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All posts tagged with “Regulatory News | Medicare.”
Report of Hospice Election for Part D (Response File)
03/01/24 at 03:00 AMReport of Hospice Election for Part D (Response File) U.S. Dept. of Health & Human Services - Guidance Portal; 2/26/24 The purpose of this Change Request (CR) is to define the response file related to CR 13202. [Click on the title's link and follow prompts to download the Guidance Document.]
CMS finalizes important changes to Medicare enrollment requirements for hospice, home health providers
03/01/24 at 01:00 AMCMS finalizes important changes to Medicare enrollment requirements for hospice, home health providersJDSupra; 2/28/24The US Centers for Medicare & Medicaid Services (CMS) finalized important changes to the Medicare enrollment regulations applicable to hospices and home health agencies (HHAs), including increasing the level of screening that hospice providers are subject to and limiting a Medicare-enrolled hospice’s ability to change majority ownership to once every 36 months.
Value-based care now driving home-based primary care growth, experts say
02/28/24 at 03:00 AMValue-based care now driving home-based primary care growth, experts sayMcKnights Home Care, by Adam Healy; 2/27/24When Independence at Home (IAH), the Centers for Medicare & Medicaid Services’ home-based primary care initiative, concluded at the end of 2023, after more than a decade, it marked the end of an era. Over the period of the model, the rise of value-based care has given providers a wealth of opportunities to bring primary care into patients’ homes.
HCA Mission Hospital regains CMS compliance
02/27/24 at 03:00 AMHCA Mission Hospital regains CMS complianceBecker's Hospital Review, by Mariah Taylor; 2/26/24CMS found Asheville, N.C.-based HCA Mission Hospital in compliance with its plan of correction and recommended removing the immediate jeopardy designation, Blue Ridge Public Radio reported Feb. 23. The hospital's plan of correction to address serious deficiencies it was cited for in January focuses on improving policies and educating staff.
[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says
02/27/24 at 02:00 AM[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says McKnights Product Theater, by Adam Healy; 2/22/24In recent years, unscrupulous hospice providers have cropped up in California and other states. In response, the Centers for Medicare & Medicaid Services has prepared a slew of tools to curtail the fraud. States continue to feel the effects. As an example, a California hospice operator last week was convicted in a Medicare fraud scheme for billing nearly $3 million for services that patients did not need, according to the Department of Justice.
CMS updates Hospice Care Compare
02/27/24 at 02:00 AMCMS updates Hospice Care CompareCMS website; 2/22/24Hospice care dataset updates; updated 2/1/24, released 2/21/24.
MA [Medicare Advantage] may be worth the gamble: How agencies can win at a new game
02/26/24 at 03:00 AMMA may be worth the gamble: How agencies can win at a new game HomeCare, by Lindsay Doak; 2/23/24 Over the past decade, a major shift has occurred in the Medicare market that many of us didn’t see coming: the takeover of Medicare Advantage (MA). ... This is a true game changer for the home health and hospice industry. ... So, how can agencies successfully contract with MA plans, while ensuring their costs are covered? This is where I like to refer to the wise words of Kenny Rogers’ “The Gambler,” who said, “If you’re gonna play the game…You gotta learn to play it right.”
Providers urge CMS to use caution in midst of hospice VBID implementation
02/26/24 at 02:00 AMProviders urge CMS to use caution in midst of hospice VBID implementationMcKnights Home Care, by Adam Healy; 2/23/24With the Medicare Advantage Value-Based Insurance Design (MA VBID) model, which allows MA organizations to participate in the hospice benefit, underway, advocates have voiced concerns that critical safeguards be put in place.
Planning Ahead: Medicare, Medicaid or Hospice for at-home care
02/23/24 at 03:00 AMPlanning Ahead: Medicare, Medicaid or Hospice for at-home careThe Mercury, by Janet Colliton; 2/21/24If you are seeking at-home care assistance for a family member that is paid either in full or in part by the government, you can find that the system is complicated and, unless your loved one fits within one of the designated categories, you may be limited to paying from your family member’s asset or your own. Here are some of the differences and criteria.Editor's Note: This concise, user-friendly article by a Certified Elder Law Attorney provides simple descriptions of this all-important information. What Hospice Medicare information does your staff need to know and use? What clarity do you provide to the public / community you serve?
How CMS’ rule could tighten accrediting organization oversight
02/22/24 at 03:00 AMHow CMS’ rule could tighten accrediting organization oversightModern Healthcare, by Mari Devereaux; 2/20/24Accrediting organizations may have to reduce their fee-based consultation services and prohibit survey participation for employees with ties to health facilities or face penalties for violating conflict-of-interest provisions if the Centers for Medicare and Medicaid Services sticks with recent oversight proposals.Editor's Note: Full access to this article requires a subscription.
Centers for Medicare & Medicaid Services corrects rule involving 2024 home health prospective payment system rate update
02/22/24 at 03:00 AMCenters for Medicare & Medicaid Services corrects rule involving 2024 home health prospective payment system rate updateCMS Federal Register; 2/21/24This document corrects technical errors in the final rule that appeared in the November 13, 2023 Federal Register titled “Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements” (referred to hereafter as the “CY 2024 HH PPS final rule”).
CMS issues additional guidance on program to allow people with Medicare to pay out-of-pocket prescription drug costs in monthly payments
02/19/24 at 02:30 AMCMS issues additional guidance on program to allow people with Medicare to pay out-of-pocket prescription drug costs in monthly paymentsCMS.gov; 2/15/24The Inflation Reduction Act’s Medicare Prescription Payment Plan will allow people to pay Medicare Part D out-of-pocket costs over the course of the year starting in 2025. [On February 15th,] the Centers for Medicare & Medicaid Services (CMS) released the second part of draft guidance for the Medicare Prescription Payment Plan that outlines requirements for Medicare Part D plan sponsors, including outreach and education requirements, pharmacy processes, and operational considerations, for the program’s first year, 2025.
Medicare program; strengthening oversight of Accrediting Organizations (AOs) and preventing AO Conflict of Interest, and related provisions
02/19/24 at 02:00 AMMedicare 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.
United States: Buying or selling a hospice? The 36-month rule prohibiting change of ownership now applies
02/16/24 at 03:00 AMUnited States: Buying or selling a hospice? The 36-month rule prohibiting change of ownership now appliesGreenbergTraurig, by Sonya C. Penley and Christopher E. Gottfried; 2/15/24Effective Jan. 1, 2024, the Centers for Medicare and Medicaid Services (CMS) extended the so-called "36-month rule" to hospices, prohibiting a change in majority ownership of a hospice, as well as the transfer of a Medicare provider agreement and Medicare billing privileges, in the 36 months after Medicare enrollment or a prior change of majority ownership. The 36-month rule previously only applied to home health agencies.
Experts see for-profit firms, rural areas as drivers of future PACE growth
02/16/24 at 03:00 AMExperts see for-profit firms, rural areas as drivers of future PACE growthMcKnights Home Care, by Adam Healy; 2/14/24InnovAge, the only publicly traded Program of All-Inclusive Care for the Elderly company, revealed last week that it continues to grapple with regulatory challenges. But its stumbling blocks of late are not curbing interest in PACE. The program — funded by Medicare and Medicaid — has continued to grow in recent years, leading states to explore new and innovative ways to bring PACE to a greater share of residents.
Private equity Medicare Advantage investment slumps: report
02/15/24 at 03:00 AMPrivate equity Medicare Advantage investment slumps: reportModern Healthcare, by Nona Tepper; 2/13/24Private equity investment in Medicare Advantage has declined in recent years amid rising interest rates and an unfavorable regulatory environment, according to a report the Private Equity Stakeholder Project published Tuesday.
NHPCO celebrates achievements of hospice and palliative care providers in nationwide Quality Connections Program
02/15/24 at 01:30 AMNHPCO celebrates achievements of hospice and palliative care providers in nationwide Quality Connections Program NHPCO press release; 2/13/24The National Hospice and Palliative Care Organization (NHPCO) recognizes the achievements of participating member organizations who have earned rings in the third program year of NHPCO’s Quality Connections program. First launched in January 2021, Quality Connections (QC) is the only national program designed to support hospice and palliative care provider delivery of high-quality, person-centered care. The program is structured around four fundamental pillars which are represented by four rings: Education, Application, Measurement, and Innovation.
Medicare Advantage provider, benefit cuts may follow rate reduction
02/13/24 at 03:00 AMMedicare 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 publishes Hospice Item Set Manual changes
02/13/24 at 03:00 AMCMS publishes Hospice Item Set Manual changesMcKnights Home Care, by Adam Healy; 2/12/24Changes went into effect 1/31/24. Table includes Chapter and/or Section in V3.01 of HIS Manual; Page # in V3.01 of HIS Manual; Revision; Explanation
Aetna forecasts higher Medicare Advantage costs
02/13/24 at 03:00 AMAetna forecasts higher Medicare Advantage costsModern Healthcare, by Lauren Berryman; 2/7/24CVS Health has downgraded its 2024 earnings guidance as its Aetna health insurance subsidiary contends with higher-than-expected Medicare Advantage costs and a looming federal rate cut, the company announced Wednesday.
Molina joins chorus reporting Medicare Advantage challenges
02/12/24 at 03:10 AMMolina joins chorus reporting Medicare Advantage challengesModern Healthcare, by Nona Tepper; 2/8/24
Medicare threatens to pull funding from HCA’s embattled Mission Hospital
02/09/24 at 04:00 AMMedicare 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.
Palliative care reimbursement, innovation and reform
02/09/24 at 03:00 AMPalliative care reimbursement, innovation and reformJD Supra - American Health Law Association, by Edo Banach; 2/7/24Sections include:
Concurrent Medicare hospice & curative care improves quality & reduces costs 13%
02/09/24 at 03:00 AMConcurrent 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.
Part 2, Latest updates from CMS Office of Minority Health: Advancing health equity in rural, tribal, and geographically isolated communities FY2023 year in review
02/09/24 at 03:00 AMPart 2, Latest updates from CMS Office of Minority Health: Advancing health equity in rural, tribal, and geographically isolated communities FY2023 year in review