Literature Review

Medicare 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 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. 

MedPAC 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"

Medicaid 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:]

[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. ...

CMS 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. 

Healthcare 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. 

CMS reportsCMS email; 3/8/24

The 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%. 

Frontline 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.

House-passed funding bill makes Medicare hospice benefit a ‘piggybank,’ provider groups argue McKnights Home Care, by Adam Healy; 3/7/24 To keep the government open in fiscal year 2024, hospice partially may be bankrolling it — and providers are not pleased about this prospect. The House late Wednesday passed a newly released appropriations bill that includes an extension of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). This act which would effectively allow the Medicare hospice benefit to act as a pay-for for nonhospice legislative priorities. 

CMS offers relief to providers affected by Change Healthcare outageModern Healthcare, by Lauren Berryman; 3/5/24The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.Editor's Note: Access to the full article requires a subscription

Hospices welcome VBID’s demise, but questions remainHospice News, by Jim Parker; 3/5/24Citing “operational challenges,” the U.S. Centers for Medicare & Medicaid Services (CMS) announced [Monday] that it would bring to a close the hospice component of the value-based insurance design (VBID) demonstration, effective Dec. 31. ... Hospice News spoke with leaders of hospice organizations, industry groups and other stakeholders to gauge providers’ perceptions of the CMS decision.