Fierce Healthcare

JANUARY 29, 2024

In 2024, 50 accountable care organizations are new to the Medicare Shared Savings Program and 71 ACOs renewed participation, according to new numbers released by Centers for Medicare & Medicaid | CMS released new data Monday showing ACO participation in the Medicare Shared Savings Program, with 19 ACOs set to participate in a new payment option, (..)

Accountable Care 279

Accountable Care Medicare Accountability Medicaid 279

Fierce Healthcare

MARCH 19, 2024

The Centers for Medicare & Medicaid Services (CMS) has announced the ACO Primary Care Flex Model (ACO PC Flex Model), allowing eligible accountable care organizations to treat people with with | Accountable care organizations are largely supportive of CMS' new primary care model released Tuesday, they wish the agency would broaden its scope (..)

Primary Care 162

Primary Care Accountable Care Accountability Medicaid 162

Home Health Care

MARCH 18, 2024

Between 2014 and 2023, personal care services accounted for at least 34% of fraud convictions in some years and as much as 48% in other years. That’s according to a new report from OIG that detailed the findings from Medicaid Fraud Control Units (MFCUs). billion, resulting in an ROI of $3.35 for every $1 spent,” the OIG reported.

Medicaid 52

Medicaid Accountability Home Care Nursing 52

Healthcare ECONOMIST

APRIL 12, 2023

A helpful reminder of what rebates are for drugs covered under State Medicaid Agencies. ICER reports in their California, based on a helpful summary from the Kaiser Family Foundation : For brand name drugs, the [Medicaid] rebate is 23.1% Certain pediatric and clotting drugs have a lower rebate amount of 17.1%.

Medicaid 91

Medicaid Accountability 91

NASHP

AUGUST 21, 2023

The National Academy for State Health Policy (NASHP) is pleased to announce a new initiative to work with states to strengthen oversight and accountability of managed long-term services and supports (MLTSS) plans, with a particular focus on payment strategies. To get updates about this opportunity, sign up for NASHP’s weekly newsletter.

Accountability 52

Accountability Medicaid Medicare 52

Healthcare ECONOMIST

MARCH 23, 2023

How big a role do these AGs play among Medicaid beneficiaries. 2023) aims to answer that using public Medicaid prescription use data between 2014 and 2020. Using these data, they find: From 2014 to 2020, 1023 AGs accounted for 175 million filled Medicaid prescriptions. A paper by Rome et al. The full article is here.

Medicaid 57

Medicaid Accountability Pharmaceuticals 57

NASHP

OCTOBER 6, 2022

Palliative Care in Medicaid. Costing Out the Benefit: Actuarial Analysis of Medicaid Experience October 6, 2022/ by Elrycc Berkman, ASA, MAAA; Tim Doyle, FSA, MAAA; and Ryan Brancati. Medicaid members with disabilities and those receiving long-term services and supports (LTSS) have a higher prevalence of serious illness.

Medicaid 98

Medicaid Nursing Medicare Accountability 98

NASHP

MARCH 22, 2024

States are increasingly turning to capitated Medicaid managed care programs to deliver long-term services and supports (LTSS) to individuals with complex needs. pdf On October 1, 2023, Virginia Medicaid combined its two managed care programs of Medallion 4.0

Medicaid 75

Medicaid Nursing Medicare Integration 75

NASHP

MARCH 1, 2024

rebalancing spending to improve access to home and community-based services, improving care transitions, or encouraging greater care coordination) Innovative oversight approaches for Medicare/Medicaid integrated models What’s In It for States? For questions or inquiries, please contact  Holly Stockdale ( hstockdale@nashp.org ).

Medicaid 80

Medicaid Care Transition Medicare Integration 80

NASHP

MARCH 13, 2023

The Consolidated Appropriations Act enacted in December 2022 delinks the Medicaid continuous coverage requirement from the COVID-19 PHE, ending the protection on March 31, 2023 (along with a phase-down through 2023 of the increased federal match rate).

Medicaid 105

Medicaid Accountability Prevention Medicare 105

NCQA

JUNE 27, 2023

More states are contracting with managed care organizations (MCO) to provide Medicaid long-term services and supports (LTSS). Hold MCOs Accountable: LTSS Distinction validates that MCOs deliver high-quality, person-centered care to people with complex needs. Why Should MCOs Earn LTSS Distinction?

Medicaid 52

Medicaid Care Transition Quality Improvement Regulations 52

Home Health Care

APRIL 22, 2024

The “Ensuring Access to Medicaid Services” rule has been finalized. First proposed by CMS in April of 2023 , the goal of the rule is to enhance access to HCBS for Medicaid beneficiaries. First proposed by CMS in April of 2023 , the goal of the rule is to enhance access to HCBS for Medicaid beneficiaries.

Home Care 114

Home Care Medicaid Accountability Regulations 114

Home Health Care

NOVEMBER 18, 2021

Both Intergen and Amazing Home Care primarily serve New York’s Medicaid population, according to a recent announcement from New York City Mayor Bill de Blasio’s office. “In To any company in New York City that thinks they can get away with withholding workers’ rights and violating our laws: We will hold you accountable.”.

Accountability 103

Accountability Home Care Medicaid Regulations 103

NASHP

APRIL 24, 2023

births, Medicaid and the Children’s Health Insurance Program (CHIP) are critical in addressing this maternal health concern. States are increasingly exploring and implementing Medicaid postpartum coverage to improve maternal health outcomes. NASHP tracks state efforts to extend Medicaid postpartum coverage.

Medicaid 52

Medicaid Prevention Accountability Quality Improvement 52

Home Health Care

MAY 4, 2023

Centers for Medicare & Medicaid Services’ (CMS) latest proposed rule , which includes a provision that would require at least 80% of Medicaid payments to go toward compensation for personal care workers. During the call, Sampson also discussed Medicaid redetermination and how he believed it would impact Modivcare.

Medicaid 70

Medicaid Regulations Accountability Medicare 70

Fierce Healthcare

AUGUST 24, 2023

The Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) has saved a net $1.8 billion in 2022 for accountable care organizations, which is th | Accountable care organizations saved a net $1.8 billion in 2022 from the Medicare Shared Savings Program, CMS said Thursday.

Accountable Care 130

Accountable Care Accountability Medicare Medicaid 130

Home Health Care

MARCH 28, 2022

Compassionate owner, Francis Kimaru, pleaded guilty to separate criminal charges brought in by the Attorney General’s Medicaid Fraud Division in September 2019. OIG releases Medicaid fraud report. Department of Health and Human Services Office of Inspector General (OIG) recently released its latest Medicaid fraud report.

Medicaid 98

Medicaid Home Care Accountability Integration 98

NCQA

APRIL 7, 2023

Nathan Chomilo, Medical Director for Minnesota Medicaid, in a discussion about his work to improve the health of Minnesotans. Nathan Chomilo, MD, FAAP, FACP, Medical Director, Minnesota Medicaid As Peggy says, “We have a collective responsibility to get the word out on what’s effective.” Focusing on culturally relevant care.

Medicaid 52

Medicaid Accountability Medicare 52

NASHP

APRIL 17, 2023

Performance measurement is a pillar of state Medicaid managed care quality improvement and oversight efforts, is often factored into plan payment, and supports public reporting. 42 Medicaid agencies collected at least one measure of behavioral health performance. Check out the map and chart below for an overview of our findings.

Medicaid 52

Medicaid Quality Assurance Quality Review Accountability 52

Sheppard Health Law

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] ILOSs must advance the objectives of the Medicaid program. ILOSs must be cost effective.

Medicaid 52

Medicaid Regulations Federal Healthcare Medicare 52

Sheppard Health Law

MAY 16, 2022

More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. ECM will be accounted for in MCP capitation rates, meaning that once the program is fully implemented, MCPs must provide the benefit to Members if they request it.

Medicaid 59

Medicaid Accountability Nursing Population Health 59

Briggs Healthcare

MARCH 22, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The OIG has posted its annual report on Medicaid fraud for FY2022. The 29-page report highlights: Here’s the Table of Contents: Reducing Medicaid fraud is a top priority for OIG, and its role in overseeing MFCUs helps achieve that priority.

Medicaid 52

Medicaid Regulations Accountability Healthcare 52

Sheppard Health Law

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

Medicaid 52

Medicaid Regulations Prevention Accountability 52

Home Health Care

DECEMBER 13, 2023

After stalling in 2021, spending on home health care returned to a more normalized growth rate in 2022, according to a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). The share of the economy accounted for by the health sector was 17.3% Medicare accounted for $944.3

Medicaid 109

Medicaid Accountability Medicare Nursing 109

Accountable Care Doctors

MARCH 19, 2021

The Council of Accountable Physician Practices (CAPP), a coalition of visionary medical groups and health systems supporting accountable value-based care, has added Joe Kimura, MD, MPH, to its board of directors. Coalition of Leading Medical Groups and Health Systems Confirms Board Appointments for 2021.

Accountability 52

Accountability Accountable Care Primary Care Population Health 52

NASHP

APRIL 17, 2023

1],[2] Nearly all state Medicaid programs are working to improve maternal health through early identification of depression during well-child visits and connecting mothers to follow-up services, as depicted in NASHP’s updated Medicaid Policies for Caregiver Depression Screening during Well-Child Visits by State.

Medicaid 52

Medicaid Prevention Primary Care Accountability 52

NASHP

OCTOBER 22, 2021

Supporting the Continuum of Care for Serious Illness in Medicaid Managed Care October 25, 2021 / by Salom Teshale, Kitty Purington, Wendy Fox-Grage, and Mia Antezzo. Delivery system transformation: Leading states such as Minnesota have long used Medicaid MCO contracts to address the needs of complex populations and those with serious illness.

Medicaid 102

Medicaid Hospice Care Integration Regulations 102

Home Health Care

MARCH 14, 2024

Individuals who are dually eligible for both Medicare and Medicaid make up a sizable portion of the overall home-based care population. In Medicare, duals make up about 19% of all enrollment, but they account for 34% of total spending. In Medicare, duals make up about 19% of all enrollment, but they account for 34% of total spending.

Medicaid 93

Medicaid Medicare Accountability Integration 93

NASHP

DECEMBER 23, 2022

With more than 40 percent of births financed by Medicaid, the Centers for Medicare & Medicaid Services (CMS) has developed an action plan that corresponds with goals outlined in the White House blueprint. Implement Medicaid benefit. Identify community assets, engage the provider community, and build infrastructure.

Medicaid 59

Medicaid Nursing Regulations Hospitals 59

Briggs Healthcare

JANUARY 31, 2023

Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), finalized the policies for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program, which is CMS’s primary audit and oversight tool of MA program payments.

Medicare 40

Medicare Accountability Regulations Medicaid 40

Sheppard Health Law

OCTOBER 27, 2021

On October 20, 2021, the Centers for Medicare and Medicaid (“ CMS ”) Innovation Center (“ Innovation Center ”) published a white paper detailing its vision for the next ten years: a health system that achieves equitable outcomes through high quality, affordable, person-centered care. Strategic Objective 1: Drive Accountable Care.

Medicaid 52

Medicaid Medicare Accountable Care Accountability 52

Healthcare It News

AUGUST 29, 2022

Galileo first launched with in-home care for Medicare and Medicaid patients, creating a framework to include social determinants of health in clinical analysis and to bridge gaps in healthcare education. "I first helped her switch her Galileo account into Spanish. "She had recently moved to the U.S. to live with her family.

Telemedicine 251

Telemedicine Primary Care Medicaid Urgent Care 251

Healthcare ECONOMIST

DECEMBER 17, 2023

In 2022, strong Medicaid and private health insurance spending growth, including a turnaround in the net cost of insurance, was somewhat offset by continued declines in federal spending associated with the COVID-19 pandemic. The share of the economy accounted for by the health sector was 17.3 Hartman et al. percent to reach $4.5

Pharmaceuticals 92

Pharmaceuticals Medicaid Accountability 92

p3care

SEPTEMBER 5, 2023

The Obama Healthcare Act (ACA) The Obamacare Act contains the following provisions that have altered US healthcare delivery: Expansion of Medicaid Health Insurance Marketplace Pre-existing Conditions Check out these key provisions to get a better understanding of the subsequent policy changes.

Healthcare 130

Healthcare Medicaid Healthcare Providers Accountability 130

Home Health Care

MARCH 21, 2024

Steel also pointed to a potential discrepancy in the way home health agencies are accounted for, and how HHS and the the Centers for Medicare & Medicaid Services (CMS) tracks enrollment data. Michelle Steel (R-Calif.) grilled the secretary about an apparent lack of progress on curbing certifications for bad actors.

Medicare 99

Medicare Medicaid Hospice Care Integration 99

Healthcare It News

JUNE 3, 2022

Since California expanded health coverage under the Affordable Care Act, a large number of people have been mistakenly bounced between Covered California, the state’s marketplace for those who buy their own insurance, and Medi-Cal, the state’s Medicaid program for low-income residents. He needed to reapply.

Accountability 235

Accountability Medicaid Prevention 235

NASHP

APRIL 15, 2022

CalAIM: Leveraging Medicaid Managed Care for Housing and Homelessness Supports April 15, 2022 / by Allie Atkeson. Driven by challenges facing individuals with complex care needs, states are increasingly working to address the physical, behavioral, and social needs of their Medicaid beneficiaries. Download the report (PDF).

Medicaid 59

Medicaid Public Hospital Hospitals Nursing 59