Literature Review

HCA Mission Hospital regains CMS complianceBecker's Hospital Review, by Mariah Taylor; 2/26/24CMS found Asheville, N.C.-based HCA Mission Hospital in compliance with its plan of correction and recommended removing the immediate jeopardy designation, Blue Ridge Public Radio reported Feb. 23. The hospital's plan of correction to address serious deficiencies it was cited for in January focuses on improving policies and educating staff.

[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 CMS’ rule could tighten accrediting organization oversightModern Healthcare, by Mari Devereaux; 2/20/24Accrediting organizations may have to reduce their fee-based consultation services and prohibit survey participation for employees with ties to health facilities or face penalties for violating conflict-of-interest provisions if the Centers for Medicare and Medicaid Services sticks with recent oversight proposals.Editor's Note: Full access to this article requires a subscription.

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. 

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. Reduced Medicaid outlays ... has placed an even greater strain on states to pay for these Medicaid programs, according to Damon Terzaghi, director of Medicaid HCBS for the National Association for Home Care & Hospice.

CMS issues additional guidance on program to allow people with Medicare to pay out-of-pocket prescription drug costs in monthly paymentsCMS.gov; 2/15/24The Inflation Reduction Act’s Medicare Prescription Payment Plan will allow people to pay Medicare Part D out-of-pocket costs over the course of the year starting in 2025. [On February 15th,] the Centers for Medicare & Medicaid Services (CMS) released the second part of draft guidance for the Medicare Prescription Payment Plan that outlines requirements for Medicare Part D plan sponsors, including outreach and education requirements, pharmacy processes, and operational considerations, for the program’s first year, 2025. 

Private equity Medicare Advantage investment slumps: reportModern Healthcare, by Nona Tepper; 2/13/24Private equity investment in Medicare Advantage has declined in recent years amid rising interest rates and an unfavorable regulatory environment, according to a report the Private Equity Stakeholder Project published Tuesday.

Aetna forecasts higher Medicare Advantage costsModern Healthcare, by Lauren Berryman; 2/7/24CVS Health has downgraded its 2024 earnings guidance as its Aetna health insurance subsidiary contends with higher-than-expected Medicare Advantage costs and a looming federal rate cut, the company announced Wednesday.

CMS proposes to increase accrediting organization oversightModern Healthcare, by Mari Devereaux; 2/9/24The Centers for Medicare and Medicaid Services proposed Thursday to crack down on accrediting organizations following concerns of biased, inconsistent survey results and conflicts of interest. The proposed rule would strengthen CMS’ oversight of accrediting bodies and mandate the organizations reduce conflicts of interest with healthcare facilities, including by limiting fee-based consulting services. The proposal also would standardize accrediting organizations' survey processes.

Medicare threatens to pull funding from HCA’s embattled Mission HospitalSTAT, by Tara Bannow; 2/6/24Five years after investor-owned HCA Healthcare took over an esteemed nonprofit hospital in North Carolina, Medicare is threatening to cut off payment for any services it provides seniors. The rare and dramatic move follows a Medicare revelation that patient safety is in “immediate jeopardy” at Mission Hospital in Asheville. That designation is the most severe the agency can hand out. HCA has just a few weeks to fix the problems or lose its Medicare funding.

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.

Government warns Medicare Advantage insurers not to deny care based on AI STAT, by Casey Ross and Bob Herman; 2/7/24In recent months, the federal government has repeatedly told Medicare Advantage insurers that they cannot use artificial intelligence or algorithms to deny medical services the government routinely covers. But in finalizing a rule to that effect, it also stepped into a thicket of questions from insurers about a technology that is especially difficult to pin down: What is AI? Can it be used at all to make decisions about the coverage of older patients? If so, how?