Literature Review

The Joint Commission: 2024 Behavioral Health Care National Patient Safety Goals

NC Medicaid rolls grow by 1,000 people a day as smooth expansion rollout continues its third monthNC Health News, by Jamie Baxley; 2/15/24When North Carolina launched Medicaid expansion on Dec. 1, state officials said the measure would provide health insurance to an estimated 600,000 low-income adults over a span of two years. It took just two months to reach 58 percent of that goal. More than 346,400 newly eligible beneficiaries have been approved for coverage as of Feb. 1, according to data from the N.C. Department of Health and Human Services.

Medicare program; strengthening oversight of Accrediting Organizations (AOs) and preventing AO Conflict of Interest, and related provisionsFederal Register, Proposed Rule by the Centers for Medicare & Medicaid Services; 2/15/24This proposed rule would set forth a number of provisions to strengthen the oversight of accrediting organizations (AOs) by addressing conflicts of interest, establishing consistent standards, processes and definitions, and updating the validation and performance standards systems. Additionally, this proposed rule would revise the psychiatric hospital survey process, add a limitation on terminated deemed providers and suppliers when reentering the program, and provides technical corrections for End-Stage Renal Disease facilities and Kidney Transplant Programs.

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.

Molina joins chorus reporting Medicare Advantage challengesModern Healthcare, by Nona Tepper; 2/8/24

California Hospice Network: State falls short in curbing potential malfeasanceHospice News, by Jim Parker; 2/8/24The continued licensing of new hospices in California despite a moratorium is “deeply disturbing and frustrating,” the California Hospice Network (CHN) indicated in a statement. The practice is undermining efforts to combat hospice fraud, which has been rampant in California according to media and state government investigations. In 2021, the state enacted two hospice reform laws  — Senate Bill 664 and Assembly Bill 1280 — designed to strengthen oversight, including a moratorium on new licenses and an extensive audit of California’s licensing and oversight processes.

Hospices & Skilled Nursing Facilities: Report All Managing EmployeesCMS: mlnconnects; 2/8/24CMS recently clarified that hospice and skilled nursing facility medical directors and administrators are always considered managing employees for Medicare provider enrollment purposes. You must report all current managing employees. If you haven’t reported a medical director or administrator, report them now. See the Medicare Program Integrity Manual: CY 2024 Home Health Prospective Payment System Updates (PDF) MLN Matters Article for more information.

Medicare Advantage in the headlines: 9 recent updatesBecker's Payer Issues, by Rylee Wilson; 1/30/24Challenges loom for Medicare Advantage in 2024, with payers reporting rising medical costs and lower growth expectations for the year. [Click on the title's link for] nine Medicare Advantage updates Becker's has reported since Jan. 22.

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.

CMS proposes Medicare Advantage rate cutBecker's Payer Issues, by Rylee Wilson; 1/31/24CMS proposed a slight decrease in Medicare Advantage benchmark payments for 2025. The agency issued its proposed 2025 rate notice Jan. 31, cutting benchmark payments by 0.2% on average. Risk model revision will amount to a 2.45% decline in revenue, according to a fact sheet issued by the agency. Plans should expect to see 3.7% higher revenue overall, with an MA risk score trend of 3.86% — the average increase in risk adjustment payments year over year — offsetting risk model revisions and a projected decline in star rating bonuses.

Has Medicare Advantage lost its luster?Becker's Payer Issues, by Rylee Wilson; 1/29/24Though Medicare Advantage enrollment keeps climbing, the program may not have the profitability it once did for insurers. In a January analysis shared with Becker's, Moody's analysts wrote that the program "seems to be losing some of its luster," facing a significant increase in medical costs and lower reimbursement rates from CMS. Earnings in Medicare Advantage shrunk by 2.1% among the insurers Moody's rated from 2019 to 2022, despite premiums and members growing by 40% in the same time period.

‘Crying wolf’ or dying breed? Incentives often ignore plight of rural skilled nursing operatorsMcKnights Long-Term Care News, by Kimberly Marselas; 1/29/24As hundreds of nursing homes have shuttered in the last few years, the very strategies meant to prop up the sector have often left the most isolated, resource-strapped facilities with nothing gained. Several new federal payment models and insurance programs are designed to allow skilled nursing providers to take on financial risk, tap into new revenue streams or access additional staffing and clinical resources.