Literature Review
All posts tagged with “Regulatory News.”
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
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
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.)
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
A whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing?
03/06/24 at 03:00 AMA whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing? Delaware Online, by Esteban Parra and Xerxes Wilson; 3/4/24A 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. ... [The whistleblower reported that] hospital officials discussed a "new hospital initiative" in which suspected "brain-dead" patients would be discharged and admitted to hospice before any declaration of brain death, according to the lawsuit. The scheme allowed for prolonged billing where previous billing ended with the patient’s death, the complaint states. [Please refer to the article for details.]
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.
Providers meet with OMB to prevent ‘devastating’ effect of 80/20 provision
03/06/24 at 03:00 AMProviders meet with OMB to prevent ‘devastating’ effect of 80/20 provision McKnights Home Care, by Adam Healy; 3/4/24Home care stakeholders have been busy on Capitol Hill voicing concerns about a controversial provision of the proposed Medicaid Access Rule. The National Association for Home Care & Hospice and Home Care Association of America met with the Office of Management and Budget last week to discuss the Access Rule’s so-called 80/20 provision. The provision, if finalized, would require that 80% of Medicaid payments for personal care, home health and homemaker services be spent on workers’ compensation. “If that one provision is finalized as proposed, it would be so detrimental that we’d likely lose a significant portion of our service delivery base and people would go without care,” Damon Terzaghi, NAHC’s director of Medicaid HCBS (home- and community-based services) said in an interview with McKnight’s Home Care Daily Pulse. “It would truly be devastating.”
Coverage denials in Medicare Advantage—Balancing access and efficiency
03/06/24 at 03:00 AMCoverage denials in Medicare Advantage—Balancing access and efficiencyJAMA Health Forum; by Suhas Gondi, MD, MBA; Kushal T. Kadakia, MSc; and Thomas C. Tsai, MD, MPH; 3/1/24 Each year, millions of claims for medical services are denied by health insurance plans. Many denials may be justified as a necessary strategy to reduce wasteful spending from low-value care. However, denials may also delay diagnosis and/or treatment for patients, and appealing denials contributes to clinician workload and burnout. This tension is apparent in the Medicare program, where denials affect millions of beneficiaries who enroll in Medicare Advantage (MA).
Medicare’s new Dementia GUIDE Model: How can physicians, hospices, and home health agencies participate?
03/05/24 at 03:00 AMMedicare’s new Dementia GUIDE Model: How can physicians, hospices, and home health agencies participate? Morgan Lewis Blog Post; 3/1/24If you have had a loved one suffer from dementia, you know the emotional, physical, and financial toll of this terrible disease. With advancements in dementia treatment, however, there is renewed hope on addressing this disease and increasing emphasis on fostering innovative care models. A central pillar of this effort is the Guiding an Improved Dementia Experience (GUIDE) model, announced by the US Department of Health and Human Service’s Centers for Medicare & Medicaid Services (CMS) in July 2023. This initiative—a new voluntary, nationwide alternative payment model—is designed to support Medicare beneficiaries with dementia, as well as their caregivers.
Home health disparities: Medicare Advantage patients receive fewer visits, worse outcomes
03/05/24 at 02:00 AMHome health disparities: Medicare Advantage patients receive fewer visits, worse outcomes Home Health Care News, by Patirck Filbin; 3/1/24Home health patients under Medicare Advantage (MA) plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits, according to a new study.
What the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry
03/04/24 at 03:00 AMWhat the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry Home Health Care News, by Andrew Donlan; 3/1/24 Since the news surfaced Tuesday that the Department of Justice had opened an antitrust investigation into UnitedHealth Group (NYSE: UNH), additional questions have bubbled up. Namely, those questions surround the home health provider Amedisys Inc. (Nasdaq: AMED), which agreed to be acquired by UnitedHealth Group’s Optum in June of last year.
CMS upends Medicare Advantage supplemental benefits data reporting for payers
03/04/24 at 02:00 AMCMS upends Medicare Advantage supplemental benefits data reporting for payers DLA Piper, by Daivd Kopans and Sua Yoon; 2/27/24 On February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued new guidance via a memorandum to Medicare Advantage (MA) organizations, Program of All-Inclusive Care for the Elderly (PACE) organizations, and Demonstration Organizations (collectively, Plans) that upends how these Plans have been reporting (or not reporting) encounter information for their covered supplemental benefits. The guidance in the memorandum is effective retroactively to January 1, 2024. [In this article] is a Q&A explaining the top points of the guidance and highlight its impact on companies across industries.
Untangling the history, causes behind the precipitous home health aide utilization drop
03/01/24 at 03:00 AMUntangling the history, causes behind the precipitous home health aide utilization drop Home Health Care News, by Patrick Filbin; 2/28/24In the last home health proposed rule from the Centers for Medicare & Medicaid Services (CMS), the federal agency in charge of reimbursement rates sent out a request for information on home health aide utilization. Specifically, the agency wondered why Medicare-covered home health aide visits and utilization had fallen off a cliff over the last few decades. According to the Center for Medicare Advocacy, home health aide visits declined by 90% from 1998 to 2019.
False Claims Act - 2023 Year in Review
03/01/24 at 03:00 AMFalse Claims Act - 2023 Year in ReviewJD Supra; by William Athanas, A. Lee Bentley III, Gene Besen, Ryan Dean, Jonathan Ferry, Daniel Fortune, Giovanni Giarratana, Ty Howard, Elisha Kobre, Anna Lashley, Gregory Marshall, Lyndsay Medlin, Stephen Moulton, Ocasha Musah, Scarlett Singleton Nokes, Cara Rice, Brad Robertson, Tara Sarosiek, Jack Selden, Erin Sullivan, Courtlyn Ward, Virginia Wright; 2/28/24As we do every year, this issue revisits the key cases and other developments from the year gone by. And by most metrics, 2023 was a notable year for the False Claims Act (FCA).
The state where all hospitals are on track to earn new Joint Commission [Equity] Certification
02/29/24 at 03:00 AMThe state where all hospitals are on track to earn new Joint Commission [Equity] CertificationBecker's Clinical Leadership, by Erica Carbajal; 2/28/24All hospitals in Massachusetts are meeting a health equity accreditation standard that The Joint Commission introduced last year, making it the first state to be recognized for the accomplishment. ... Achieving the standard is the first step to obtain The Joint Commission's recently launched health equity certification, which all of the state's hospitals plan to earn by 2025, according to a joint news release from the Massachusetts Health & Hospital Association and accrediting body.