Literature Review
All posts tagged with “Regulatory News.”
False Claims Act statistical year in review
03/28/24 at 03:00 AMEnforceMintz - False Claims Act statistical year in review Mondaq - Mintz; by Kevin M. McGinty, Laurence Freedman, Karen Lovitch and Brian Dunphy; 3/27/24 Mintz's annual report on False Claims Act case activity analyzes data from the DOJ and the firm's Health Care Qui Tam Database, and explores the 2023 spike in FCA case activity, the ongoing moderate decline in health care–related activity, and continuing robust recoveries in health care cases. ... Also interesting is the absence of hospice care facilities from this year's table. In a number of recent years, those entities had been a growing category of FCA defendants in our internal data.
Nearly half of health systems are considering dropping Medicare Advantage plans
03/27/24 at 03:00 AMNearly half of health systems are considering dropping Medicare Advantage plans Becker's Hospital CFO Report, by Andrew Cass; 3/22/24 ... "HFMA Health System CFO Pain Points Study 2024" is based on a survey of 135 health system CFOs conducted in January. According to the report, 16% of health systems are planning to stop accepting one or more Medicare Advantage plans in the next two years. Another 45% said they are considering the same but have not made a final decision.
Improving the Quality of Quality Metrics
03/26/24 at 03:00 AMImproving the Quality Of Quality Metrics Health Affairs; by Aditya Narayan, Bob Kocher, and Nirav R. Shah; 3/19/24... The landscape of health care quality measures is dynamic, reflecting efforts to enhance patient care, safety, and outcomes. These measures are developed and reimbursed by a variety of stakeholders, including government agencies such as the Centers for Medicare and Medicaid Services (CMS), health care organizations, and independent bodies such as the National Quality Forum and the Agency for Healthcare Research and Quality (AHRQ). The development process involves rigorous research, stakeholder engagement, and consensus-building to ensure measures are evidence-based, applicable across different health care settings, and meaningful to patient care.Editor's Note: Read and share this informative, big-picture article about the evolution of healthcare's quality metrics, its tools, and best practices.
A $400M incentive drives hospitals to meet health equity goals
03/25/24 at 03:00 AMA $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 models
03/25/24 at 03:00 AMNew 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.
Maryland health officials have applied for new federal ‘AHEAD model.’ Here’s what it means.
03/22/24 at 03:15 AMMaryland health officials have applied for new federal ‘AHEAD model.’ Here’s what it means. Maryland Matters, by Danielle J. Brown; 3/20/24State health officials have placed their bid for Maryland to be among the first participants in a federal program that will help fund state initiatives to improve patient outcomes and bridge inequities, while constraining hospital and medical costs. The U.S. Centers for Medicare and Medicaid Services (CMS) is rolling out the new States Advancing All-Payer Health Equity Approaches and Development Model, called the AHEAD Model, and states are invited to apply for funding.
New ACO model paves way for innovative home-based primary care services: CMS
03/22/24 at 03:00 AMNew ACO model paves way for innovative home-based primary care services: CMS McKnights Home Care, by Adam Healy; 3/20/24 The Centers for Medicare & Medicaid Services on Tuesday unveiled a new person-centered care payment model that expands how and where beneficiaries can receive primary care. “People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”
Medicare Advantage health equity factor to shake up ratings
03/22/24 at 02:00 AMMedicare Advantage health equity factor to shake up ratings Modern Healthcare, by Nona Tepper; 3/20/24 A federal effort to promote health equity will redistribute billions of dollars in Medicare Advantage Star Ratings bonus payments among health insurance companies. Beginning in 2027, the Centers for Medicare and Medicaid Services will reward Medicare Advantage plans that demonstrate progress addressing health disparities. At the same time, the agency scrapped a bonus policy that benefited insurers that sustained high overall quality ratings over time.
Medi-Cal Update - Hospice Care Program Bulletin
03/21/24 at 03:00 AMMedi-Cal Update - Hospice Care Program BulletinMedi-Cal, March Bulletin[Topics include:]
Personal care workers received most Medicaid fraud convictions in 2023: OIG
03/20/24 at 03:00 AMPersonal care workers received most Medicaid fraud convictions in 2023: OIG McKnights Home Care, by Adam Healy; 3/15/24 More personal care workers were convicted for Medicaid fraud than any other provider type last year, according to a new report released Thursday by the Department of Health and Human Services Office of the Inspector General. OIG found that 279 personal care services (PCS) attendants were convicted of Medicaid fraud in 2023 — far more than the next four highest provider types combined. These convictions amounted to more than $10.5 million in criminal charges.
Medicare Advantage prior authorization: The impact - increased access to care
03/20/24 at 02:00 AMMedicare Advantage prior authorization: The impact - increased access to care HHS-OIG; 3/19/24 HHS-OIG’s work on this issue drew national attention to the problem spurring the Centers for Medicare & Medicaid Services, the Industry, and Congress to action. Editor's Note: You can download the "Impact Brief" from this site. Click on the title's link.
Dual eligibles, PACE expansion bill draws bipartisan support, industry endorsements
03/19/24 at 03:00 AMDual eligibles, PACE expansion bill draws bipartisan support, industry endorsements McKnights Home Care, by Adam Healy; 3/18/24A bipartisan group of senators introduced legislation that would improve care coordination for dual-eligible beneficiaries and expand the Program of All-Inclusive Care for the Elderly to a larger share of people. The legislation’s primary function would be to require every state to develop a comprehensive, integrated health plan for dual-eligible beneficiaries, according to a summary. The bill also would require every state to allow PACE programs to be established, open up enrollment to any time in a given month, and extend PACE coverage to people under 55 years of age.
Accountable Care Organization leader perspectives on the Medicare shared savings program - A qualitative study
03/19/24 at 03:00 AMAccountable Care Organization leader perspectives on the Medicare shared savings program - A qualitative study
When Medicaid comes after the family home
03/18/24 at 03:00 AMWhen 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.)
Care Alternatives, whistleblowers resolve hospice fraud suit
03/18/24 at 03:00 AMCare Alternatives, whistleblowers resolve hospice fraud suitBloomberg Law, by Daniel Seiden; 3/15/24
Whistleblower cases on the rise nationwide; Sarbanes-Oxley, Dodd-Frank laws open door for more to speak out
03/13/24 at 03:00 AMWhistleblower cases on the rise nationwide; Sarbanes-Oxley, Dodd-Frank laws open door for more to speak out PressReader, Herald-Tribune; by Esteban Parra and Xerxes Wilson; 3/10/24A former medical director specializing in neurosurgery at southern Delaware's largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified "brain-dead" patients in order to overbill for services.
Healthcare technology regulatory update - March 2024
03/13/24 at 03:00 AMHealthcare technology regulatory update - March 2024 JD Supra, by Justin Chavez and Vimala Devassy; 3/8/24Federal and state agencies are actively proposing and enacting health technology-related legislation and regulations.
How CON laws influence hospice quality, program integrity
03/11/24 at 03:00 AMHow CON laws influence hospice quality, program integrityHospice News, by Holly Vossel; 3/8/24Variations in hospice certificate of need (CON) state laws are raising program integrity concerns.Notable mentions: Susan Ponder-Stansel, President and CEO of Alivia Care; Paul Ledford, President and CEO of the Florida Hospice & Palliative Care Association; Eddie Belluomini, COO of 1Care Hospice & 1Care Kids; Paula Sanders, Executive Director of the Georgia Hospice and Palliative Care Organization; Matt Hansen, Executive Director of the Homecare & Hospice Association of Utah.
The states where most Medicare beneficiaries have Medicare Advantage plans
03/11/24 at 03:00 AMThe states where most Medicare beneficiaries have Medicare Advantage plans Becker's Payer Issues, by Andrew Cass; 3/6/24 Twenty-six states now have more than half of their Medicare enrollees in Medicare Advantage plans, according to a March 5 report from Chartis, a healthcare advisory services firm. Nationwide, half of Medicare-eligible beneficiaries are now enrolled in Medicare Advantage plans. [Click on the title's link for] the 26 states where Medicare Advantage market penetration exceeds 50%.
Frontline hospice staff need to understand new CMS survey methods
03/11/24 at 02:00 AMFrontline hospice staff need to understand new CMS survey methodsHospice News, by Holly Vossel; 3/5/24Ensuring staff are educated around revisions to hospice survey processes will be key to navigating ongoing regulatory changes in the industry. This year will bring further implementation of survey validation activities, but also new regulatory oversight processes, according to Kim Skehan, vice president of accreditation for the Community Health Accreditation Partner (CHAP) organization.
Wound coding changes bring compliance, legal questions
03/07/24 at 03:30 AMWound coding changes bring compliance, legal questions McKnights Long-Term Care News, by Josh Henreckson; 3/5/24 Changes to end-of-life wound classification in a recent Minimum Data Set update should be a positive for long-term care, but regulatory and legal ambiguity still surrounded the new coding procedures at press time.
MA’s cost-management tools may be hurting home healthcare quality, outcomes
03/07/24 at 03:00 AMMA’s cost-management tools may be hurting home healthcare quality, outcomesMcKnights Long-Term Care News, by Adam Healy; 3/5/24Medicare Advantage’s use of cost-reducing tools such as copays, prior authorizations and restricted provider networks may be preventing home healthcare providers from delivering higher-quality care, according to one home healthcare leader.
CMS offers relief to providers affected by Change Healthcare outage
03/07/24 at 03:00 AMCMS offers relief to providers affected by Change Healthcare outageModern Healthcare, by Lauren Berryman; 3/5/24The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.Editor's Note: Access to the full article requires a subscription
The top strategies healthcare organizations can use to reduce denials
03/06/24 at 03:00 AMThe top strategies healthcare organizations can use to reduce denials MedCityNews, by Laxmi Patel; 3/5/24Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.