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All posts tagged with “Regulatory News | Medicare.”
Returning to the community: Health care after incarceration: A guide for health care reentry
06/10/24 at 03:00 AMReturning to the community: Health care after incarceration: A guide for health care reentryCMS; 6/6/24This joint publication by CMS and the U.S. Department of Justice Office of Justice Programs helps people recently released from incarceration take charge of their health, connect to health services, and find additional resources. It is available in Spanish on the Access Care webpage and more languages are coming soon.
SCAN wins Medicare Advantage star ratings lawsuit against CMS
06/06/24 at 03:00 AMSCAN wins Medicare Advantage star ratings lawsuit against CMSModern Healthcare; by Nona Tepper; 6/4/24SCAN Health Plan has prevailed in a widely watched federal lawsuit brought last year against the Centers for Medicare and Medicaid Services that alleged regulators did not appropriately calculate the insurer's Medicare Advantage star rating. The decision could have industrywide implications for the star ratings program if regulators decide to recalculate all carriers’ star scores for the 2024 plan year. The ruling could also affect several pending cases filed by other insurers against CMS. It also could be appealed.
3 keys to hospice oversight preparation
06/06/24 at 03:00 AM3 keys to hospice oversight preparation Hospice News; by Jack Silverstein; 6/4/24 When hospice providers are being investigated not just by CMS but the FBI, the stakes for compliance are higher than ever. In May of 2024, the federal law enforcement agency placed its spotlight on the rising number of complaints about hospice fraud, in which hospices participate in signing up seniors for care without the seniors’ knowledge. Integrity concerns are in four states: Arizona, California, Nevada and Texas. The mechanics vary but the end result is the same: hospices getting paid for services they either did not provide, provided at a substandard level or had no authority to provide at all. ...
Hospice groups to CMS: Don’t rush CAHPS changes
06/06/24 at 03:00 AMHospice groups to CMS: Don’t rush CAHPS changes Hospice News; by Jim Parker; 6/3/24Hospice industry organizations have voiced support for proposed updates to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, but raised questions on the implementation timeline. ... One key concern about the timeline is the need for vendors to develop updated electronic medical record (EMR) systems as well as methods of collecting the data, according to Katy Barnett, director of home care and hospice operations for LeadingAge. ... The proposed changes include:
Reap what you sow
06/05/24 at 03:15 AMReap what you sowFraud of the Day; by Larry Benson; 6/4/24Newly released Federal Trade Commission data show that consumers reported losing more than $10 billion to fraud in 2023, marking the first time that fraud losses have reached that benchmark. This marks a 14% increase over reported losses in 2022. The short of this report is that there is more opportunity in fraud than ever before. And fraudsters don’t care who they are scheming from. Including the dying. Shiva Akula owned and oversaw the day-to-day operations of Canon Healthcare, LLC, a hospice facility with offices in Louisiana and Mississippi. ... Between January 2013 and December 2019, Akula billed Medicare approximately $84 million in fraudulent claims. He was paid approximately $42 million relating to these fraudulent claims. And leaving the dying to just do that. Die without the extra care he profited from. ... [Akula was sentenced to serve 20 years in prison and to repay $42 million in fraudulent Medicare billing claims.]
Hospice Certifying Physician edit in effect
06/05/24 at 03:00 AMHospice Certifying Physician edit in effectAAPC - American Academy of Professional Coders; by Rebecca Johnson; 6/3/24 The Centers for Medicare & Medicaid Services (CMS) and its Home Health and Hospice (HHH) Medicare Administrative Contractors (MACs) are all systems go for the new — and potentially troublesome — claims system edit. The edit went into effect June 3. ... In the 2024 Hospice Payment Rate Update final rule, CMS adopted a requirement that two categories of physicians must be enrolled in or validly opted out of Medicare for hospice services to be paid: the hospice medical director or the physician member of the hospice interdisciplinary group; and the attending physician that certifies the patient for hospice. CMS did at least grant hospices’ requests for an implementation delay at that time, moving the deadline from the proposed Oct. 1, 2023, to May 1, 2024. Then, on the eve of that start date, CMS bumped the edit for one more month. ...
LeadingAge: CMS on right track with high-acuity hospice RFI
06/05/24 at 03:00 AMLeadingAge: CMS on right track with high-acuity hospice RFIHospice News; by Jim Parker; 5/31/24 The senior care advocacy group LeadingAge has praised the U.S. Centers for Medicare & Medicaid Services (CMS) inquiries into high-acuity palliative care, but expressed concern over reimbursement and staffing issues. The agency’s 2025 proposed hospice rule featured a series of requests for information (RFI) on issues like health equity, social determinants of health and future quality measures. The RFIs contain further questions about the utilization of higher-cost palliative treatments under the Medicare Hospice Benefit. The agency posed similar queries in its proposed rule for 2024. The new proposal seeks greater clarity on the financial risks and costs that providers say represent barriers to providing those services, such as palliative chemotherapy, radiation blood transfusions or dialysis, among others.
NHPCO: CMS did not account for full burden of implementing HOPE Tool
06/03/24 at 03:00 AMNHPCO: CMS did not account for full burden of implementing HOPE Tool Hospice News; by Jim Parker; 5/29/24 The U.S. Centers for Medicare & Medicaid Services (CMS) may not have accounted for the financial and administrative burdens associated with its implementation of the Hospice Outcomes and Patient Evaluation (HOPE) Tool. In comments on the 2025 proposed hospice rule, the National Hospice and Palliative Care Organization (NHPCO) voiced concerns that the agency’s regulatory impact assessment may not have taken all the details into account, including the need for staffing and technology investments. “Clinical and administrative cost calculations do not align with the reality of the true costs of implementation,” NHPCO indicated in a letter to CMS. “In the proposed rule, CMS significantly underestimated the burden and costs hospices will incur to comply with HOPE requirements. The agency’s estimated cost burden of approximately $185 million across all hospices fails to account for several important factors.”
To guard themselves from sanctions, home health agencies need to invest in QAPI programs, NAHC experts say
05/30/24 at 03:00 AMTo guard themselves from sanctions, home health agencies need to invest in QAPI programs, NAHC experts say McKnights Home Care; by Adam Healy; 5/22/24 To protect themselves against the Centers for Medicare & Medicaid Services’ compliance enforcement mechanisms, home care providers must focus on quality assessment and performance improvement (QAPI) programs, experts at the National Association for Home Care & Hospice said during a webinar. ... Earlier this month, the Centers for Medicare & Medicaid Services released updates to its enforcement remedies and alternative sanctions for home health and hospice agencies. These remedies and sanctions may be imposed in lieu of termination for providers with condition-level deficiencies. They include civil money penalties, payment suspensions, temporarily-appointed management, directed plans of correction or in-service training.
Hospice CAHPS scores updated 5/22/24
05/30/24 at 02:00 AMHospice CAHPS scores updated 5/22/24CMS CAHPS® website; multiple updates posted 5/22/24 CMS has posted numerous CAHPS® Hospice Survey updates. Click on the title's link to access the CMS site. Click on "Care Compare Reporting Updates" or the following 5/22/24 updates:
Health equity: Insights on the CMS Framework and Leadership in Healthcare
05/27/24 at 03:00 AMHealth equity: Insights on the CMS Framework and Leadership in HealthcareCHAP Podcast; by CHAP and Marisette Hassan; 5/23/24As a nurse, witnessing the pervasive disparities in healthcare access was a profound wake-up call. Our conversation with Marisette Hassan takes us on a journey through the challenges and aspirations of achieving health equity, a mission that has never been more critical than in the shadow of the COVID-19 pandemic. When systems fail to serve everyone equally, the consequences are dire, and our discussion underlines the urgency of this issue. With Marisette's insights on the CMS health equity framework, we unpack the layers of this complex issue, from the importance of data collection to the necessity of culturally tailored services.
Medicare Advantage will 'sink' rural hospitals, experts warn
05/16/24 at 03:00 AMMedicare Advantage will 'sink' rural hospitals, experts warn Modern Healthcare; by Michael Mcauliff; 5/14/24Studies by Chartis [Center for Rural Heaalth] and others paint the bleak picture for rural hospitals. According to a recent estimate by the nonprofit Center for Healthcare Quality and Payment Reform, about 700 rural hospitals are at risk of closing. A recent Chartis report estimated 167 rural hospitals have closed since 2010, with another 418 vulnerable to closure now. [Click on the title's link for patient care examples and more stats.]
Humana, Aetna likely to lose Medicare Advantage members
05/16/24 at 03:00 AMHumana, Aetna likely to lose Medicare Advantage members Modern Healthcare; by Nona Tepper and Lauren Berryman; 5/14/24 Industry heavyweights CVS Health Aetna and Humana foresee Medicare Advantage membership losses next year. Anticipated changes to health plan offerings and benefit design to achieve long-term business profitability could mean losing a significant portion of their Medicare Advantage membership, executives told investors at the Bank of America Securities Healthcare Conference on Tuesday. ... Headed into next year, Aetna may adjust benefits, tighten its prior authorization policies, reassess its provider networks and exit markets, CVS Health Chief Financial Officer Tom Cowhey told investors. ... [Humana Chief Financial Officer Susan Diamond] anticipates losing about 5% of its 6.1 million Medicare Advantage members, ... Conversely, UnitedHealth Group’s UnitedHealthcare insurance business appears to be better positioned for growth heading into 2025 ... , executives said. UnitedHealth Group CEO Andrew Witty said, ... “The thing we don't want is unsustainable ups and downs in our performance in any particular regard. ... You should just expect more of the same from us in terms of what we’re doing.”
NAHC advocacy scores wins in Congress
05/15/24 at 03:00 AMNAHC advocacy scores wins in CongressNAHC Newsroom; Press Release; 5/10/24Tireless advocacy by the National Association for Home Care & Hospice (NAHC) and our partners at the National Hospice and Palliative Care Organization, has resulted in the approval of the Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261) through the Ways & Means Committee of the U.S. House of Representatives. While the committee advanced the legislation, it will still need to be passed by the full House of Representatives and the Senate as well. This first step was crucial to get the bill on the pathway to its ultimate enactment into law. This legislation provides:
Nurse practitioners improve skilled nursing's dementia care outcomes, but regulatory barriers remain: study
05/15/24 at 03:00 AMNurse practitioners improve skilled nursing's dementia care outcomes, but regulatory barriers remain: studyMcKnights Long-Term Care News; by Josh Henreckson; 5/13/24[Nurse pracitioners'] NPs’ involvement can significantly improve end-of-life care outcomes for residents with Alzheimer’s disease and related dementias (ADRD), according to the results of a new study in JAMA Health Forum. ... Those benefits, however, were shrunk by state regulations on the scope of care NPs are allowed to provide. ... Elizabeth White, PhD, assistant professor of health services, policy and practice at Brown University [describes,] “For example, when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.” Editor's Note: We posted this JAMA Health Forum article on : Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia.
Hospice remains underserved by Medicare Advantage, data shows
05/15/24 at 03:00 AMHospice remains underserved by Medicare Advantage, data showsBioMedWire; 5/13/24 While the Medicare Advantage space grows bigger, it is difficult for regulators and the medical industry to decide how best to integrate hospice into MA programs. This is a major concern because hospice care is the only segment of the healthcare sector that isn’t catered for in Medicare Advantage (MA). ... Almost 50% of all individuals (1.7 million) on MA programs that succumbed to their terminal illnesses in 2022 were recipients of hospice services. ...
New DOJ task force to tackle competition-related concerns in healthcare
05/14/24 at 03:00 AMNew DOJ task force to tackle competition-related concerns in healthcare McKnights Senior Living; by Kathleen Steele Gaivin; 5/13/24 The Justice Department said its Antitrust Division’s new Task Force on Health Care Monopolies and Collusion will consider “widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, healthcare IT services, access to and misuse of healthcare data and more.” The group’s mandate is to facilitate policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.
Treasury extends Medicare insolvency date, citing savings from home health
05/14/24 at 03:00 AMTreasury extends Medicare insolvency date, citing savings from home health McKnights Home Care; by Adam Healy; 5/13/24 Medicare insolvency received a five-year extension — and part of the reprieve can be attributed to the cost of home health. Myriad factors, including job growth and low unemployment rate, contributed to the extension. The projections were also partly influenced by home health spending which has been “significantly lower than estimated prior to the pandemic,” according to the Social Security and Medicare Trustees report. “As a result of the recent home health staffing shortages, the trustees continue to consider the spending level for this service to be suppressed,” they said in the report. “Thus, they have increased their home health spending growth factor by 2.9 percentage points in each of the next 3 years.”
Planning ahead: How Medicare services at home differ from at-home Medicaid
05/13/24 at 03:00 AMPlanning ahead: How Medicare services at home differ from at-home Medicaid The Mercury; by Janet Colliton; 5/10/24 When asked how they would like to receive long-term care services many consumers, probably most, indicate they would like to receive them at home. Expectations for extensive help at home with government support often exceed what is available and this, considering shortages in available health care workers and limited funding is likely to continue. However, knowing the differences between what is offered under Medicare versus Medicaid is extremely helpful. ... [Click on the title's link for practical, user-friendly descriptions of Medicare versus Medicaid at home, for short term rehab, hospice, and more.]
Hospice Certifying Physician Medicare Enrollment Information
05/09/24 at 03:00 AMHospice Certifying Physician Medicare Enrollment InformationPalmetto GBA email; 5/6/24Pursuant to our authority under section 6405 of the Affordable Care Act, and as part of CMS' larger strategy to address hospice program integrity and quality of care, certifying physicians, including hospice physicians and hospice attending physicians, must be enrolled in or opted-out of Medicare for the hospice service to be paid. Effective June 3, 2024, (delayed from May 1, 2024) CMS will begin implementing edits to enforce this new rule and will deny hospice claims if the physician entered in the Attending field on the claim is not in the Provider Enrollment Chain and Ownership System (PECOS) as an enrolled or opted-out physician.
Health Equity Data Definitions, Standards, and Stratification: New resource available
05/09/24 at 03:00 AMHealth Equity Data Definitions, Standards, and Stratification: New resource available Centers for Medicare and Medicaid Services; by CMS; May 2024Resource of health equity-related data definitions, standards, and stratification practices ... This document serves as a technical resource that can be used by organizations and entities, such as providers, states, community organizations, and others, that wish to harmonize with CMS when collecting, stratifying, and/or analyzing health equity-related data. It may also clarify differences in results that may arise when different data standards and definitions are used. This document includes suggested definitions, standards, and stratification practices for the following sociodemographic elements:
Fraudulent hospice providers may be moving between states
05/09/24 at 03:00 AMFraudulent hospice providers may be moving between states Hospice News; by Jim Parker; 5/7/24Fraudulent hospices continue to proliferate, and some may be moving between states to escape regulators. 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. Thus far, California is the only state to take action on the issue, including a moratorium on hospice licensing. The U.S. Centers for Medicare & Medicaid Services has also taken steps to bolster program integrity.
Star ratings of Leapfrog's 25 straight-'A' and 'F' hospitals
05/08/24 at 03:00 AMStar ratings of Leapfrog's 25 straight-'A' and 'F' hospitals Becker's Hospital Review; by Mackenzie Bean; updated 5/3/24 A comparison of data from CMS and The Leapfrog Group suggests that a hospital's strong performance in one national quality rating system does not necessarily mean it will be a top performer in another. Leapfrog updated its spring safety grades May 1, recognizing 15 hospitals that have received an "A" grade in every consecutive update since 2012. Of these hospitals, only eight received a five-star rating from CMS. Similar discrepancies are seen across Leapfrog's "F" hospitals. While two did receive one star — the lowest possible rating — another five received two stars, and one hospital earned four stars. [Click on the title's link for the list.]
Medicare program suddenly ending leaves seniors in limbo
05/08/24 at 03:00 AMMedicare program suddenly ending leaves seniors in limbo Newsweek; by Suzanne Blake; 5/6/24 Some hospice patients on Medicare Advantage are now facing uncertainty after the government ended a pilot program. Medicare Advantage is one of the top programs for seniors looking for health insurance, and more than 50 percent of those eligible now use the privatized Medicare Advantage option instead of just traditional Medicare. ... According to the Medicare Payment Advisory Commission, around half of 1.7 million Medicare Advantage recipients who died in 2022 were in hospice for end of life care.
TCN News Stories of the Month, April 2024
05/08/24 at 02:00 AMTCN News Stories of the Month, April 2024TCN Talks; by Chris Comeaux; 5/1/24In this week’s podcast Mark Cohen joins once more for the Top News Stories for the prior month. This is a new format as Mark has retired from publishing the Hospice News Today as he has transitioned it to Cordt Kassner and the daily publication has been rebranded as Hospice and Palliative Care Today. You can subscribe for free here: https://www.hospicepalliativecaretoday.com.