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All posts tagged with “Regulatory News | Medicare.”
New report blasts nursing home citations, rate of abuse tags
03/21/24 at 03:00 AMNew report blasts nursing home citations, rate of abuse tagsMcKnights Long-Term Care News, by Josh Henreckson; 3/20/24An organization dedicated to helping seniors find care issued a report Tuesday raising alarm about the number of nursing home abuse citations in 2023, but senior care leaders say a more punitive approach to surveys is actually hurting residents and their facilities. The SeniorLiving.org report used last year’s Medicare data to highlight that nursing homes received nearly 95,000 health citations during that time frame. Of that number, nearly 7,700 — or approximately 8% — were citations for abuse, neglect or exploitation.
Medi-Cal Update - Hospice Care Program Bulletin
03/21/24 at 03:00 AMMedi-Cal Update - Hospice Care Program BulletinMedi-Cal, March Bulletin[Topics include:]
CMS.gov: ACO Primary Care Flex Model
03/20/24 at 03:00 AMCMS.gov: ACO Primary Care Flex ModelCMS.gov; 3/19/24The ACO Primary Care Flex Model (ACO PC Flex Model) is a voluntary model that will focus on primary care delivery in the Medicare Shared Savings Program (Shared Savings Program). It will test how prospective payments and increased funding for primary care in Accountable Care Organizations (ACOs) impact health outcomes, quality, and costs of care. The flexible payment design will empower participating ACOs and their primary care providers to use more innovative, team-based, person-centered and proactive approaches to care. The model, which starts January 1, 2025, aims to grow participation in ACOs and the Shared Savings Program and increase the number of people with Medicare in an accountable care relationship.
Personal care workers received most Medicaid fraud convictions in 2023: OIG
03/20/24 at 03:00 AMPersonal care workers received most Medicaid fraud convictions in 2023: OIG McKnights Home Care, by Adam Healy; 3/15/24 More personal care workers were convicted for Medicaid fraud than any other provider type last year, according to a new report released Thursday by the Department of Health and Human Services Office of the Inspector General. OIG found that 279 personal care services (PCS) attendants were convicted of Medicaid fraud in 2023 — far more than the next four highest provider types combined. These convictions amounted to more than $10.5 million in criminal charges.
For-profit nursing home owners rebut report that left few untarnished
03/20/24 at 02:00 AMFor-profit nursing home owners rebut report that left few untarnished McKnights Long-Term Care, by Kimberly Marselas; 3/18/24 A brutal takedown of private nursing home ownership published last week included both pointed and widespread attacks on the role of for-profit companies in the sector, adding to stakeholders’ fears that negative characterizations will stymie much-needed future investment. ... However, what the article failed to highlight, providers and their representatives pointed out to McKnight’s Long-Term Care News Friday, are the investments many for-profits providers are pouring into quality and innovation efforts in a field with historically low margins — margins that they said dried up during the pandemic’s crisis days.Editor's Note: See the original article (posted above this summary) this article rebuts, "For-profit nursing homes are cutting corners on safety and draining resources with financial shenanigans - especially at midsize chains that dodge public scrutiny."
For-profit nursing homes are cutting corners on safety and draining resources with financial shenanigans − especially at midsize chains that dodge public scrutiny
03/20/24 at 02:00 AMFor-profit nursing homes are cutting corners on safety and draining resources with financial shenanigans − especially at midsize chains that dodge public scrutinyThe Conversation, by Sean Campbell and Charlene Harrington; 3/14/24 ... Overall, private-equity investors wreak havoc on nursing homes, slashing registered nurse hours per resident day by 12%, outpacing other for-profit facilities. The aftermath is grim, with a daunting 14% surge in the deficiency score index, a standardized metric for determining issues with facilities, according to a U.S. Department of Health and Human Services report.The human toll comes in death and suffering. A study updated in 2023 by the National Bureau of Economic Research calculated that 22,500 additional deaths over a 12-year span were attributable to private-equity ownership, equating to about 172,400 lost life years. The calculations also showed that private-equity ownership was responsible for a 6.2% reduction in mobility, an 8.5% increase in ulcer development and a 10.5% uptick in pain intensity.
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
Should the DOJ break up UnitedHealth Group?
03/19/24 at 02:00 AMShould the DOJ break up UnitedHealth Group? MedCity News, by Marissa Plescia; 3/17/24 The U.S. Department of Justice has reportedly recently launched an antitrust investigation of UnitedHealth Group, which begs the question of whether the healthcare giant should be broken up. Experts have varying opinions.
MedPAC releases March 2024 report on Medicare payment policy
03/18/24 at 03:00 AMMedPAC releases March 2024 report on Medicare payment policy CMS MedPAC; 3/15/24 Washington, DC, March 15, 2024—Today, the Medicare Payment Advisory Commission (MedPAC) releases its March 2024 Report to the Congress: Medicare Payment Policy. The report presents MedPAC’s recommendations for updating provider payment rates in traditional fee-for-service (FFS) Medicare for 2025 and for providing additional resources to acute care hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes. ... MedPAC recommends ... eliminating the payment update for hospice providers; and payment reductions for three post-acute care sectors (skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities).Click here for this report's "Chapter 9: Hospice Services"
California Leads the State-Level Battle Against Hospice Fraud
03/15/24 at 02:30 AMCalifornia Leads the State-Level Battle Against Hospice Fraud Hospice News, by Jim Parker; 3/13/24As hospice program integrity remains in the spotlight, California remains the only state to take action on curbing the problem. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. California’s Department of Justice (CDOJ) in 2021 issued a report detailing the state’s history of lax oversight.
Medicaid Fraud Control Units Fiscal Year 2023 Annual Report
03/15/24 at 02:00 AMMedicaid Fraud Control Units Fiscal Year 2023 Annual ReportU.S. Department of Health and Human Services, Office of Inspector General; 3/14/2024Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. [This 32 page, downloadable document includes:]
A fond farewell: Musings on the end of the Medicare Advantage Hospice Carve-In Demonstration
03/15/24 at 01:00 AMA fond farewell: Musings on the end of the Medicare Advantage Hospice Carve-In Demonstration Husch Blackwell, podcast with Meg Pekarske and Chris Comeaux; 3/14/24It came as a surprise to our team when we learned that the Centers for Medicare & Medicaid Services (CMS) was ending the hospice component of Value-Based Insurance Design (VBID) on December 31, 2024. Upon learning this, Husch Blackwell’s Meg Pekarske contacted Chris Comeaux, the president and CEO of Teleios Collaborative Network, to see if he wanted to share his thoughts on this unexpected turn of events and what may be on the horizon. This is a forward-looking conversation where we explore how the lessons learned can galvanize new advocacy on the best ways to care for patients with advanced illnesses.
[Updated] Inefficient, unfair audits continue to burden hospices, new survey report finds
03/14/24 at 02:15 AM[Updated] Inefficient, unfair audits continue to burden hospices, new survey report findsMcKnights Home Care, by Adam Healy; 3/12/24Clunky audit processes have long strained hospice providers’ time and money, and though regulators have made some improvements, many agencies still report glaring issues with investigations, according to a new report released Tuesday by four major hospice organizations. ... Many audits have failed to meet their expressed purpose: Reining in noncompliance. ...
Nearly 53% of hospices undergo multiple audits simultaneously
03/14/24 at 02:05 AMNearly 53% of hospices undergo multiple audits simultaneouslyHospice News, by Jim Parker; 3/12/24Program integrity and an onslaught of audits are top of mind for many hospice providers in 2024. The nation’s four largest hospice industry organizations — LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI) — in late 2023 conducted a 133-respondent provider survey focused on regulation. ... About 52.9% reported having multiple audits, each of a different type, within six months of one another, and 31% said they were required to submit the same charts for each of these audits.
CMS Statement on continued action to respond to the cyberattack on change healthcare
03/14/24 at 02:00 AMCMS Statement on continued action to respond to the cyberattack on change healthcareCMS.gov Press Release; 3/9/24 The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers.
CMS hears you, hospice providers
03/14/24 at 02:00 AMCMS hears you, hospice providersMcKnights Home Care, by Liza Berger; 3/8/24 Rarely does the Centers for Medicare & Medicaid Services succeed in shocking us. The large bureaucracy, which is not exactly known for its nimbleness, managed to do so this week when it abruptly cancelled the hospice component of the Value-Based Insurance Design Model. ... For those who wonder whether advocacy works, I’d chalk this up to a win for providers — and a clear example of advocacy in action.
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.
Hospice provider experience underscores urgency of program integrity efforts
03/13/24 at 02:00 AMHospice provider experience underscores urgency of program integrity efforts: Findings reveal current audit process' shortcomings HomeCare News; 3/12/24 Following a series of meetings with the Centers for Medicare & Medicaid Services (CMS) and Members of Congress on efforts to improve and protect hospice program integrity, four national hospice organizations—LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI)—released findings of a hospice provider survey that the organizations say underscores the urgency and need for CMS and Congress to act.
Nursing homes bury 63 percent of profits in related-party tunnels, but not all play the game: study
03/11/24 at 03:00 AMNursing homes bury 63 percent of profits in related-party tunnels, but not all play the game: study McKnights Long-Term Care News, by Josh Henreckson; 3/8/24 As much as 63% of nursing home profits in Illinois were hidden from state regulators using related party transactions in 2019, according to the results of a new study from UCLA and Lehigh University researchers. Those results are likely indicative of a nationwide trend that has continued through the pandemic and into 2024, experts told McKnight’s Long-Term Care News Thursday.
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%.
Medicare Hospice – exploding in size but riddled with quality concerns
03/11/24 at 03:00 AMMedicare Hospice – exploding in size but riddled with quality concerns Penn LDI, by Hoag Levins; 3/8/24 Five top experts on hospice care convened in a virtual discussion of the Medicare Hospice program. This video is the full session.
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.