: ... a hospice program, a home health agency, ... to publicly report to the Secretary of Health and Human Services on an annual basis: (i) transactions entered into ... [Click on the title's link to continue reading.]
Why home health providers should expect to see a ‘less draconian’ final payment rule
07/25/24 at 03:00 AMWhy home health providers should expect to see a ‘less draconian’ final payment rule Home Health Care News; by Joyce Famakinwa; 7/22/24 As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule. “We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.” Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.
Medicare physician pay has plummeted since 2001. Find out why.
07/25/24 at 03:00 AMMedicare physician pay has plummeted since 2001. Find out why. American Medical Association - AMA; by Tanya Albert Henry; 7/17/24 Medicare physician payment—often called Medicare reimbursement—must be tied to an inflation index called the Medicare Economic Index (MEI). As part of its campaign to fix the unsustainable Medicare pay system, the AMA has outlined in a quick, easily navigable fashion why this payment fix needs to happen now. ... The AMA’s two-page explainer on the Medicare Economic Index (PDF) outlines how it incorporates these two categories reflecting the resources used in medical practices:
Does Medicare pay for dementia care? Here’s what coverage you can expect for treatments and therapies
07/22/24 at 03:00 AMDoes Medicare pay for dementia care? Here’s what coverage you can expect for treatments and therapies Aol - Fortune; by Margie Zable Fisher; 7/18/24 Age-related memory loss is common, but more serious memory problems may be a sign of dementia, which is not a normal part of aging. ... Dementia patients have a variety of medical issues. “In addition to symptoms related to dementia, the overwhelming majority of dementia patients have one or more chronic health conditions,” says Matthew Baumgart, Vice President of Health Policy, at the Alzheimer's Association. Medicare (and Medicare Advantage) provide some coverage for dementia, beginning with the diagnosis, says Baumgart. [Click on the title's link for practical, user-friendly information about what Medicare provides arose the trajectory of dementia's progression. CMS's new GUIDE pilot program is described.]
Hospice CARES Act would update medical reviews, seek to reduce audits
07/16/24 at 03:00 AMHospice CARES Act would update medical reviews, seek to reduce audits Hospice News; by Jim Parker; 7/12/24 The forthcoming Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act from U.S. Rep. Earl Blumenaur (D-Oregon), if enacted, would implement a number of changes to medical review processes. ... Though the bill language is still in development, it will likely contain proposed updates to payment mechanisms for high-acuity palliative services, changes to the per-diem payment process and actions to improve quality and combat fraud. The bill would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities among recently established providers concentrated primarily in California, Arizona, Texas and Nevada. ... Among the anticipated provisions of the bill would be an item requiring the U.S. Centers for Medicare & Medicaid Services (CMS) to use documentation in a patient’s medical record as supporting material. The documentation would include the reasons that an attending physician certified a patient for hospice and establish a six-month terminal prognosis.
Chevron deference derailed
07/15/24 at 03:00 AMChevron deference derailed The Rowan Report; by Kristin Rowan; 7/12/24 ... Chevron Deference in Home Health: Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice [NAHC] has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it. Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022. The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. [Click on the title's link to continue reading the discourse between CMS and NAHC, specific to home health.]
Caring with compassion: VNA Health’s commitment to holistic home health care
07/15/24 at 03:00 AMCaring with compassion: VNA Health’s commitment to holistic home health care VNA Health Live Well; by VNA Health; 7/10/24 Santa Barbara County has a unique home health care organization that is focused on serving its patients and their families without worrying about turning a profit. “As a nonprofit, VNA Health is more invested in the overall care of the patient,” said registered nurse Jadona Collier, the director of home health. “We provide programs and services that cannot be billed to Medicare or insurance.” The organization offers holistic care, meaning that, regardless of the service being used — including home health care, palliative care, hospice, and bereavement care — its medical professionals care about patients.
C-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’
07/15/24 at 03:00 AMC-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’ Hospice News; by Holly Vossel; 7/12/24 Efforts to establish potential payment mechanisms for high-acuity palliative services within the Medicare Hospice Benefit will require greater clarity from regulators, according to the Coalition to Transform Advanced Care (C-TAC). The U.S. Centers for Medicare & Medicaid Services’ (CMS) 2025 proposed hospice payment rule contained a request for information (RFI) on the potential implementation of reimbursement pathways for “high intensity palliative care services,” such as chemotherapy, blood transfusion and dialysis. CMS in its proposed rule indicated that, “Hospice care changes the focus of a patient’s illness to comfort care (palliative care) for pain relief and symptom management from a curative type of care.” C-TAC’s recommendations are as follows: [Click on the title's link to read more.]