According to a new Government Accountability Office (GAO) report, Medicare fraud and abuse by home health care providers resulted in a 44 percent increase in spending over five years. (Kaiser Network) The GAO reviewed home health care payments from 2002 to 2006 and found that the number of Medicare beneficiaries increased 17 percent and spending reached $13 billion. The increases were caused by some providers exaggerating medical conditions and other providers billing the government for … [Read more...] about GAO: Fraud and Abuse Increased Medicare Home Health Services Spending
New Legislative Bills
The following bills were introduced this month and may affect providers: HB 166 - Relating to providing home- and community-based support services under the Medicaid program to persons who are deaf-blind with multiple disabilities. HB 510 - Relating to the registration of certain assisted living facilities; providing penalties. HB 1186 - Relating to the transfer or discharge of certain residents in certain assisted living facilities. HB 1398 - Relating to a pilot project to establish … [Read more...] about New Legislative Bills
MedPAC Supports CMS Changes to MA Payment Scale
MedPAC, the group that advises Congress on Medicare issues, says it supports the Centers for Medicare and Medicaid Services's (CMS) decision to change the scale used to adjust the reimbursement rate for Medicare Advantage (MA) plans based on a beneficiary's level of sickness. This method is designed to prevent over- and underpayments. (Kaiser Network) From MedPAC's March 5 letter (PDF): CMS is proposing an adjustment to risk scores to recognize differences between the coding practices in … [Read more...] about MedPAC Supports CMS Changes to MA Payment Scale
Legislative Bills Get Public Hearings, Sent to Committee
Last month, I published a post with a list of bills introduced in the 81st Legislative Session that impact providers. Some of these bills have been scheduled for public hearings and referred to committees. Click on the links to find out the present status of the bills: HB 5 - Relating to the elimination of smoking in all workplaces and public places; providing penalties. HB 67 - Relating to a medical assistance buy-in program for children with certain developmental disabilities. HB 87 … [Read more...] about Legislative Bills Get Public Hearings, Sent to Committee
Texas Register Updates: STAR+PLUS Changes
The following information was obtained from the February 27 issue of the Texas Register: Public Notices The Texas Health and Human Services Commission (HHSC) announced its intent to submit to the Centers for Medicare and Medicaid Services a request to amend the State of Texas Access Reform + PLUS (STAR+PLUS) program, to integrate delivery of acute and long-term care services through a managed care system. HHSC also intends to submit an amendment to the Texas State Plan for Medical … [Read more...] about Texas Register Updates: STAR+PLUS Changes
“Compassionate” Bureaucratism
If you have ever had the notion that regulators care about your residents, consumers and/or patients, look at this for a reality check. (AP) - A New York City doctor's flat-fee, $79-a-month medical practice has run afoul of state insurance regulators who have told him to shut it down. Dr. John Muney said Wednesday he's negotiating to try to keep the arrangement at his AMG Medical Group centers. The fee includes unlimited office visits, some tests and in-office surgeries. It doesn't … [Read more...] about “Compassionate” Bureaucratism
Information and Provider Letters: CDS Options, Complaints Under HDM, Etc.
The Texas Department of Aging and Disability Services (DADS) released five information letters and one provider letter: Respite and Adjunct Support Services provided by Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs) through the Consumer Directed Services (CDS) Option in Medically Dependent Children Program (MDCP) DADS informed providers that MDCP Respite and Adjunct Support Services provided by RNs and LVNs is available through the CDS option, effective February 10, … [Read more...] about Information and Provider Letters: CDS Options, Complaints Under HDM, Etc.
MedPAC’s 2009 Report to Congress
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, released its 2009 report to Congress. The report includes payment policy recommendations for nine payment systems: hospital inpatient, hospital outpatient, physicians, ambulatory surgical center, outpatient dialysis, skilled nursing, home health, inpatient rehabilitation facilities, and long-term care hospitals. From the press release: FEE-FOR-SERVICE PAYMENT UPDATE … [Read more...] about MedPAC’s 2009 Report to Congress
Texas Register Updates: CLASS Renewal, Etc.
The following information was obtained from the February 13 and February 20 issues of the Texas Register: Public Notice The Texas Health and Human Services Commission (HHSC) intends to submit a request to renew the Community Living and Support Services (CLASS) program, a Medicaid home and community-based services waiver program under the authority of Title XIX, Section 1915(c), of the Social Security Act. The current waiver will expire August 31, 2009, and the proposed effective date for … [Read more...] about Texas Register Updates: CLASS Renewal, Etc.
CMS Quick Links for Tuesday
Last week the Centers for Medicare and Medicaid Services (CMS) announced that it would postpone implementation of a competitive bidding rule for durable medial equipment providers until April. CMS was required do another round of bidding and make changes, so the implementation date was pushed back. The comment period for the final rule ends on March 17, 2009. (Kaiser Network) CMS would like to make it easier for Medicare beneficiaries with conditions like epilepsy, mental illness, and … [Read more...] about CMS Quick Links for Tuesday
