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
Notification Requirements in Response to an Emergency or Disaster
Provider Letter 18-16 - This Long-Term Care regulatory provider letter is to inform a Home and Community Support Services Agency (HCSSA or agency) of notification requirements for temporary agency changes in response to an emergency or disaster. The letter details provider responsibilities regarding initial or renewal application changes due to an emergency or disaster, temporarily relocation of a place of business as a result of an emergency or disaster, providing services to clients who … [Read more...] about Notification Requirements in Response to an Emergency or Disaster
$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
CMS Proposes Improvements in Managing the Medicaid program in Partnership with States
The Medicaid Review Process and Approval times are at the forefront of CMS effort to "implement changes resulting in faster processing of state requests to make program or benefit changes to their Medicaid program through the state plan amendment (SPA) and section 1915 waiver review process. According to reports, SPAs allow states to change their Medicaid program policies or operational approaches, while 1915 waivers let states develop home and community-based services for individuals who … [Read more...] about CMS Proposes Improvements in Managing the Medicaid program in Partnership with States
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
New Version of Pre-Claim Review for Home Health Proposed by CMS
The Centers for Medicare & Medicaid Services (CMS) is announcing that under the new program, home health agencies (HHAs) could choose to undergo either pre-claim or post-payment reviews, or to forgo reviews but take a 25% payment reduction on all claims submitted for home health services. In the CMS memo issued Tuesday, CMS proposes to roll out the reviews in Illinois, Ohio, North Carolina, Florida and Texas, with the option to expand to other states under the jurisdiction of Medicare … [Read more...] about New Version of Pre-Claim Review for Home Health Proposed by CMS
