Literature Review

Medicare Advantage provider, benefit cuts may follow rate reductionModern Healthcare, by Nona Tepper; 2/6/24Medicare Advantage insurers are likely to respond to a modest rate cut next year by adjusting premiums, benefits, provider reimbursements and other factors to emphasize profitability, financial analysts said. Although the Centers for Medicare and Medicaid Services has downplayed the effects of its proposed 0.16% reduction in the Medicare Advantage benchmark rate for 2025, the rule issued last Wednesday is the latest in a string of policies that has Medicare insurers and their investors wary about the program.

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?

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. 

CMS confirms nursing home staffing ratios to finalize this yearBecker's Hospital Review, by Mariah Taylor; 1/24/24CMS said it will finalize the nursing home minimum staffing proposal in 2024, officials said in a national stakeholder call Jan. 23. The CMS team said they received more than 46,000 comments on the proposal, which was used to inform the final rule.

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.