Literature Review

CMS seeks input on Medicare Advantage transparency policyModern Healthcare, by Alison Bennett; 1/25/24The Centers for Medicare and Medicaid Services wants public input to guide possible future regulations to mandate greater transparency from Medicare Advantage plans, according to a request for information issued Thursday. The agency has sought to shed more light on Medicare Advantage operations and finances in recent years and required insurers to reveal information in areas such as medical loss ratio calculations, prior authorization processes, supplemental benefits and health equity.

Palmetto Hospice updates and review webinar: February 13, 2024Press release; 2/5/24Webinar 2/13/24 @ 1:00 PM ET. Please click here to register for this webinar session. This session is designed to provide insight for your Hospice agency staff. During this session, a representative will provide Hospice Billing Updates, Value-Based Insurance Design (VBID) Model information, 2024 Final Rule Summary and other helpful information and tips.

Review choice demonstration is here to stayHome Health Care News, by Patrick Filbin; 2/1/24The Centers for Medicare & Medicaid Services (CMS) has been tight-lipped about its Review Choice Demonstration (RCD) plans beyond May 2024. However, industry leaders believe RCD will be extended across the country on a more permanent basis — a development that agency leaders should recognize as a momentum shifting change. “We’re seeing a monumental shift in home health care and how we actually operate,” Kim Gaffey, founder and CEO of Gaffey Home Nursing and Hospice, said during a webinar Thursday. 

It is going to be a bad year (or more) for the Medicare businessWall Street Journal, by David Wainer; 1/25/24America’s seniors are going to keep up their elevated use of the medical system throughout the year. That is the message from Humana’s earnings release on Thursday, which is sending stocks of insurance giants sliding.

In-home care providers await updates on CMS Medicaid proposal, begin preparing for 80/20 ruleHome Health Care News, by Patrick Filbin; 1/23/24Drawing parallels between the intentions of the Centers for Medicare & Medicaid Services (CMS) and the narrative of a Charles Dickens novel is an uncommon venture. ...  “When the 80/20 rule came out, many of us saw this as a ‘Tale of Two Cities’ situation,” Dave Totaro, chief government affairs officer at Bayada Home Health Care, recently said during a Home Health Care News webinar. 

Home health benefit will become a 'skeleton' if Medicare payment adjustments continue, industry leader cautionsHome Health Care News, by Joyce Famakinwa; 1/23/24... The 2024 final home health payment rule included a 0.8% aggregate payment increase and a permanent prospective adjustment of -2.890%, plus dozens of other notable changes to home health care. ... With these cuts, NAHC [National Association for Home Care & Hospice] has estimated that 48% of all home health agencies will have overall negative margins in 2024.

Historic 21.3 million people choose ACA Marketplace coverageCMS.gov Press Release; 1/24/24Marketplace enrollment climbs nearly 5 million higher than previous year. ... Total plan selections include more than five million people — about a fourth — who are new to the Marketplaces and 16 million people who renewed their coverage. Notably, open enrollment continues in four states and Washington, D.C., through January 31. 

Number of Georgians dropped from Medicaid nears 500,000 The Atlanta-Journal Constitution, by Ariel Hart; 1/22/24Georgia has dropped at least 488,000 from Medicaid, the government health insurance for the poor, as part of a federally mandated project to ensure those covered by the program qualify to remain on it.

$15 billion win for physicians on prior authorizationAMA, by Kevin B. O'Reilly; 1/18/24Under the leadership of Administrator Chiquita Brooks-LaSure, the Centers for Medicare & Medicaid Services (CMS) has released a final rule making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians. Together, the changes will save physician practices an estimated $15 billion over 10 years, according to the U.S. Department of Health and Human Services (HHS).

Owner of defunct Skyline chain pleads guilty in $39M fraud caseMcKnight's Long-Term Care News, by Kimberly Marselas; 1/18/24Joseph Schwartz, former owner of Skyline Management and a 90-plus nursing home empire whose collapse sent patients and workers scrambling in 2018, pleaded guilty Wednesday to his role in a $39 million fraud scheme.

MedPAC approves hospital, physician pay bump; Doubles down on post-acute cutsInsideHealth Policy, by Bridget Early; 1/12/24Congress’ Medicare pay advisors recommended pay raises in 2025 for hospitals and physicians along with extra so-called Medicare safety-net pay and voted Thursday ... to recommend a second year’s worth of post-acute pay cuts as it approved proposals that would lower base pay rates for skilled nursing facilities, home health agencies and inpatient rehabilitation facilities. 

OIG report has clues for 2024 healthcare fraud enforcementLAW360, by Mackenzie Wortley, Elizabeth Nevins and Megan Miller; 1/16/24In late 2023, the U.S. Department of Health and Human Services and the U.S. Department of Justice released the Health Care Fraud and Abuse Control Program Annual Report for fiscal year 2022, highlighting continued enforcement and recovery actions under the program.

CMS terminates 2 Centene Medicare Advantage plansModern Healthcare, by Nona Tepper; 1/8/24A pair of Centene Medicare Advantage plans must suspend enrollment and marketing because of poor star ratings, the Centers for Medicare and Medicaid Services notified the company.