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All posts tagged with “Regulatory News | Medicaid.”
CMS: Advance health equity during National AANHPI Heritage Month
05/06/24 at 03:00 AMCMS: Advance health equity during National AANHPI Heritage Month CMS.gov; email 5/2/24 During May, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Heritage Month by highlighting disparities for Asian Americans, Native Hawaiians, and Pacific Islanders. These communities account for more than 7% of the U.S. population and have the fastest population growth rate among all racial and ethnic groups, having almost doubled since 2000. Between 2017 and 2019, the number of Asian Americans enrolled in Medicare grew by 11%, which was the highest percentage increase in enrollment compared to White, Black, and Hispanic enrollees. ... [Read for more descriptions, data and resources.]
Noncompete ban may squeeze rural hospitals, report shows
05/06/24 at 03:00 AMNoncompete ban may squeeze rural hospitals, report shows Modern Healthcare; by Alex Kacik; 5/2/24 The federal noncompete ban may squeeze rural nonprofit hospitals that continue to see labor costs rise, a new report shows. Last week, the Federal Trade Commission voted to finalize a rule preventing most employers from enforcing or issuing contracts that restrict employees from working for a competitor. ... Larger hospitals are more likely to have the financial flexibility to offer clinicians and staff higher wages, likely at the expense of smaller, rural hospitals, Fitch Senior Director Kevin Holloran said.
What Hospice VBID’s ending means for palliative care
05/03/24 at 03:00 AMWhat Hospice VBID’s ending means for palliative care Hospice News; by Markisan Naso; 5/1/24 The impending demise of the hospice component of U.S. Centers for Medicare & Medicaid Services’ value-based insurance design (VBID) model has largely been met with a sense of relief by providers as they plan new initiatives for palliative care in 2025. ... The program, which initially contained promising components designed to give patients better access to palliative care, instead became an increasing source of frustration for organizations. ... With the end date for the hospice component of the VBID model approaching, many palliative care providers are left with concern for their patients and questions about the coming transition, as they shift focus to what happens next. Editor's Note: This article includes perspectives from Rory Farrand, Vice President of Palliative and Advanced Medicine at NHPCO, and Mollie Gurian, Vice President of Home-Based and HCBS Policy at LeadingAge.
[FL] Attorney General Moody announces arrest of two Seminole County residents for Medicaid fraud
05/02/24 at 03:00 AM[FL] Attorney General Moody announces arrest of two Seminole County residents for Medicaid fraud Office of Attorney General Ashley Moody [Florida]; by Kylie Mason; 4/23/24 Attorney General Ashley Moody’s Medicaid Fraud Control Unit, ... announced the arrest of Debora Behnke and Suman Bhattacharjee ... [They] ran Pioneer Medical Transportation LLC and submitted fraudulent claims for nonemergency medical transportation for Medicaid recipients, stealing more than $250,000 from the Medicaid program. "Instead of transporting vulnerable Medicaid recipients, these individuals falsely billed the taxpayer-funded program for services never completed. In some instances, they even convinced patients to move across the state—with no regard for the best interest of the patients—and still charged Medicaid for transporting them from the original, longer distance. ..."
Judi Lund Person: Unleashed
05/02/24 at 02:00 AMJudi Lund Person: UnleashedTCN Talks; by Chris Comeaux; 4/18/24Judi Lund Person, former vice president of regulatory and compliance at NHPCO, shares her journey into the hospice industry and her passion for ensuring patients and families receive the care they need and want. Judi emphasizes the importance of addressing bad hospice care and uncovering fraud and abuse in the industry. She discusses the proposed changes in the 2025 Hospice Wage Index and Payment Conditions; ... the HOPE tool and the revised hospice survey; ... the sunset of the VBID demonstration; and the need to focus on accountable care organizations and quality reporting. This is a great listen for staff, leaders, and boards of hospice and palliative care organizations. Here’s a great quote from the discussion: “You never know when something you do or somebody you talk to changes the course of your life."
HHS issues new rule to strengthen nondiscrimination protections and advance Civil Rights in health care
05/01/24 at 03:00 AMHHS issues new rule to strengthen nondiscrimination protections and advance Civil Rights in health careHHS Press Office; 4/26/24Today, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. By taking bold action to strengthen protections against discrimination on the basis of race, color, national origin, sex, age, and disability, this rule reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.
Hospice Claims Edits for Certifying Physicians
05/01/24 at 03:00 AMHospice Claims Edits for Certifying PhysiciansCenters for Medicare & Medicaid Services (CMS); Related CR Release Date 4/18/24; Effective Date: 5/1/24; Implementation Date: 10/7/24Related CR Title: Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare EnrollmentStarting May 1, 2024, we’ll deny hospice claims if the certifying physician, including hospice physician and hospice attending physician, isn’t on our PECOS hospice ordering and referring files. This addresses hospice program integrity and quality of care per Section 6405 of the Affordable Care Act.
Congresswoman Kat Cammack introduces legislation to block 80-20 Rule
04/30/24 at 03:00 AMCongresswoman Kat Cammack introduces legislation to block 80-20 Rule Home Health Care News; by Joyce Famakinwa; 4/26/24 ... On Thursday, Congresswoman Kat Cammack (R-Fla.) introduced a bill to block the U.S. Department of Health and Human Services (HHS) from finalizing the 80-20 provision. Additionally, the legislation would also block HHS from implementing any similar rules that place a minimum requirement for how much of Medicaid spending on HCBS goes towards direct workers’ wages. Cammack’s reason for introducing this legislation is her belief that the 80-20 provision will severely limit access to care at a time when providers are already struggling to serve patients.
Kansas won't have legal medical pot or expand Medicaid for at least another year
04/30/24 at 03:00 AMKansas won't have legal medical pot or expand Medicaid for at least another year Newsday; by The Associated Press; 4/26/24 Kansas will remain among the handful of states that haven't legalized the medical use of marijuana or expanded their Medicaid programs for at least another year. Republican state senators on Friday blocked efforts to force debates on both issues before the GOP-controlled Legislature's scheduled adjournment for the year Tuesday. Supporters of each measure fell short of the 24 of 40 votes required to pull a bill on each subject out of committee.
How Avow Hospice used triage to boost quality, reduce turnover
04/30/24 at 03:00 AMHow Avow Hospice used triage to boost quality, reduce turnoverHospice News; by Jim Parker; 4/26/24Avow Hospice has implemented a triage system that has resulted in improved quality scores and reduced turnover. The Florida-based provider uses an acuity system that draws data from its electronic medical record (EMR) system to help stratify patients based on their most likely immediate needs. To complement these efforts, Avow also revamped its approach to night time and weekend visits, Rebecca Gatian, COO of Avow Hospice, said at the National Hospice and Palliative Care Organization’s Virtual Interdisciplinary Conference.
Federal Court halts lawsuit over Medicare home health payments
04/30/24 at 03:00 AMFederal Court halts lawsuit over Medicare home health payments Bloomberg Law; by Tony Pugh; 4/28/24 A federal court in Washington DC tossed a lawsuit against HHS over a disputed payment system that has slashed reimbursements for thousands of home health agencies since it was implemented in 2020. The US District Court for the District of Columbia ruled in a memorandum opinion on April 26 that plaintiffs in the suit by the National Association for Home Care & Hospice (NAHC) failed to exhaust their administrative rememdies because they "skipped the agency's process for seeking expedited judicial review." Because of that, the court "will grant the federal government's motion for summary judgment." [Additional content may require subscription.]
Payment cuts are having a compounding, dire effect on the home health industry
04/29/24 at 03:00 AMPayment cuts are having a compounding, dire effect on the home health industry Home Health Care News; by Andrew Donlan; 4/25/24 Home health providers’ fight against cuts to fee-for-service Medicare payment has become a year-by-year battle. But the yearly cuts are compounding, which is exactly what industry advocates are trying to illustrate to Congress prior to the next payment rule proposal. ... Many of the cuts CMS has implemented are permanent, and multiple cuts on top of each other moving forward – plus unsatisfactory adjustments for inflation – are putting significant pressure on providers.
California hospital to lay off 191 workers as it faces loss of Medicare contract
04/29/24 at 03:00 AMCalifornia hospital to lay off 191 workers as it faces loss of Medicare contract Becker's Hospital CFO Report; by Kelly Gooch; 4/24/24 Stanislaus Surgical Hospital in Modesto, Calif., which is facing a decision from CMS to end its Medicare contract, is laying off 191 employees, according to regulatory documents filed with the state April 15. The layoffs are effective April 30, the same day CMS said it will terminate the Medicare Provider Agreement with the hospital. In a notice dated April 11, the agency said it is terminating the agreement because of the hospital's noncompliance with the Medicare conditions of participation.
Relief provisions not enough to mitigate damage of 80/20 policy, providers say
04/29/24 at 03:00 AMRelief provisions not enough to mitigate damage of 80/20 policy, providers say McKnights Home Care; by Adam Healy; 4/24/24 Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate. “Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,” the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published.
Getting your claims denied? Here are reasons why and what you can do about it
04/29/24 at 03:00 AMGetting your claims denied? Here are reasons why and what you can do about itMedial Economics; by Gretchen Heinen, RN, PHN, BSN and Wael Khouli, MD, MBA; 4/25/24A recent voluntary, national survey by Premier shed new light on denied claims. The survey, conducted from October to December 2023, revealed that nearly 15% of all claims across Medicare Advantage, Medicaid, Commercial, and Managed Medicaid are denied. Of those denied claims, 45% to 60% were overturned, albeit with a costly appeal process sometimes involving multiple appeals. ... With a skillfully crafted appeal letter, a denial can be overturned 50% to 70% of the time. In this article, we will cover denial basics, reasons for claim denials, and actions to take. It is crucial to address all potential reasons for claim denial, including: ...
NAHC expresses disappointment regarding Medicaid Access Rule
04/26/24 at 03:00 AMNAHC expresses disappointment regarding Medicaid Access Rule HomeCare; 4/23/24 The National Association for Home Care & Hospice (NAHC) released a statement noting that it was, 'extremely disappointed that the Centers for Medicare and Medicaid Services (CMS) elected to finalize the “payment adequacy” provision in the Medicaid Access Final Rule (CMS 2442-F).' "This is a misguided policy that will result in agency closures, force providers to exit the Medicaid program, and will ultimately make access issues worse around the country," a statement from the organization read. "As NAHC and our partners across the homecare industry have demonstrated, such a provision is not only unworkable due to the varied nature of Medicaid programs across the country, CMS also lacks statutory authority to impose this mandate."
Hospice groups, AOs speak out on proposed Accreditor Oversight Rule
04/26/24 at 03:00 AMHospice groups, AOs speak out on proposed Accreditor Oversight Rule Hospice News; by Jim Parker; 4/22/24Some accreditation organizations (AOs) have balked at the U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed rule designed to strengthen oversight of those institutions. ... Three such organizations currently have deeming authority for hospices, The Joint Commission, the Accreditation Commission for Health Care (ACHC) and Community Health Accreditation Partner (CHAP). These accreditors have joined a host of other stakeholders in making public comments on the proposed rule, with some requesting clarifications and others outright denying that CMS has the authority to establish such requirements.
States lack resources to support new Medicaid waiver programs, association asserts
04/25/24 at 03:00 AMStates lack resources to support new Medicaid waiver programs, association asserts McKnights Home Care, by Adam Healy; 4/22/24 Medicaid 1115 waivers, which are commonly used to improve or expand home- and community-based services, face serious challenges as understaffed state programs are increasingly incapable of moving proposals through the administrative “pipeline,” the National Association of Medicaid Directors said in a recent letter. “The tough reality is that the Center for Medicaid and CHIP Services, which has taken many steps to streamline its administrative processes, simply does not have the staff resources to move forward all of the waivers in its pipeline,” Kate McEvoy, executive director of NAMD, wrote in the letter.
Medicare Advantage fight shifts to 340B arena
04/24/24 at 03:00 AMMedicare Advantage fight shifts to 340B arena Modern Healthcare, by Alex Kacik; 4/22/24Hospitals' fight to boost Medicare Advantage reimbursement has extended to plans' pay for 340B drugs. The hospitals’ plea to adjust Medicare Advantage pay stems from regulation aimed at making providers that participate in the drug discount program whole after the Supreme Court reversed 340B rate cuts that were in place from 2018 to 2022.
What the ‘fundamentally contradicting’ Medicaid Access Rule includes
04/24/24 at 03:00 AMWhat the ‘fundamentally contradicting’ Medicaid Access Rule includes Home Health Care News, by Andrew Donlan; 4/22/24 The White House teased the finalized Medicaid Access Rule early Monday, and the Centers for Medicare & Medicaid Services (CMS) later revealed more intricate details attached to the rule. [The] timeline of the rule is now clear. Specifically: ... [Click on the title's link for more]
20M fewer Medicaid enrollees means trouble for providers
04/24/24 at 02:00 AM20M fewer Medicaid enrollees means trouble for providersModern Healthcare, by Nona Tepper; 4/23/24Over the past year, states have removed more than 20 million beneficiaries from Medicaid after suspending eligibility redeterminations during the COVID-19 public health emergency. Thousands of those people are Clinica Family Health patients. The Lafayette, Colorado-based community health center felt the pain of lost reimbursements when patients went from having Medicaid coverage to being uninsured, a fate that has befallen almost one-fourth of these former Medicaid enrollees nationwide, according to KFF. Clinica Family Health responded with cutbacks but is still in the hole.
Md. health dept. processed 1.5 million Medicaid enrollees in 12 months; one month left in ‘unwinding’
04/23/24 at 03:00 AMMd. health dept. processed 1.5 million Medicaid enrollees in 12 months; one month left in ‘unwinding’Maryland Matters, by Danielle J. Brown; 4/19/24... Prior to the pandemic people with Medicaid insurance had to reapply annually. Medicaid terminations were paused over the COVID pandemic in order to ensure people were covered during a global health crisis. But starting in 2023, Medicaid re-enrollments were no longer automatic, and people had to reenroll in the program to continue coverage in a period often referred to as the ‘Medicaid unwind.’ ... At the start of the unwinding period, the data show that there were about 1,787,000 people enrolled in Medicaid in March 2023. A year later, there are 1,690,000 people covered by the program. ... But most of the terminations are due to what are called “procedural terminations,” which means that someone either did not start or did not complete their Medicaid reapplication. ... People with procedural terminations have short window after losing coverage when they can reapply to Medicaid and get covered again if they are still eligible.
What home health providers can learn from CMS’ other proposed rules for 2025
04/22/24 at 02:30 AMWhat home health providers can learn from CMS’ other proposed rules for 2025Home Health Care News, by Joyce Famakinwa; 4/19/24... CMS released the 2025 proposed payment rules for hospice and skilled nursing facilities (SNFs) in March. On the hospice side, the proposed rule included a 2.6% increase in the per diem base rate. Aside from the pay raise for hospices, the proposal also included a market basket index update, and notable changes to some of the geographic areas subject to particular indices. “There are rural areas that became urban and urban areas that became rural in the new CBSs — core based statistical areas,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.
Examining how improper payments cost taxpayers billions and weaken Medicare and Medicaid
04/22/24 at 02:00 AMExamining how improper payments cost taxpayers billions and weaken Medicare and Medicaid HHS-OIG; by Christi A. Grimm, Inspector General, Office of Inspector General, U.S. Department of Health and Human Services; 4/16/24 HHS Inspector General Christi A. Grimm Testifies Before the U.S. House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations on April 16, 2024. IG Grimm briefs members on HHS-OIG's work to address improper payments in Medicare and Medicaid managed care programs. Click here to watch the testimony.
Mississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’
04/19/24 at 03:00 AMMississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’Mississippi Today - Legislature; by Bobby Harrison and Geoff Pender; 4/17/24Hundreds of people rallied at the Mississippi Capitol for a second day Wednesday, urging lawmakers to expand Medicaid to provide health coverage for an estimated 200,000 Mississippians. ... Speakers recounted their struggles with access to affordable health care in Mississippi and chanted for the Legislature to, “Close the coverage gap now,” and for “Full Medicaid expansion now.” ... [Dr. Randy] Easterling recounted a story of two of his friends diagnosed with similar cancers. One was uninsured and self-employed, and did not get early diagnosis or treatment. He’s now in hospice and on death’s door. The other friend, with insurance, received an early diagnosis and treatment and is now cancer free.