Many families and health care providers are debating whether the Centers for Medicare and Medicaid Services, which runs Medicare (CMS) and Congress are doing enough to implement processes to protect patients and their families from hospice providers who may be exploiting the service. Recently, CMS finalized a $340 Million/ 1.8 percent increase in Hospice payments for Medicare Hospice providers. According to reports, the Office of Inspector General (OIG) at HHS synthesized 10 years of … [Read more...] about CMS authorizes increase of $340 million in Hospice payments for FY 2019
$8.6 Million in State Flexibility Grants Awarded by CMS to 30 States For Obamacare
The $8.6 million in State Flexibility Grants announced by the Centers for Medicare & Medicaid Services (CMS) that would be allocated to 30 states and the District of Columbia comes with the Trump Administration' approval despite recent attempts to disassemble the ACA. The funding from Obamacare, which is part of $250 million for State Rate Review Grants provided by the Patient Protection and Affordable Care Act (PPACA) to improve the process for how States review proposed health … [Read more...] about $8.6 Million in State Flexibility Grants Awarded by CMS to 30 States For Obamacare
$434 Million in Financial Payments Improperly Issued by CMS to Insurers
In a new report by The HHS Office of Inspector General, the Centers for Medicare & Medicaid Services (CMS) was found to have wrongly funded $434.4 million in financial assistance payments to qualified health plan (QHPs) issuers for 461,127 policies. The audit revealed that the improperly authorized funding occurred in 2014, the first year the ACA law’s health insurance marketplaces went online. According to the report, CMS relied on insurers to verify that their enrollees were confirmed and … [Read more...] about $434 Million in Financial Payments Improperly Issued by CMS to Insurers
Fiscal Year 2018 Cutoff Dates for Fee-for-Service Year-end Closeout Processing
Information Letter 18-08 & No. 18-09 This letter announces several dates regarding Fiscal Year 2018 Claims Processing for claims to be paid by the Texas Health and Human Services Commission (HHSC). August 24, 2018 by noon is the cutoff date for Home and Community-based Services Providers and Texas Home Living Providers . For all other agencies, providers and facilities listed below, the cutoff dates are as follows: • Fiscal Year 2016 Miscellaneous Fee-for-Service (FFS) Claims Cutoff: … [Read more...] about Fiscal Year 2018 Cutoff Dates for Fee-for-Service Year-end Closeout Processing
Proposed Rule for Permanent Risk Adjustment Program for 2018
A new Centers for Medicare & Medicaid Services (CMS) Press release details the proposed additional rule to address risk adjustment program for the 2018 benefit year. The rule would give payers the ability to receive 2018 risk adjustment payments by resolving legal contentions of the program’s operation and give CMS the ability to issue risk adjustment payments without interruptions for the current plan year. According to reports the risk adjustment payments also reimburse health insurers … [Read more...] about Proposed Rule for Permanent Risk Adjustment Program for 2018
New CMS payment system for skilled nursing facilities reimburses providers for care not volume
CMS new Patient-Driven Payment Model (PDPM) will be implemented on Oct. 1, 2019. CMS finalized the Patient-Driven Payment Model for skilled nursing facilities (SNF), which will link Medicare payments to value and care, rather than volume/ fee-for-service care. The rule according to news reports “would reduce documentation standards around patient assessments, saving facilities approximately $2 billion over 10 years," and would "give a $975 million collective raise next year to post-acute care … [Read more...] about New CMS payment system for skilled nursing facilities reimburses providers for care not volume
Who has the greatest impact on high healthcare costs?
In a new NEJM Catalyst Buzz Survey, the question of who is the biggest driver of high healthcare costs brings physicians, healthplans, pharmacuetical & bio-tech companies under scrutiny. Doctors who have been blamed for the inflated cost of US healthcare due to expensive recommendations or overtreating patients have maintained that even though the discussion needs to be had with patients about healthcare costs, they have no power to determine the price of a drug or new healthcare … [Read more...] about Who has the greatest impact on high healthcare costs?
Invitation Only. New changes to the FMSA enrollment training process
Information Letter No. 18-05: Effective the date of this letter, registration for the FMSA enrollment training will be available by invitation only. The purpose of this letter is to notify current and prospective financial management services agencies (FMSAs) of changes to the FMSA enrollment training process. INVITATIONS TO REGISTER Invitations for registration will be extended only to FMSA contract applicants who have initiated the contract application process with HHSC or an MCO in order … [Read more...] about Invitation Only. New changes to the FMSA enrollment training process
Government’s two-year spending plan includes $1.9 billion Nursing home cuts
According to reports, nursing home cuts will freeze skilled nursing facilities' share of the “market basket” at a 2.4% increase in October. The Congressional Budget Office (CBO) had previously projected a 2.7% hike, though the final rate won't be set until CMS announces its proposed rules for 2019. The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) President and CEO Mark Parkinson issued the following statement regarding the Senate budget proposal: “We are … [Read more...] about Government’s two-year spending plan includes $1.9 billion Nursing home cuts
Health and Human Services Commission Allocating $47.7 million to Improve State Hospital System
According to HHS, in order to begin improving the state’s inpatient psychiatric care system which provides care for adults, adolescents and children, a total of $47.7 million will be allocated to renovate and architecturally plan for the replacement of existing facilities as well as plan and design a new hospital. The funding is part of $300 million approved by the 85th Texas Legislature to improve the state hospital system in the 2018-2019 biennium) Projects to be funded and implemented … [Read more...] about Health and Human Services Commission Allocating $47.7 million to Improve State Hospital System
