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All posts tagged with “Regulatory News | Medicare.”



The Inflation Reduction Act and patient costs for drugs to treat heart failure

11/23/24 at 03:40 AM

The Inflation Reduction Act and patient costs for drugs to treat heart failureJAMA Network Open; Erin Trish, PhD; Karen Van Nuys, PhD; Joanne Wu, MS; Nihar R. Desai, MD, MPH; 10/24The 2022 Inflation Reduction Act (IRA) contains several provisions to lower Medicare drug costs, including permitting the Centers for Medicare & Medicaid Services (CMS) to limit the prices of certain medicines and altering the standard Part D benefit to limit patient out-of-pocket costs. CMS has set the prices of 10 drugs effective 2026, including 3 commonly prescribed as part of combination therapy for heart failure (HF): dapagliflozin, empagliflozin, and sacubitril/valsartan. Dapagliflozin and empagliflozin also treat other conditions, including diabetes and chronic kidney disease. In this cross-sectional study of Medicare beneficiary costs ... benefit redesign eliminates the coverage gap in 2025, and caps annual out-of-pocket expenditures, [and] ... will reduce and smooth patient out-of-pocket burden.

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Empassion achieves $34 million in savings in novel Medicare program serving high needs patients

11/22/24 at 03:00 AM

Empassion achieves $34 million in savings in novel Medicare program serving high needs patients Globe Newswire, New York City; 11/21/24 Empassion Health, Inc., the nation’s largest managed care provider of high-quality end-of-life care for adults living with serious illness so that they can have more good days, today reported near-record results for four Medicare Accountable Care Organizations (ACOs) serving Original Medicare lives in 35 states.  Specifically, Empassion achieved total gross savings of $34.1m in the High Needs Population Track of ACO REACH for Performance Year 2023 while managing a record number of lives – nearly 9,000 across 35 states – in total cost-of care arrangements.  This includes a 50-percent reduction of unnecessary hospital stays.  Empassion also earned the highest quality scores for provider communication and care coordination.  “While we are enormously proud of the $34 million in Medicare savings, more important is that Empassion provided high-quality end-of-life care for adults living with serious illness so that they had more good days,” said Robin Heffernan, the CEO of Empassion. “These outcomes are specific to Empassion and its unique model. ..." 

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Pontiac hospital to lay off most of its staff as feds pull Medicare reimbursement

11/21/24 at 03:00 AM

Pontiac hospital to lay off most of its staff as feds pull Medicare reimbursement Modern Healthcare; by Dustin Walsh; 11/19/24 Pontiac General Hospital plans to lay off most of its staff as CMS is cutting the troubled hospital from Medicare funding. The Pontiac, Michigan-based hospital is laying off 186 employees, including 94 mental health technicians, on Nov. 29. Another 62 employees, including 13 nurses, will be laid off Dec. 6 and Dec. 20, according to a WARN notice.

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CMS issues ‘significant’ survey changes for 2025 [long-term care]

11/21/24 at 03:00 AM

BREAKING: CMS issues ‘significant’ survey changes for 2025 [long-term care] McKnights Long-Term Care News; by Kimberly Marselas; 11/19/24 The Centers for Medicare & Medicaid Services on Monday issued “significant revisions” to its long-term care surveyor guidance, with changes affecting everything from admission and discharge standards to the use of psychotropic medications and newly adopted infection prevention practices. CMS released an advance copy of the 900-page document online, including new critical element pathways, to give providers and surveyors time to adjust to the new requirements before they go into effect Feb. 24, 2025. A significant portion of the changes is related to chemical restraints and unnecessary psychotropic medication.

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The Alliance applauds Gerald’s Law passing through Congress

11/21/24 at 03:00 AM

The Alliance applauds Gerald’s Law passing through Congress National Alliance for Care at Home (the Alliance; formerly NAHC and NHPCO); Press Release; 11/19/24 The National Alliance for Care at Home (the Alliance) celebrates the historic passage of H.R. 8371, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act in the U.S. House of Representatives last night with a bipartisan vote of 389-9. This landmark legislation includes Section 301, Gerald’s Law, which addresses a critical gap in benefits impacting seriously-ill veterans and their families receiving hospice care. The story of Gerald “Jerry” Elliott, a U.S. Army veteran, underscores the importance of this legislative achievement. Diagnosed with cancer, Jerry was admitted to his local Veterans Affairs (VA) hospital in 2019 before transitioning to VA hospice care at home to be surrounded by his family. After his passing, his family discovered they were ineligible for full burial and funeral financial support because Jerry died outside of a VA facility.

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Hospices leaders: ‘Vigilant’ compliance pivotal in MAC auditing climate

11/20/24 at 03:00 AM

Hospices leaders: ‘Vigilant’ compliance pivotal in MAC auditing climate Hospice News; by Holly Vossel; 11/18/24 e auditing environment has heated up in the hospice industry, with inconsistencies reportedly proliferating among the various types of regulatory enforcement activity — particularly those performed by Medicare Administrative Contractors (MACs). The issue has some hospice providers delving deeper into a range of compliance strategies. Differences exist in the scope of data being reviewed by MAC auditors, as well as the audit appeals approval and denial processes, said Ashley Arnold, senior vice president of quality at St. Croix Hospice. The Minnesota-headquartered hospice provides care across 85 locations in 10 Midwestern states and has an average daily census of roughly 5,200 patients.  

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For-profit hospices increasing despite poor performance

11/20/24 at 03:00 AM

For-profit hospices increasing despite poor performance EurekAlert!, Weill Cornell Medicine; Peer-reviewed publication; 11/18/24 Hospices are increasingly owned by private equity firms and publicly traded companies, but recently Weill Cornell Medicine researchers found that they performed substantially worse than hospices owned by not-for-profit agencies. This is concerning as nearly 75% of hospice programs, which care for patients in their last stage of life, are for-profit. The study, published Nov. 18 in JAMA, highlights the need for policy interventions that focus on increasing transparency and accountability in hospice ownership. ... The researchers analyzed Consumer Assessment of Health Care Providers and Systems (CAHPS) data from January 2021 through December 2022. CAHPS, the national standard for assessing the quality of patient care, surveyed the caregivers of those who passed away in hospice by telephone and mail. The researchers compared measures for communication, timely care, treating family members with respect, emotional and religious support, help for symptoms, hospice care training, hospice rating and willingness to recommend. ... Of the 2,676 hospices included in the final analysis, approximately 25% were owned by private equity and publicly traded companies and 40% were other types of privately owned for-profit hospices. Though only 25% of the hospices surveyed were not-for-profit, they provided the highest-rated quality care including focus on managing pain, comfort, dignity and quality of life.

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Hospice of Santa Cruz County enters regional partnership ahead of coming reimbursement model changes

11/19/24 at 03:15 AM

Hospice of Santa Cruz County enters regional partnership ahead of coming reimbursement model changes Modesto Bee, Scotts Valley, CA; by PK Hattis; 11/16/24 The health care landscape has changed a lot in the past 42 years, but for hospice care providers, some things have remained remarkably consistent. ... But that reimbursement process is about to be upended in only a few years and it has caused a handful of hospice providers, including a branch in Santa Cruz County, to form a regional partnership in hopes of ensuring the unique health care service endures for decades to come. Hospice of Santa Cruz County, founded in 1978 when the hospice movement was in its infancy, announced it has locked arms with four other nonprofit hospices and health care organizations to form Chapters Health West - a coalition that will allow the organizations to pool resources ahead of an era of reimbursement model upheaval. "We've been here for 47 years; we want to be here for another 47 years," Hospice of Santa Cruz County CEO Cathy Conway told the Sentinel in recent interview from her office in Scotts Valley. "What got us here for the last 47 won't get us to the next 47 because these changes are happening."

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CMS Innovation Center reimagines rural health care approaches

11/19/24 at 03:00 AM

CMS Innovation Center reimagines rural health care approaches Center for Medicare and Medicaid Innovation; 11/12/24 Re-Imagining Rural Health: Themes, Concepts, and Next steps from the CMS Innovation Center "Hackathon" Series. ... Over sixty million Americans currently live in areas identified as rural, Tribal, frontier, and geographically isolated areas, including the U.S. Territories. Compared to people living in urban areas, rural Americans are more likely to experience poverty, be older, be uninsured, and have a disability. At the same time, rural communities face unique barriers to accessing care due to more limited availability of health care providers, including primary care, specialty care and home and community-based services, and residents often have to travel long distances to obtain health care. [Click on the title's link to continue reading (and distribute) this important 20 page whitepaper.]

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Inside the Justice Department’s Amedisys-Optum lawsuit

11/19/24 at 03:00 AM

Inside the Justice Department’s Amedisys-Optum lawsuit Hospice News; by Jim Parker; 11/18/24 ... DOJ’s chief concern is that the combination of the two companies would dampen competition in the hospice and home health space. Should the transaction proceed, Optum would control 30% or more of the home health or hospice services in eight states, according to the Justice Department’s complaint. The deal would expand Optum’s home health and hospice footprint to five additional states, allowing the company to gain nearly 500 locations in 32 states. “UnitedHealth Group Incorporated and Amedisys, Inc. are two of the largest home health and hospice service providers in the country,” DOJ indicated in the complaint. “Today, competition between UnitedHealth and Amedisys benefits millions of Americans who need home health or hospice services. But the proposed merger between UnitedHealth and Amedisys would forever eliminate that competition.”

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New report for 2024: Rural-urban disparities in health care in Medicare

11/19/24 at 02:00 AM

New report for 2024: Rural-urban disparities in health care in Medicare Centers for Medicare & Medicaid Services (CMS); 11/14/24 Advancing Health Equity in Rural, Tribal, and Geographically Isolated Communities. FY2023 Year in Review, November 2023. From the Co-Chairs: ... This year’s annual report demonstrates CMS’ ongoing commitment to advancing health equity for individuals living and working across diverse geographies. These actions span a wide breadth of the agency’s authorities and roles, including regulation, payment, coverage, tools and publications, partner engagement, health system innovations, quality of care, and regional coordination. Across these actions, CMS maintains a focus on the goal of improving the lives of our enrollees and those who care for them. We eagerly anticipate our continued collaboration and partnership with all those CMS serves to advance health care in rural, tribal, and geographically isolated communities.

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CMS ramps up efforts to root out ‘door knocker’ hospice schemes

11/18/24 at 03:00 AM

CMS ramps up efforts to root out ‘door knocker’ hospice schemes Hospice News; by Holly Vossel; 11/15/24 The U.S. Centers for Medicare & Medicaid Services (CMS) recently elaborated on its plans to expand public education campaigns designed to help protect hospice beneficiaries from fraudulent actors in the space. ... “One of the areas we’re working with right now is to enhance education — beneficiary education specifically,” Pryor said during a recent CMS webinar. “We have hospice beneficiaries who are unfortunately fraudulently signed up for the benefit in these kind of, what we call, ‘door knocker scams.’” The scams include bad actors reaching out to beneficiaries with offers of free goods and services, such as groceries, TVs, reclining chairs and furniture, Pryor explained. The fraudulent marketing tactics are posing significant complications for Medicare beneficiaries, he said.

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CMS to surveyors: Keep eyes open for hospice fraud

11/15/24 at 03:00 AM

CMS to surveyors: Keep eyes open for hospice fraud Hospice News; by Jim Parker; 11/14/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a memo to accreditation bodies and state agencies advising surveyors to watch out for potential hospice fraud. The memo directs surveyors to refer issues to CMS if they suspect fraudulent activity. These actions were spurred by a rash of fraudulent hospices that have emerged primarily in California, Texas, Nevada and Arizona. “While the primary purpose of [state agencies and accreditation organization] surveys is to determine compliance with the Medicare Hospice CoPs, there are several elements of the survey process that can uncover concerns that would necessitate a referral to CMS for potential fraud,” CMS indicated in the memo. 

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Medicare premiums increasing in 2025

11/13/24 at 03:00 AM

Medicare premiums increasing in 2025 Fox 29 Philadelphia; by Megan Ziegler; 11/12/24The Centers for Medicare and Medicaid Services (CMS) announced this month that standard monthly premiums for its Part B plan are increasing by about 6% in the new year. The jump outpaces both inflation and the cost-of-living adjustment (COLA) recently announced by Social Security. Inflation was up in September about 2.4% from a year ago, and the COLA increase is set for 2025 at 2.5%, which is estimated to be about $48. ... The standard monthly premium for Medicare Part B enrollees is increasing next year to $185, an increase of $10.30, or just less than 6%, from $174.70 in 2024, the CMS announced. The annual deductible for all Medicare Part B beneficiaries is also increasing by $17 to $257. 

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Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program

11/13/24 at 03:00 AM

Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program Hospice News; by Holly Vossel; 11/11/24 Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape. The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency. ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported. [Click on the title's link to continue reading.]

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Homecare owner allegedly withholds $86k in wages

11/12/24 at 03:00 AM

Homecare owner allegedly withholds $86k in wages HomeCare, Indianapolis, IN; 11/11/24 The U.S. Department of Labor (DOL) has alleged that home health care company owner Hahn March violated federal wage laws and withheld $86,000 in wages by using improper pay practices at her two Indianapolis, Indiana, companies: Signal Health Group Inc. and SHG Employee Leasing Company. In 2018, federal investigators cited March for not paying overtime wages to employees at her then-owned company, Aging and Disabled Home Healthcare. ... The complaint was filed following an investigation by the DOL Wage and Hour Division, which discovered March and Nancy Stanley, the chief financial officer of both companies, used an artificial regular rate pay scheme to lower hourly pay rates and, in turn, shortchanged employees $86,427 in overtime wages. ... The DOL is seeking $172,854—including $86,427 in back wages and an equal amount in liquated damages—for 43 current and former employees. ... “Employees who work in home health care—one of our nation’s lowest-paying professions—provide necessary daily and hospice care that allow individuals to remain in their homes and aid them in navigating their basic needs, providing dignity and comfort to clients and their families,” said Aaron Loomis, Wage and Hour Division district director.

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Long-term care market to grow by USD 394.8 billion from 2024-2028, as aging population drives demand with AI impact on market trends - Technavio

11/11/24 at 03:00 AM

Long-term care market to grow by USD 394.8 billion from 2024-2028, as aging population drives demand with AI impact on market trends - Technavio Cision; by PR Newswire; 11/8/24 Report on how AI is redefining market landscape - The global long-term care (LTC) market size is estimated to grow by USD 394.8 billion from 2024-2028, according to Technavio. The market is estimated to grow at a CAGR of over 3.21% during the forecast period. Growing demand for long-term care from aging population is driving market growth, with a trend towards expansion and growth of several healthcare domain. However, lack of skilled nursing staff for long-term care  poses a challenge.Key market players include Abri Health Care Services LLC, Amedisys Inc., Brookdale Senior Living Inc., CareOne Management LLC, Diversicare Healthcare Services Inc., Extendicare Canada Inc, FCP Live In, Genesis Healthcare Inc., Honor Technology Inc., Illumifin Corp., Kindred Health Holdings LLC, Life Care Centers of America Inc., Revera Inc., SeniorLiving.org, Sonida Senior Living Inc., Sunrise Senior Living LLC, and Wickshire Senior Living.

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Quality hospice researchers seek to untangle possible relationships between tax status and outcomes

11/11/24 at 03:00 AM

Quality hospice researchers seek to untangle possible relationships between tax status and outcomes Hospice News; by Holly Vossel; 11/8/24 ... More private equity (PE) investors have stepped into the hospice and home health space in recent years. This trend extends across the broader health care continuum, as certain types of owners — notably private equity entities — have come under scrutiny from lawmakers. Providers’ tax status may be among the potential risk factors of fraudulent hospice spending. For-profit business and operational infrastructures can differ from nonprofit hospices, which have historically represented much of the providers in the industry. But research has found that the tide is shifting. Private equity transactions represented half of all home health and hospice deals in 2018 and 2019, resulting in a 300% increase in patients enrolled under PE-backed providers, according to research published in the Journal of Palliative Medicine. ... Live discharges occur in less than 10% of patients at nonprofit hospices, study author Lauren Hunt indicated. This compared to an overall 20% of live discharge rates among patients of for-profit hospices. 

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Reps. Van Duyne, Panetta introduce bill to reform hospice Special Focus Program

11/08/24 at 03:00 AM

Reps. Van Duyne, Panetta introduce bill to reform hospice Special Focus Program Hospice News; by Jim Parker; 11/6/24 Reps. Beth Van Duyne (R-Texas) and Jimmy Panetta (D-California) have introduced a bill that would reform aspects of the hospice Special Focus Program (SFP). If enacted, the Enhancing Hospice Oversight and Transparency Act also would increase the penalty for hospices that do not report quality measure data to 10% by 2027, up from 4% currently. The SFP has the authority to impose enforcement remedies against hospices with poor performance based on its algorithm. Hospices flagged by the SFP also will be surveyed every six months rather than the current three-year cycle and could face monetary penalties or expulsion from the Medicare program. 

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How hospices can leverage palliative care to ‘stay relevant’ in value-based care

11/07/24 at 03:00 AM

How hospices can leverage palliative care to ‘stay relevant’ in value-based care Hospice News; by Jim Parker; 11/6/24 U.S. health care is moving steadily towards value-based reimbursement, and having a robust palliative care program can help hospices ensure they are not left behind. The U.S. Centers for Medicare & Medicaid Services (CMS) is working to ensure that 100% of Medicare beneficiaries are aligned with a risk-based payment model by 2030. This can include Medicare Advantage (MA) and Accountable Care Organization (ACO) programs. With hospice reimbursement confined to the traditional Medicare benefit, a palliative care program is a likely entry point for those providers to access value-based reimbursement, Sue Lynn Schramm, a partner of the hospice and palliative care consulting company Confidis LLC, said in a presentation at the National Hospice and Palliative Care Organization Annual Leadership Conference. This may be even more the case now that the hospice component of the value-based insurance design model (VBID), often called the Medicare Advantage Hospice Carve-In, is ending on Dec. 31, Schramm said.

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Calendar Year (CY) 2025 Home Health Prospective Payment System Final Rule Fact Sheet (CMS-1803-F)

11/06/24 at 03:00 AM

Calendar Year (CY) 2025 Home Health Prospective Payment System Final Rule Fact Sheet (CMS-1803-F) CMS Newsroom; Final Rule Fact Sheet (CMS-1803-F); 11/1/24On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) final rule, which updates Medicare payment policies and rates for Home Health Agencies (HHAs). This rule also updates the intravenous immune globulin (IVIG) items and services’ payment rate for CY 2025 for Durable Medical Equipment (DME) suppliers. As described further below, CMS estimates that Medicare payments to HHAs in CY 2025 would increase in the aggregate by 0.5%, or $85 million, compared to CY 2024. [Click on the title's link for more information.]

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Longer hospice stays among dementia patients save Medicare dollars

11/06/24 at 02:50 AM

Longer hospice stays among dementia patients save Medicare dollars Hospice News; by Holly Vossel; 11/4/24 Hospice utilization has tripled among patients diagnosed with Alzheimer’s disease and related dementias (ADRD) during the past two decades. The trend has ignited concerns about these patients’ lengths of stay, as well as praise for hospices’ cost-savings potential. Massachusetts Institute of Technology (MIT) researchers analyzed Medicare fee-for-service claims spanning between 1999 and 2019, including data on hospice billing, patient enrollment, hospitalizations, health costs and chronic condition indicators. Roughly 14.7% of ADRD patients utilized hospices services in 2019, nearly triple the 4.4% of patients who received this care in 1999, according to the research, which was published in the National Bureau of Economic Research. The research compared billing claims among nonprofit and for-profit providers to explore spending associated with longer hospice stays among dementia patients. ...

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Healthcare billing fraud: 10 recent cases

11/01/24 at 03:00 AM

Healthcare billing fraud: 10 recent casesBecker's Hospital Review; by Andrew Cass; 10/28/24

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20 Medicare FAQs: Do you know the answers?

10/31/24 at 03:00 AM

20 Medicare FAQs: Do you know the answers? WealthUp; by Riley Adams, CPA; 10/29/24 Medicare is instrumental in ensuring that older adults, as well as individuals of all ages with certain medical conditions, have access to affordable health care. It’s also infuriatingly complex in some respects. According to the 2024 KFF Survey of Consumer Experiences, 37% of respondents said it was either “somewhat difficult” or “very difficult” to understand at least one of five aspects of their Medicare coverage. That’s at least better than employer-sponsored insurance (54%) or Medicaid (46%), but it’s still a high percentage that shows many Americans don’t know Medicare inside and out. ... I’ve compiled a list of some of the most frequently asked questions (FAQs) about Medicare, and (more importantly) answers to those questions. The better you understand this vital social program, the easier it should be to make educated decisions regarding it. [Click here and scroll down to "Common Medicare Questions."] 

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LeadingAge: Diverting patients from SNF to home health does more harm than good

10/30/24 at 03:00 AM

LeadingAge: Diverting patients from SNF to home health does more harm than good McKnights Home Care; by Adam Healy; 10/28/24 Mounting evidence suggests that Medicare Advantage plans are directing beneficiaries to home health when they should receive skilled nursing facility care, which is negatively affecting providers’ care quality, according to LeadingAge. The Senate Committee Permanent Subcommittee on Investigations recently reported that MA plans may be diverting patients in need of SNF care to home health as a means of saving money. In an Oct. 25 letter, LeadingAge said this practice damages care quality and patient health outcomes, and asked the Medicare Payment Advisory Commission (MedPAC) to investigate the issue further. 

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