Literature Review
All posts tagged with “Regulatory News | Medicare.”
Humana will pay $90 million in Medicare drug fraud settlement
08/20/24 at 03:00 AMHumana will pay $90 million in Medicare drug fraud settlement Bloomberg Law; by Daniel Seiden; 8/16/24 Humana Inc. agreed to pay $90 million to the federal government to settle a whistleblower’s False Claims Act suit alleging that the company submitted fraudulent bids for Medicare Part D prescription drug contracts. Whistleblower Steven Scott alleged that, since 2011, Humana began offering its Medicare Part D prescription drug plan, known as the basic Walmart Plan, and “knowingly provided benefits under that plan that have been significantly less valuable than Humana promised in its bids,” according to Scott’s suit filed in 2016 in the US District Court for the Central District of California. ... This suit was among several in 2016, including suits against Humana, United Health, Cigna Corp., and Optum RX Inc., accusing health insurers of secretly overcharging for prescription drugs.
Hospice care for those with dementia falls far short of meeting people’s needs at the end of life
08/20/24 at 02:00 AMHospice care for those with dementia falls far short of meeting people’s needs at the end of life University of Michigan; by Maria J. Silveira; 8/18/24 ... Strikingly, only 12% of Americans with dementia ever enroll in hospice. Among those who do, one-third are near death. This is in stark contrast to the cancer population: Patients over 60 with cancer enroll in hospice 70% of the time. In my experience caring for dementia patients, the underuse of hospice by dementia patients has more to do with how hospice is structured and paid for in the U.S. than it does patient preference or differences between cancer and dementia. ... In the U.S., ... Medicare’s rules and regulations make it hard for dementia patients to qualify for hospice when they and their families need support the most – long before death. In Canada, where hospice is structured entirely differently, 39% of dementia patients receive hospice care in the last year of life. ...
Stay ahead of Medicare fraudsters ... Watch out for Medicare fraudsters
08/19/24 at 03:00 AMStay ahead of Medicare fraudsters ... Watch out for Medicare fraudsters The Times of Noblesville, Indiana; Information provided by the U.S. Department of HEalth & Human Services 8/16/24 (Family Features) ... Watch Out for Medicare Hospice Fraud: Beware of scammers offering older Americans in-home perks, like free cooking, cleaning and home health services, while they are unknowingly being signed up for hospice services. The scammers then unlawfully bill Medicare for these services in your name. Remember this advice to avoid hospice scams: [practical tips for the public] ... Report Medicare Fraud ...Editor's Note: This information for the public--provided by the U.S. Department of Health & Human Services--provides an important resource for your community outreach, marketing, and admissions employees.
Biden administration says Medicare negotiated price discounts on 10 prescription drugs
08/16/24 at 03:00 AMBiden administration says Medicare negotiated price discounts on 10 prescription drugs USA Today; by Ken Alltucker; 8/15/24 ... The Biden administration announced Thursday that Medicare had negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. The discounts will range from 38% to 79% when the negotiated prices take effect in 2026. The bargaining will save Medicare $6 billion when the price cuts are implemented in two years, according to U.S. Department of Health and Human Services estimates.
Staff education an anchor amid widespread hospice audits
08/16/24 at 03:00 AMStaff education an anchor amid widespread hospice audits Hospice News; by Holly Vossel; 8/14/24 ... More than half of hospice providers reported having multiple types of audits within a six-month span in a survey earlier this year. ... Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE) audits are among the most common types of audits that hospices undergo simultaneously alongside others. ... Staff need a firm understanding around the potential red flags on regulators’ radars and how to avoid common compliance errors in their roles, ... Compliance training should be focused on staff’s overall responsibilities alongside the larger bottom line of quality, she said. ... Notable mentions: Jason Bring, co-chair of post-acute and long-term care at the law firm Arnall Golden Gregory LLP (AGG)l; Megan Turby, vice president of quality and compliance at Gulfside Healthcare Services; Dr. Lisa Barker, chief medical officer at Gulfside Healthcare Services
Cost report prompts tweaks to ACO REACH model
08/15/24 at 03:00 AMCost report prompts tweaks to ACO REACH model Modern Healthcare; by Bridget Early; 8/12/24 The Centers for Medicare and Medicaid Services is making changes to its largest accountable care organization experiment to ensure it’s actually saving money. In a notice published on its website Aug. 1, CMS outlines a slew of planned updates to the ACO Realizing Equity, Access and Community Health, or ACO REACH, model in 2025. Notably, the agency is changing how it establishes benchmarks for "high-needs population" ACOs to guard against overspending while addressing the so-called "ratcheting effect," under which ACOs that contain spending face higher hurdles to earning shared savings in future years because of their past successes. [Limited access due to paywall.]
The tangled web of pediatric palliative care payment and policy
08/15/24 at 03:00 AMThe tangled web of pediatric palliative care payment and policy Hospice News; by Holly Vossel; 8/13/24 A complex web of state regulations and reimbursement systems can challenge pediatric palliative care access for seriously ill children and their families. The nation’s fragmented health care system lacks clear guidance when it comes to navigating chronic, complex conditions in children, adolescents and young adults, according to Jonathan Cottor, CEO and founder of the National Center for Pediatric Palliative Care Homes. Much of the current state palliative regulations and reimbursement pathways focus on adult patient populations, representing a significant barrier to improved quality and support in the pediatric realm, Cottor said.
NAHC President Dombi: There’s ‘good and bad’ to payers entering home health care
08/15/24 at 02:00 AMNAHC President Dombi: There’s ‘good and bad’ to payers entering home health care Home Health Care News; by Joyce Famakinwa; 8/13/24 Before retiring at the end of year, National Association for Home Care & Hospice (NAHC) President William A. Dombi still has items to check off his to-do list. On the top of this list is the previously announced NAHC and National Hospice and Palliative Care Organization (NHPCO) merger. ... Ultimately, Dombi has seen home-based care evolve when he reflects back on his tenure at NAHC. ... [Dombi] sees the evolution of home-based care through large payers, such as Humana Inc. and UnitedHealth Group, investing in the space. “I think you can certainly look at it from a positive perspective, saying, these plans had options to invest in X, Y and Z in health care, and they chose home care and physicians,” he said. “Their forecast says it’s about community-based health care services.” However, he noted the downsides of payers investing heavily in the space, too. ...
CDC releases new profile of assisted living residents
08/14/24 at 03:00 AMCDC releases new profile of assisted living residents McKnights Long-Term Care News; by Kimberly Bonvissuto; 8/10/24 Residents living in assisted living and other residential care communities in 2022 mostly were female (67%), white (92%) and 85 or older (53%), according to a new report from the Centers for Disease Control and Prevention’s National Center for Health Statistics. The CDC said that data from the National Post-acute and Long-term Care Study outlined in the profile of residential care community residents in 2022 would help inform policymakers, providers, researchers and consumer advocates planning to help meet the needs of a rapidly growing older adult population.
Free CHAP Webinar: CMS Posts Final Hospice Rule - Quality changes and regulatory requirement
08/14/24 at 03:00 AMFree CHAP Webinar: CMS Posts Final Hospice Rule - Quality changes and regulatory requirement Community Health Accreditation Partner (CHAP); taught by Dr. Jennifer Kennedy; posted 8/13/24, webinar will be 8/21/24, 1:00-2:00 pm EDTCMS posted the final rule for hospice providers which drives big changes into motion for 2025. [Click here for the] Final FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule (CMS-1810-F), posted on the Federal Register on August 7, 2024. This free webinar will be taught by Jennifer Kennedy, Vice President, Quality, Compliance and Standards, CHAP. She spent many years as a leader and nurse in diverse healthcare settings with the past 25 years in hospice and palliative care. Dr. Kennedy came to CHAP in 2021 with a vision of moving the organization’s quality forward as “the” accreditation partner of choice for the majority of community-based providers. She believes no matter what type of care a patient receives or how many times they receive care, every experience should be of the highest quality. Webinar Objectives:
Heart disease, cancer remain leading causes of death in US
08/14/24 at 03:00 AMHeart disease, cancer remain leading causes of death in US Becker's Hospital Review; by Elizabeth Gregerson; 8/9/24 Heart disease and cancer remained the leading causes of death in 2023, according to provisional data released Aug. 8 by the CDC. Mortality data is collected by the National Center for Health Statistics National Vital Statistics System from U.S. death certificates, according to an analysis published Aug. 8 in JAMA. After a sharp increase in the rate of deaths from heart disease during the pandemic, the 2023 rate (162.1) reportedly was closer to pre-pandemic levels (161.5). The rate of deaths from cancer decreased from 146.2 in 2019 to 141.8 in 2023. Cause of death data is based on the underlying cause of events leading to death. Death rate is recorded as the age adjusted death rate per 100,000 deaths, authors of the JAMA analysis said.
CMS unveils services available to patients in the GUIDE Model, integrates palliative care principles
08/13/24 at 03:00 AMCMS unveils services available to patients in the GUIDE Model, integrates palliative care principles Hospice News; by Jim Parker; 8/12/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has outlined the range of services that will be available to patients aligned with the agency’s Guiding an Improved Dementia Experience (GUIDE) payment model. The payment model is designed to improve quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health and functional needs. While the model does not use the term “palliative care,” it does incorporate principles and practices traditionally associated with those services, such as interdisciplinary care and caregiver support, among others. ... Nearly 400 health care organizations are developing Dementia Care Programs (DCPs) to potentially serve hundreds of thousands of Medicare beneficiaries nationwide, the CMS stated in a fact sheet.
Are there bedbugs and busted equipment at your Florida hospital? What inspectors found
08/13/24 at 03:00 AMAre there bedbugs and busted equipment at your Florida hospital? What inspectors found Miami Herald; by Michelle Marchante; updated 8/12/24 Bed bugs. Broken equipment. Staffing challenges. Fewer patients. And a pile of hazardous waste. These are just some of the problems spotted by patient care ombudsmen during visits to Florida hospitals owned by Steward Health Care System and now up for sale. ... Key takeaways:
Making your Customer Experience [CX] investment strategy work
08/13/24 at 02:00 AMMaking your Customer Experience [CX] investment strategy work CMSWire [not to be confused with CMS=Centers for Medicare & Medicaid Services]; by Jeb Dasteel, Amir Hartman, Brian P. O'Neill and Marc Madigan; 8/12/24 Uncover the key elements of a successful customer experience strategy, from capability planning to aligning with core business objectives. ... Investing in a customer experience strategy is fraught with complications and feelings. Most of us in the world of CX are here because we believe that thoughtful CX spending will make an impact on the performance of our company.Editor's Note: This article is written for a much larger scope than our hospice and palliative readership. However, it highlights the importance of tying "customers' experiences" to the company/organization's core goals and business objectives. The Centers for Medicare & Medicaid Services' CAHPS Hospice Compare Scores [not to be confused with this CMSWire source] reflect the hospice "customer experience," from the perspective of the bereaved caregiver. While the CMS Hospice Compare site sorts these public information scores alphabetically (per location and organization), our newsletter's sponsor Hospice Analytics' National Hospice Locator sorts this same data by the highest scores, for the purpose of helping the public "consumer" find the hospice that will provide them with the best "customer experience."
Value-Based Insurance Design Model: Hospice Benefit Component
08/12/24 at 03:00 AMValue-Based Insurance Design Model: Hospice Benefit ComponentCMS email; 8/9/24Calendar Year (CY) 2024 Technical and Operational Guidance on the Conclusion of the Hospice Benefit Component. The guidance covers CMS’s requirements and expectations for the remainder of the Hospice Benefit Component’s operations through Calendar Year (CY) 2024 along with requirements and expectations for operations on and after January 1, 2025. This document covers the following topics:
Closing the gap in value-based care: Lessons from provider-led ACO experience
08/09/24 at 03:00 AMClosing the gap in value-based care: Lessons from provider-led ACO experienceHealth Affairs; by Clive Fields, Gary M. Jacobs; 8/6/24Achieving the Centers for Medicare and Medicaid Services’ (CMS’s) goal to bring every Medicare patient into a value-based care (VBC) arrangement by 2030 requires bold action. With six years left to achieve that goal (as of January 2024), only half of current Medicare beneficiaries are aligned with an accountable care organization (ACO) providing care within a VBC arrangement. This gap is large, but accelerated participation and reaching the 2030 goal remain possible. To close the gap, policy makers must apply the lessons learned from the real-world experience of models developed by the Center for Medicare and Medicaid Innovation (the Innovation Center), the Medicare Shared Savings Program (MSSP), and other CMS demonstrations. ACOs participating in the MSSP and alternative payment models developed by the Innovation Center have proven that they can deliver high-quality care, improve the patient experience, and generate savings for Medicare. The Congressional Budget Office has found that physician-led ACOs and ACOs with a larger proportion of primary care providers, as opposed to specialists or clinicians in non-primary care settings, generate greater savings.
Enhabit walks away from UnitedHealthcare after ‘9 months of unsuccessful negotiations’
08/09/24 at 03:00 AMEnhabit walks away from UnitedHealthcare after ‘9 months of unsuccessful negotiations’Home Health Care News; by Joyce Famakinwa;8/7/24Staying on course with its payer innovation strategy, Enhabit Inc. (NYSE: EHAB) has decided to walk away from certain Medicare Advantage (MA) payers – and namely UnitedHealth Group’s (NYSE: UNH) UnitedHealthcare. That decision, and the recent home health proposed payment rule, were top of mind for Enhabit leaders on Tuesday.
CMS 2025 Hospice Final Rule: Additional responses
08/07/24 at 03:05 AMCMS 2025 Hospice Final Rule: Additional Responses
Hospice advocate Judi Lund Person ... featured on Close Up Radio
08/07/24 at 02:00 AMHospice advocate Judi Lund Person ... featured on Close Up Radio Western Slope Now, Ashburn, VA; by EIN Presswire; 7/26/24 (article) and 7/29/24 (recording)... Talking about where you’d like to be, who you’d like to be, and what you’d like to do is essential to entering this life-stage with confidence and grace. As the former Vice President of Regulatory and Compliance at the National Hospice and Palliative Care Organization (NHPCO) and a longtime advocate for hospice services under Medicare, Judi Lund Person has been working hard for more than 40 years to protect the definition of hospice care and to provide resources and guides for hospice providers to meet the Medicare requirements and provide high quality hospice care. ... Her passion for supporting patients and families during and after death began as a child. “When I was 12, my dad had a heart attack at night and passed when he was only 42. With two younger sisters, ages eight and ten, I was stunned that no one seemed to know what to do with us concerning our grief as children. We were left to try and figure it out on our own. I always thought that wasn’t quite right. Deep down, that experience was a driver for my career. I always knew families deserved more support during the grieving process,” shares Ms. Person. Editor's Note: Click here for the session's description. Click here for the recording.
Healthcare providers wary CMS dementia pilot will not cover costs
08/06/24 at 03:05 AMHealthcare providers wary CMS dementia pilot will not cover costsModern Healthcare; by Diane Eastabrook;7/23/24Hospitals, primary care practices and other healthcare providers are split over whether Medicare will pay them enough to cover dementia patients at home as part of a new pilot. Nearly 100 providers began enrolling patients July 1 in the Centers for Medicare and Medicaid Services’ Guiding an Improved Dementia Experience model, known as GUIDE. Another 300 others will begin enrolling patients in the program on July 1, 2025. Some participants that previously provided comprehensive wrap-around services for dementia patients at home said getting a monthly care management payment for each fee-for-service beneficiary will cover costs they had been absorbing. But others aren’t sure the reimbursement will be enough to scale up programs or cover the cost of care for these complex patients.
Home health sees spending, utilization decline as hospice equivalents grow, MedPAC reports
08/06/24 at 03:00 AMHome health sees spending, utilization decline as hospice equivalents grow, MedPAC reportsMcKnight's Home Care; by Adam Healy; 7/19/24Though hospice spending and utilization appear to be on the rise, Medicare spending on home health has fallen amid declining utilization in recent years, according to a new report by the Medicare Payment Advisory Commission. In 2022, the year of the most recent available data, Medicare home health spending shrank to $16.4 billion. That compares to $17 billion the year prior, the report found. Meanwhile, the number of home health users declined by 6.3% from 2021, and the overall share of Medicare beneficiaries that use home health shrank by 3% from the year prior. The total number of in-person home health visits decreased by 9.6% year-over-year in 2022... Meanwhile, the hospice industry has experienced both reimbursement and utilization gains in recent years, MedPAC reported. Medicare hospice payments rose 2.7% year-over-year in 2022, while the number of beneficiaries using hospice services ticked up by 0.4%. These patients are also receiving more care; the total number of hospice days provided to beneficiaries increased by 2% in 2022.
Hospice Coalition Questions and Answers: June 20, 2024
08/05/24 at 03:00 AMHospice Coalition Questions and Answers: June 20, 2024Palmetto GBA; 7/15/2024Meeting Q&A and these attachments: Attachment A: Hospice Appeals Report 2024; Attachment B: Hospice CAP Updates.
Help improve the PEPPER Program
08/02/24 at 03:00 AMHelp improve the PEPPER ProgramPEPPER email; 7/30/24There is a temporary pause in distributing Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) as the Centers for Medicare & Medicaid Services (CMS) work to improve and update the program and reporting system. This pause will remain in effect through the fall of 2024. We recognize the importance of these reports to your practice. Therefore, during this time, CMS will be working diligently to enhance the quality and accessibility of the reports. In fulfilling this commitment, CMS seeks responses to a series of questions listed in the Request for Information (RFI). These questions will provide CMS with information that may be used to reevaluate PEPPERs and improve the effectiveness and accessibility of the program. The RFI (PDF) is available here. Responses are due on or before 08/19/2024 and must be provided via online submission at the following address: CBRPEPPERInquiries@cms.hhs.gov.
CMS 2025 Hospice Final Rule: Content and Initial Responses
08/01/24 at 02:00 AM[CMS Fact Sheet] Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule (CMS-1810-F) CMS Fact Sheet - Final Rule (CMS-1810-F); 7/30/24 On July 30, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1810-F) updating Medicare hospice payment rates and the aggregate cap amount, for fiscal year (FY) 2025, in accordance with existing statutory and regulatory requirements. This rule also finalizes the proposal to adopt the most recent Office of Management and Budget (OMB) statistical area delineations, which impacts the hospice wage index and clarifies current policy related to the hospice “election statement” and the “notice of election” (NOE), as well as adds clarifying language regarding hospice admission and certification of terminal illness. The final rule summarizes public comments received related to the request for information regarding implementing a separate payment mechanism to account for high-intensity palliative care services. Editor's Note: Click here for the full Final Rule.
HHS unveils major revamp to shift health data, AI strategy and policy under ONC
07/31/24 at 03:00 AMHHS unveils major revamp to shift health data, AI strategy and policy under ONC Fierce Healthcare; by Emma Beavins; 7/25/24 The Office of the National Coordinator for Health Information Technology (ONC) has been renamed and restructured, the Department of Health and Human Services (HHS) announced [July 25]. The restructuring will affect technology, cybersecurity, data and artificial intelligence strategy and policy functions. The agency will be renamed the Office of the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC). Head of ONC, Micky Tripathi, will hold the new title of assistant secretary for technology policy in addition to his title of national coordinator for health IT. ... Under ASTP, there will be an Office of Policy, an Office of Technology, an Office of Standards, Certification and Analysis and an Office of the Chief Operating Officer.