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All posts tagged with “Regulatory News | Medicare.”
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.
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 [On February 15th,] the Centers for Medicare & Medicaid Services (CMS) released the second part of draft guidance for the Medicare Prescription Payment Plan that outlines requirements for Medicare Part D plan sponsors, including outreach and education requirements,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.
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
Hospices & skilled nursing facilities: Report all managing employees
02/09/24 at 03:00 AMHospices & Skilled Nursing Facilities: Report All Managing EmployeesCMS: mlnconnects; 2/8/24CMS recently clarified that hospice and skilled nursing facility medical directors and administrators are always considered managing employees for Medicare provider enrollment purposes. You must report all current managing employees. If you haven’t reported a medical director or administrator, report them now. See the Medicare Program Integrity Manual: CY 2024 Home Health Prospective Payment System Updates (PDF) MLN Matters Article for more information.
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:
Medicare Advantage in the headlines: 9 recent updates
02/09/24 at 02:30 AMMedicare Advantage in the headlines: 9 recent updatesBecker's Payer Issues, by Rylee Wilson; 1/30/24Challenges loom for Medicare Advantage in 2024, with payers reporting rising medical costs and lower growth expectations for the year. [Click on the title's link for] nine Medicare Advantage updates Becker's has reported since Jan. 22.
Part 1, Latest updates from CMS Office of Minority Health: Rural-urban disparities in health care in Medicare
02/09/24 at 02:00 AMEnhancing rural and geographic health equity: Latest updates from CMS OMHCMS Office of Minority Health (CMS OMH); released 2/7/24
Government warns Medicare Advantage insurers not to deny care based on AI
02/09/24 at 02:00 AMGovernment 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 say
02/07/24 at 04:00 AMPatient-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.
Medicare Advantage profitability on the decline, Moody's finds
02/06/24 at 04:00 AMMedicare Advantage profitability on the decline, Moody's findsHealthcare Finance, by Jeff Lagasse; 2/2/24A significant spike in utilization is putting cost pressure on insureres, which will likely affect earnings. While Medicare Advantage remains attractive to the healthcare industry due to strong growth, high revenue and earnings per member, profitability is on the decline, according to a new analysis by Moody's Investor Service.
'A monumental shift': Home health providers believe review choice demonstration is here to stay
02/05/24 at 04:00 AMReview 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.
Cancer facts & figures 2024
02/05/24 at 04:00 AMCancer facts & figures 2024American Cancer Society; 2024Cancer Facts & Figures 2024 is an educational companion for Cancer Statistics 2024, a scientific paper published in the American Cancer Society journal, CA: A Cancer Journal for Clinicians. These annual reports provide:
Lee County belt tightening means a reduction in hospice care
02/05/24 at 04:00 AMLee 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.
Facing the future: Home health providers gear up for 2024’s value-based care, M&A landscapes
02/05/24 at 03:30 AMFacing the future: Home health providers gear up for 2024’s value-based care, M&A landscapesHome Health Care, by Andrew Donlan; 2/1/24Home-based care providers have faced many headwinds over the past few years. They’ll continue to do so in 2024. But uncertainty has also plagued providers, and there may be less of that this year. Providers know the threat of fee-for-service Medicare cuts. They know Medicare Advantage (MA) penetration is an unstoppable force. They know staffing woes will be a mainstay, even if the labor market nominally improves.