A lawsuit accuses President Donald Trump's Treasury, Labor and HHS secretaries of weakening Americans' access to life-saving medical care by letting the rule regarding short-term plans bypass the ACA's essential health benefit and pre-existing condition requirements, according to reports. According to the Trump Administration: This final rule amends the definition of short-term, limited-duration insurance for purposes of its exclusion from the definition of individual health insurance … [Read more...] about Trump Administration Sued Over Short-Term Health Plans Offering Limited Benefits
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
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
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
Trump Signs Electronic Visit Verification (EVV) Into Law
With no opposition from the House or Senate, the U.S. Senate unanimously approved legislation of the H.R.6042 bill delay the nationwide deadline for electronic visit verification (EVV) or ( in-home health service bill) in Medicaid-reimbursed personal care services until 2020. President Donald Trump signed Rep. Brett Guthrie’s health care bill into law on July 30th. According to news reports, the 21st Century Cures Act, initially signed into law in 2016 under the Obama Administration, … [Read more...] about Trump Signs Electronic Visit Verification (EVV) Into Law
Three Federal Health Privacy Rules including HIPPA to be reformed by HHS
U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) laws let providers share certain private information with patient family members and outside groups in emergencies; and now the U.S. Department of Health and Human Services (HHS) secretary Alex Azar confirmed that HHS will undertake an effort to reform federal health privacy rules, stating that "In the coming months, under the leadership of my deputy secretary, Eric Hargan, HHS will be releasing requests for information … [Read more...] about Three Federal Health Privacy Rules including HIPPA to be reformed by HHS
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
Guidelines Regarding Plans of Correction Associated with a PASRR Violation
Provider Letter 18-09 (NF) - This letter addressed Long-Term Care Regulations by HHSC. Nursing facilities (NFs) must comply with both state and federal requirements related to Preadmission Screening and Resident Review (PASRR). This includes coordinating Level I screening and Level II evaluation assessments, participating in interdisciplinary team meetings (IDTs), and providing necessary specialized services for individuals with intellectual disabilities (ID), developmental disabilities (DD) or … [Read more...] about Guidelines Regarding Plans of Correction Associated with a PASRR Violation
Amended Nursing Peer Review Committee (NPRC) Requirements and a State Agency’s Duty to Report
PL 18-06 - Long-Term Care Regulatory Provider Letter (PL) The Texas Health and Human Services Commission released the provider letter to nursing providers (ALF, DAHS, HCSSA, ICF/IID, and Nursing Facilities) the letter details that House Bill (HB) 3296, 85th Legislature, Regular Session, 2017, amended Texas Occupations Code §303.0015, regarding the establishment of a NPRC. Additionally, this letter clarifies the process a surveyor from the Texas Health and Human Services Commission (HHSC) … [Read more...] about Amended Nursing Peer Review Committee (NPRC) Requirements and a State Agency’s Duty to Report
