The New York Times is writing about the ACA's Hospital Readmissions Reduction Program and the question of whether or not this is causing increased mortality among older patients. This should be of increased interest to nursing facilities since the refusal of readmission after a nursing home sends a resident to the hospital and subsequent death of the resident when returned to the facility may increase scrutiny of the nursing home rather than the correctness of a hospital refusing … [Read more...] about Hospital Re-Admissions and the Elderly
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
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
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
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
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
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
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
The 11-member Physician-Focused Payment Model Technical Advisory Committee(PTAC) established by MACRA to consider whether models submitted by stakeholders qualify as Medicare alternative payment models voted to move forward on proposals for two alternative payment models for review by the HHS secretary. One model, the Patient and Caregiver Support for Serious Illness model, was submitted by the American Academy of Hospice and Palliative Medicine. The second model is the Advanced Care Model … [Read more...] about Two new proposals address alternative payment models for patients in Palliative Care.
A proposal was recently released by the Center for American Progress (CAP) for Medicare Extra, an enhanced version of the Medicare program and a plan to guarantee universal health coverage in the United States. The plan would be available to all Americans, regardless of income, health status, age, or insurance status. According to reports, Medicare Extra highlights and tries to resolve the reasons for the high cost of the American healthcare system head-on by placing caps on doctor and … [Read more...] about Medicare Extra for All Plan: A Universal Healthcare plan backed by Progressives and Conservatives.