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All posts tagged with “Regulatory News | Medicaid.”
2023’s Most Impactful Hospice Regulatory Moves
12/14/23 at 03:07 AM2023’s Most Impactful Hospice Regulatory MovesHospice NewsDecember 12, 2023Program integrity issues that have heated up in the hospice space during the past five years reached a boiling point in 2023. Hospice providers have seen an array of increased regulatory oversight in 2023. That momentum has been fueled by two main concerns among regulators—risks of patient safety and evidence of malfeasance in the space. Hospice News sat down with providers, advocacy groups, legal experts and other stakeholders to uncover the most significant hospice regulatory trends from this year and their anticipated impacts heading into 2024 and beyond. ...Editor's Note: Quoted in the article, Jason Wallace, partner in health care, Barnes & Thornburg LLP; Ben Marcantonio, COO and interim CEO, NHPCO; Carrie Uebel, senior vice president and chief ethics and compliance officer, Compassus
MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freeze
12/13/23 at 03:19 AMMedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025.
UnitedHealth hit with Medicare Advantage marketing complaint
12/09/23 at 04:00 AMUnitedHealth hit with Medicare Advantage marketing complaintModern HealthcareDecember 7, 2023Advocates for people with disabilities are calling on regulators [to] halt what they describe as misleading Medicare Advantage marketing by UnitedHealth Group. The Center for Medicare Advocacy, National Health Law Program, Disability Rights Connecticut and National Disability Rights Network wrote the Centers for Medicare and Medicaid Services, the Federal Trade Commission and other state and federal officials Thursday to protest UnitedHealthcare advertisements for Dual Eligible Special Needs Plans appearing in Connecticut. The ads target people with both Medicare and Medicaid and spotlight extra benefits from Medicare Advantage plans that state and federal laws already require, the groups wrote. “Unquestionably, this misleading advertising is intended to induce, and has induced, thousands if not tens of thousands of older adults and disabled low-income individuals we are charged with representing to sign up for UnitedHealthcare’s plan, having been led to believe this means they can get extra benefits,” the letter says. UnitedHealth Group did not immediately respond to an interview request.
New Mexico’s Medicaid Rate Hike Bodes Well For Addus, Other Home-Based Care Providers
12/09/23 at 04:00 AMNew Mexico’s Medicaid Rate Hike Bodes Well For Addus, Other Home-Based Care ProvidersHome Health Care NewsDecember 7, 2023New Mexico is increasing its reimbursement rates for providers that bill Medicaid in the state. Overall, providers are set to get an additional $409 million in reimbursement. The increases will start taking shape on claims made on or after July 1, 2023. Another rate hike is expected in the future for CY 2025. “Thanks to this substantial funding boost, Medicaid providers across New Mexico will now receive reimbursements at rates as high as 120% of Medicare,” Lorelei Kellogg, the acting director for the New Mexico Medicaid program, said in a press release. “By elevating rates, New Mexico Medicaid continues to work toward the goal of ensuring that all New Mexicans enrolled in the program have access to vital health care services.”
NJ extends Medicaid palliative care for poor and elderly
12/09/23 at 04:00 AMNJ extends Medicaid palliative care for poor and elderlyNJ Spotlight NewsDecember 7, 2023New Jersey plans to expand health insurance coverage so that low-income residents with a serious advanced illness can get pain relief and other palliative care at home, regardless of their prognosis, or if they live independently, in a nursing home or assisted living. The state Assembly is expected to take a final vote Thursday on bipartisan legislation that adds community-based palliative care—including specialized medical treatment, emotional and spiritual support and other services to improve patients’ quality of life—to the list of benefits Medicaid will pay for in New Jersey.