Literature Review

Alzheimer’s disease and dementia care: 5 Medicare benefits consumers should know Globe Newswire, KELOLAND Media Group; by medicareresources.org; 6/19/24 With the Food and Drug Administration’s approval of new medications like Leqembi, there’s increased focus on ways Medicare can help alleviate the significant costs of Alzheimer’s and dementia care. ... “Alzheimer’s disease and other forms of dementia can come with a heavy financial burden as well as an emotional toll, which is why it’s critical patients and families understand when and how Medicare can help mitigate costs,” said Louise Norris, a health policy analyst for medicareresources.org. “People may be surprised, especially about new coverage of diagnostic tests and medications." ... Here are five critical benefits medicareresources.org says consumers might not know about:

Compliance landmines in the hospice regulatory landscape Hospice News; by Holly Vossel; 6/14/24 Hospice providers are navigating a minefield in today’s regulatory environment to avoid getting caught up in the mix of fraudulent activity in the space. The current state of hospice regulations has providers walking compliance tightropes, according to Patrick Harrison, senior director of regulatory and compliance at the National Hospice and Palliative Care Organization (NHPCO). Fraud, waste and abuse exist in several different industries and health care is no exception. But the majority of hospices are striving to provide quality end-of-life experiences to terminally ill patients and their families, Harrison said at the Hospice News Elevate conference in Washington D.C. 

Red River Valley expands services for dual-eligible populationsHospice News; by Holly Vossel; 6/11/24North Dakota-based Hospice of the Red River Valley is focused on expanding its home- and community-based services among dual-eligible Medicare and Medicaid populations in need of greater support. Serious and terminally ill patients in lower socioeconomic and underserved regions face several competing challenges in accessing health care, according to Tracee Capron, executive director at Hospice of the Red River Valley. Developing a sustainable care delivery model that better addresses unmet needs among patients and their families requires significant investment, Capron said. 

To 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 of the Red River Valley awarded $2 million grantNewsDakota; by Steve Urness; 5/25/24The North Dakota Department of Health and Human Services, Medical Services Division, has awarded a substantial grant of up to $2 million to Hospice of the Red River Valley. This grant is designated for the expansion of home and community-based services to Medicaid members residing in under served regions of North Dakota.

CMS extends Medicaid waivers to 2025 Becker's Payer Issues; by Rylee Wilson; 5/13/24 CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. The waivers, previously set to expire at the end of 2024, will be extended for six more months, Daniel Tsai, deputy CMS administrator and director of the Center for Medicaid and CHIP services, wrote in a May 9 memo to states. Nearly all states were expected to complete the unwinding process by June 2024, Mr. Tsai wrote, but because several states took extension waivers from CMS, several states will continue renewals past June. 

New 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.

Health 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:

Medicaid disenrollments higher than expected: Report Becker's Payer Issues; by Rylee Wilson; 5/2/24 The number of people disenrolled from Medicaid through the redeterminations process has surpassed original estimates from the Urban Institute and Robert Wood Johnson Foundation. According to a May 2 report, as of November 2023, nearly 9 million people had been disenrolled from Medicaid. The figure came out to 60.5% of the foundation's original estimate of 14.8 million people losing coverage, with several months remaining in the redetermination process. 

Star 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.]

CMS: Advance health equity during National AANHPI Heritage Month CMS.gov; email 5/2/24 During May, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Heritage Month by highlighting disparities for Asian Americans, Native Hawaiians, and Pacific Islanders. These communities account for more than 7% of the U.S. population and have the fastest population growth rate among all racial and ethnic groups, having almost doubled since 2000. Between 2017 and 2019, the number of Asian Americans enrolled in Medicare grew by 11%, which was the highest percentage increase in enrollment compared to White, Black, and Hispanic enrollees. ... [Read for more descriptions, data and resources.]

What Hospice VBID’s ending means for palliative care Hospice News; by Markisan Naso; 5/1/24 The impending demise of the hospice component of U.S. Centers for Medicare & Medicaid Services’ value-based insurance design (VBID) model has largely been met with a sense of relief by providers as they plan new initiatives for palliative care in 2025. ... The program, which initially contained promising components designed to give patients better access to palliative care, instead became an increasing source of frustration for organizations. ... With the end date for the hospice component of the VBID model approaching, many palliative care providers are left with concern for their patients and questions about the coming transition, as they shift focus to what happens next.  Editor's Note: This article includes perspectives from Rory Farrand, Vice President of Palliative and Advanced Medicine at NHPCO, and Mollie Gurian, Vice President of Home-Based and HCBS Policy at LeadingAge.

Judi Lund Person: UnleashedTCN Talks; by Chris Comeaux; 4/18/24Judi Lund Person, former vice president of regulatory and compliance at NHPCO, shares her journey into the hospice industry and her passion for ensuring patients and families receive the care they need and want. Judi emphasizes the importance of addressing bad hospice care and uncovering fraud and abuse in the industry.  She discusses the proposed changes in the 2025 Hospice Wage Index and Payment Conditions; ... the HOPE tool and the revised hospice survey;  ... the sunset of the VBID demonstration; and the need to focus on accountable care organizations and quality reporting. This is a great listen for staff, leaders, and boards of hospice and palliative care organizations. Here’s a great quote from the discussion: “You never know when something you do or somebody you talk to changes the course of your life."