Two interesting articles have been recently published. One deals with the closing of the hospital in rural Milam County, Texas. This has caused residents to travel further for care and has disincentivized some to seek needed care. Days after the two hospitals in Milam County abruptly shuttered in December, Renee Mueck started feeling stomach pain so sharp she couldn’t drive herself to the nearest hospital about 40 minutes away. Mueck, 60, said her husband drove her to a hospital … [Read more...] about Rural Health Care in the News
Changes in RoP for Nursing Homes
November 2019 was supposed to see the implementation of Phase 3 of the changes to Nursing Home Rules of Participation. That has been rolled back to 2019. Moreover, CMS has proposed a new rule that will cause significant changes in some areas. In the proposed rule, posted to the Federal Register Tuesday evening, CMS recommends having surveyors look at QAPI plans at the end of an inspection. That could limit the possibility that areas identified for improvement would be used as … [Read more...] about Changes in RoP for Nursing Homes
CMS Allows Arbitration Agreements in Nursing Homes, Delays Phase 3 ROP’s
The CMS has issued a final rule to allow pre-dispute arbitration agreements under the condition that the residents' receipt of care is not conditioned on signing them. Providers must inform residents or their representatives that they do not have to sign the agreement. The purpose of the rule is to: The CMS proposal supports patients and their caregivers by removing the ban on binding arbitration agreements while requiring nursing homes to ensure residents have the ability to choose … [Read more...] about CMS Allows Arbitration Agreements in Nursing Homes, Delays Phase 3 ROP’s
Nursing Home Staffing Levels Lower than Reported?
Modern Healthcare magazine is reporting that the results of a study published in Health Affairs are indicating that staffing levels are "often lower than reported" and "below what CMS expects." One area of special concern is staffing of RN's: "The numbers were most stark for RNs, where 91% of the organizations met expectations less than 60% of the time. Almost all facilities are required to have at least one RN on site for at least eight hours every day. But nearly 4% of … [Read more...] about Nursing Home Staffing Levels Lower than Reported?
Administration Considering Pulling Medicare Coverage from Some Drugs to Encourage Negotation of Price
In an effort to give insurers leverage for negotiation, Trump is advocating pulling protections guaranteeing Medicare coverage: Pharmaceutical companies that raise the cost of certain drugs risk losing protections that guarantee Medicare coverage, part of a Trump administration proposal to give insurers leverage to negotiate lower prices. The U.S. Centers for Medicare and Medicaid Services on Monday proposed exceptions to six protected classes of treatments for illnesses … [Read more...] about Administration Considering Pulling Medicare Coverage from Some Drugs to Encourage Negotation of Price
Medicare and Medicaid Programs – CMS, HSS Proposed Regulatory Provisions Fact Sheet
Today the Centers for Medicare & Medicaid Services (CMS), in order to promote Medicaid and Medicare program efficiency, transparency, and burden reduction, proposed new rules that revise the applicable conditions of participation (CoPs) for providers and conditions for coverage (CfCs). The link of this rule will be republished in the Federal Register on Sept. 20. According to the fact sheet summary excerpt: This proposed rule would reform Medicare regulations that are identified as … [Read more...] about Medicare and Medicaid Programs – CMS, HSS Proposed Regulatory Provisions Fact Sheet
Multiple Bipartisan Healthcare Bills Head to Congress
The series of bipartisan healthcare bills are being considered expedited rules that require two-third votes for approval. One bill H.R. 3635, amends title XVIII (Medicare) of the Social Security Act to revise the process by which Medicare administrative contractors (MACs) issue and reconsider local coverage determinations (LCDs) that: (1) are new, (2) restrict or substantively revise existing LCDs, or (3) are otherwise specified in regulation. According to reports, it would provide … [Read more...] about Multiple Bipartisan Healthcare Bills Head to Congress
CMS authorizes increase of $340 million in Hospice payments for FY 2019
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
HHS Releases Report on Hospice Care Fraud in US
A report released recently released by the Office of Inspector General (OIG) at the US Department of Health titled: Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity has highlighted that hospice care fraud is a nationwide problem in the US. The report found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care for Nursing home residents and other patients. When care is provided hospices’ inappropriate … [Read more...] about HHS Releases Report on Hospice Care Fraud in US
PPAT Notice-Proposed Changes to the ICF/IID Administrative Penalties Rules
HHSC published the proposed changes mandated by House Bill (H.B.) 2025 to the ICF/IID rules which calls for changes to rules governing administrative penalties, license terms and related policies in various programs including the ICF/IID program, DAHS, ALFs, NFs and Pediatric Extended Care Facilities. HB 2025 is the act relating to the regulation of certain long-term care facilities, including facilities that provide care to persons with Alzheimer ’s disease or related disorders; authorizing an … [Read more...] about PPAT Notice-Proposed Changes to the ICF/IID Administrative Penalties Rules
