Literature Review

CMS 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

Medicare 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.

Medicare 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.

Part 2, Latest updates from CMS Office of Minority Health: Advancing health equity in rural, tribal, and geographically isolated communities FY2023 year in review

Palliative care reimbursement, innovation and reformJD Supra - American Health Law Association, by Edo Banach; 2/7/24Sections include:

Government warns Medicare Advantage insurers not to deny care based on AI STAT, by Casey Ross and Bob Herman; 2/7/24In recent months, the federal government has repeatedly told Medicare Advantage insurers that they cannot use artificial intelligence or algorithms to deny medical services the government routinely covers. But in finalizing a rule to that effect, it also stepped into a thicket of questions from insurers about a technology that is especially difficult to pin down: What is AI? Can it be used at all to make decisions about the coverage of older patients? If so, how?

Patient-centered focus is key to reducing hospitalizations, value-based success, experts sayMcKnights Home Care, by Adam Healy; 2/6/24To keep hospitalization rates low — and thereby produce better results within the Home Health Value-Based Purchasing (HHVBP) model — providers need a good understanding of patients’ goals to tailor care to meet their unique wants and needs. ... Keeping these goals at the forefront of care can reduce their chances of being hospitalized, according to Cindy Campbell, senior director of advisory services at healthcare technology firm WellSky. But defining patients’ goals is not just a recommendation, she noted: It’s mandated by the Centers for Medicare & Medicaid Services.

Review choice demonstration is here to stayHome Health Care News, by Patrick Filbin; 2/1/24The Centers for Medicare & Medicaid Services (CMS) has been tight-lipped about its Review Choice Demonstration (RCD) plans beyond May 2024. However, industry leaders believe RCD will be extended across the country on a more permanent basis — a development that agency leaders should recognize as a momentum shifting change. “We’re seeing a monumental shift in home health care and how we actually operate,” Kim Gaffey, founder and CEO of Gaffey Home Nursing and Hospice, said during a webinar Thursday. 

Lee County belt tightening means a reduction in hospice careWIUM Trstates Public Radio, by Will Buss; 2/1/24Lee County Supervisors are looking for ways to reduce spending. As a result, the health department is scaling back the level of hospice care it provides terminally ill residents. Administrator Michele Ross said the department has pushed to retain hospice service but will refer more residents to private providers.

What home health providers need to know about CMS’ Medicare enrollment changesHome Health Care News, by Patrick Filbin; 1/31/24The Medicare enrollment process undergoes annual changes at the Centers for Medicare & Medicaid Services (CMS) to ensure it remains up to date with evolving regulations, policies and health care practices. A number of changes went into effect on Jan. 1, and several of them will affect home health agencies. Here’s what home health agencies should know about those changes.

Centers for Medicare & Medicaid Services issues rule: Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System rate update; HH Quality Reporting Program requirements; HH ...Department of Health and Human Services, by Centers for Medicare & Medicaid Services; 1/31/24SUMMARY: This 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"). Effective date: This correcting document is effective January 31, 2024

Video raises concerns about a father’s final days in senior care homeThe Atlanta-Journal Constitution Online, by Allie Gross; 1/30/24A 78-year-old veteran's final days at a Georgia senior care home, Savannah Court of Lake Oconee, raise troubling questions about care at the facility and the state's oversight. The new concerns come as the facility faces possible closure with a second license revocation hearing scheduled for Jan. 30, 2024.