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
HHS facesbbacklash & concerns over proposed changes by the Trump administration to Title X Program
The U.S. Department of Health and Human Services (HHS) and the Trump administration published a series of proposed changes to the regulations governing the Title X family planning program. Title X, enacted in 1970, is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services gives access to fundamental health care possible for 4 million low-income, uninsured, and underserved Americans each … [Read more...] about HHS facesbbacklash & concerns over proposed changes by the Trump administration to Title X Program
Proposed Amendments to streamline ICF/IID & HCS/TxHmL Provider Cost Report Rules
HHSC Report- Effective January 1st 2018, information contained in PPAT on cost report rule changes to be adopted by March 2018, address the implementation of a cost report reform initiative for HCS/TxHmL and ICF/IID providers as required by Texas Health and Human Services Commission (HHSC)On Jan. 1st, HHSC requires only even-year cost reports beginning with the providers’ 2018 fiscal year cost reports for HCS/TxHmL (§355.722(a) and ICF/IID(§355.105(c)(1) )providers. HHSC also proposes … [Read more...] about Proposed Amendments to streamline ICF/IID & HCS/TxHmL Provider Cost Report Rules
Texas lawmakers approve major nursing home quality reforms
According to reports, the 2017 Texas regular legislative session made vast changes affecting older Texans. Lawmakers approved several top priorities for AARP Texas including bills that, among other things, will protect seniors’ financial future, improve access to health care, and help unpaid family caregivers and their families.Also included was major nursing home quality reforms that seek to hold operators of nursing homes and other long-term care facilities more accountable when they have been … [Read more...] about Texas lawmakers approve major nursing home quality reforms
CMS cancels planned Home Health Groupings Payment Model, announces new rule
CMS announced in a rule that it would not move forward with the Home Health Groupings Model. These regulations are effective on January 1, 2018. According to CMS, this final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. The … [Read more...] about CMS cancels planned Home Health Groupings Payment Model, announces new rule
Updated Preferred Provider Arrangement for All Managed Care Organizations
MCO Preferred Provider Memorandum In the latest memo update for all managed care organization starting in Fiscal year 2018, HSS is providing Guidance on Preferred Provider Arrangements and Network Access Requirements. The Medicaid and CHIP managed care contracts, including the Uniform Managed Care Contract (UMCC), will require that managed care organizations (MCOs) continue to transition provider payment methodologies from volume based payment approaches to quality-based alternative payment … [Read more...] about Updated Preferred Provider Arrangement for All Managed Care Organizations
Civil Money Penalty (CMP) Projects are Subject to Unannounced Visits to Ensure Project Implementation
Provider Letter No. 17-17 - DADS addresses Civil Money Penalty projects(CMP) regarding the documentation regarding the status of their project and the monitoring of the performance of the contract deliverables as indicated in Attachment C to the contract, Special Conditions for CMP Funded Contracts, section 4.01, Measurement. If your facility has applied and been approved by the Centers for Medicare & Medicaid Services (CMS) to receive CMP funds, your facility is subject to unannounced … [Read more...] about Civil Money Penalty (CMP) Projects are Subject to Unannounced Visits to Ensure Project Implementation
Challenges Continue for LTC Regarding Change of Therapy Documentation
Nursing facilities continue to battle Medicare denials because of documentation issues:Untimely certifications, missed or incorrectly billed Change of Therapy documentation, and lack of documentation supporting a signed physician order for skilled therapy are among the top reasons facilities are battling Medicare claims denials, an expert said in late April.Check your systems for communication between your MDS people and the therapy providers. … [Read more...] about Challenges Continue for LTC Regarding Change of Therapy Documentation
Medicaid and Managed Care–Who Benefits?
Is Medicaid really broke? If not, who is making money where Managed Care is involved? According to this, not the providers. Is this ignored so that attention is focused on allegations of fraud by providers? … [Read more...] about Medicaid and Managed Care–Who Benefits?