HIT Consultant

OCTOBER 30, 2023

Under the Medicare Shared Savings Program, a healthcare provider that is an Accountable Care Organization (ACO), ACO participant, or ACO provider or supplier would be deemed ineligible to participate in the program for a period of at least one year.

Medicare 98

Medicare Accountable Care Healthcare Providers Regulations 98

Healthcare Success

JULY 5, 2022

You're selling a product or service regulated by the state (or county). Traditional fee for service, accountable care, concierge service, HMOs, cash-only vs. private insurance-only vs. Medicaid/Medicare—all produce different incentives and behaviors because the compensation model impacts how your product/service gets paid for and by whom.

Doctors 157

Doctors Private Practices Accountability Hospitals 157

Sheppard Health Law

AUGUST 3, 2023

As we previewed in our blog article in March on the establishment of California’s new Office of Health Care Affordability (OHCA), OHCA has issued proposed regulations available on the OHCA website, that provide anticipated details on OHCA’s advance review authority regarding certain transactions in the healthcare space.

Regulations 52

Regulations Accountable Care Accountability Healthcare 52

HIT Consultant

JANUARY 20, 2023

The TNAP program is designed to accommodate stakeholders that will exchange data, including QHINs, other health information networks, health information exchanges, accountable care organizations, data registries, labs, providers, payers, vendors, and suppliers.

Health Data 98

Health Data Accountable Care Accountability Healthcare 98

Healthcare Success

JULY 31, 2023

It has application in value-based care, patient population health, accountable care organizations (ACOs), and health management organizations (HMOs). As you learn how to increase patient engagement in healthcare through targeted marketing campaigns, be sure to follow all applicable laws and regulations (e.g.,

Prevention 130

Prevention Accountability Healthcare Accountable Care 130

HIT Consultant

DECEMBER 3, 2024

Strengthening Referral Pathways: While physical therapy remains outside primary care’s traditional scope, patients in many states have direct access without requiring a referral. However, practices must address potential risks, including insurance compliance and healthcare payor audits, while preparing for emerging regulations.

Physical Therapy 52

Physical Therapy Accountable Care Primary Care Prevention 52

Health Blawg

JANUARY 16, 2019

Hey, coordinated care is a good idea. The first RFI to issue was the one seeking input on the regulations implementing the Stark law and the federal anti-kickback statute (See: Stark and AKS RFI and public comments ). The original HIPAA regulations were drafted by HHS in the absence of any particular statutory framework.

Regulations 60

Regulations Accountability Health Data Healthcare 60

Health Blawg

JANUARY 16, 2019

Hey, coordinated care is a good idea. The first RFI to issue was the one seeking input on the regulations implementing the Stark law and the federal anti-kickback statute (See: Stark and AKS RFI and public comments ). The original HIPAA regulations were drafted by HHS in the absence of any particular statutory framework.

Regulations 60

Regulations Accountability Health Data Healthcare 60

NCQA

SEPTEMBER 12, 2024

Defining National Goals for IDD Health Outcomes The IIDDEAL project convened more than 180 contributors—people with IDD, families and caregivers, clinicians, researchers, payers and regulators—to discover what health and life outcomes should be prioritized, and how health care leaders can support those outcomes. Learn more about IEC.

Measurable Quality 52

Measurable Quality Accountable Care Regulations Accountability 52

Health Dialog

JUNE 16, 2016

The latest FDA rule , which will take effect August 8 th this year, extends regulations to include all tobacco products, including e-cigarettes (also called electronic cigarettes or electronic nicotine delivery systems (ENDS)), dissolvables, hookah tobacco, cigars, pipe tobacco, and any novel or future tobacco products.

Prevention 40

Prevention Regulations Accountable Care Population Health 40

NASHP

DECEMBER 10, 2021

ACO Accountable Care Organizations. CBCM Community Based Care Management Program. PCCM Primary Care Case Management. PH-MCO Physical Health Managed Care Organization. RAE Regional Accountable Entity. In addition, CHWs are often included in Accountable Communities for Health (ACH). Acronym Guide.

Medicaid 122

Medicaid Primary Care Prevention Nursing 122

NASHP

NOVEMBER 12, 2021

If not, policymakers may consider defining it in regulation.]. Any affiliation, arrangement, or contract that results in a change of control for a health care entity. Note: Policymakers may need to define some of these terms and specify how they are to be calculated in regulation. Section 2: Notice. (A)

Regulations 52

Regulations Rehabilitation Accountable Care Hospitals 52

Sheppard Health Law

MAY 9, 2023

While not as onerous as the original proposal, the new notice and disclosure process will result in greater (1) transparency into financial investor involvement in health care entities, and (2) access to data on health care transactions in light of health equity considerations that are becoming a greater focus in the industry.

Regulations 52

Regulations Accountable Care Accountability Medical Services 52

NASHP

MAY 26, 2022

HCA has certified PDAs for end-of-life care, cardiac care, cancer screening, total joint replacement, spine care, maternity and labor/delivery. Washington’s certification process for PDAs involves the Health Care Authority identifying a priority area and calling for submissions for PDA certifications.

Patient Experience 52

Patient Experience Medicaid Accountable Care Regulations 52

NASHP

OCTOBER 20, 2022

High-quality, integrated care requires strong system-level partnerships, information and data sharing, and family-centered practices. Yet, states often face barriers to integrated care including a lack of trust across agencies, privacy regulations that may hinder data sharing, and misaligned eligibility, enrollment, and referral systems.

Medicaid 98

Medicaid Integration Accountability Quality Improvement 98

NASHP

OCTOBER 16, 2023

Washington defines the coverage in regulation and details it in a billing guide. Providers wishing to offer PPC must be licensed as a hospice provider and receive approval to provide the palliative care service from the Medicaid agency. EPSDT services are only available to Medicaid beneficiaries under age 21.)

Medicaid 52

Medicaid Medicare Regulations Accountable Care 52

Accountable Care Doctors

OCTOBER 21, 2020

The COVID-19 pandemic has upended health care in America, and as of this writing, is still raging on. A quick snapshot reveals how decades-long investments by CAPP groups to better integrate their care delivery systems is paying off. Continue to encourage the migration of care from the health care campus to the home.

Primary Care 59

Primary Care Integration Remote Care Population Health 59

NASHP

MAY 10, 2024

Practices participating in the Medicare Shared Savings Program (MSSP) or the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) (CMS released guidance on model overlaps with these and other programs and AHEAD.)

Primary Care 52

Primary Care Medicaid Medicare Hospitals 52

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

Health Blawg

APRIL 8, 2018

All-payor ratesetting in Maryland, we recently learned, turned out to be not everything it was cracked up to be (I came of age as a health care lawyer and regulator in the former People’s Republic of Massachusetts under similar all-payor ratesetting rules). How do we integrate lessons from the past and present?

Primary Care 60

Primary Care Integration Urgent Care Pharmaceuticals 60

NASHP

AUGUST 5, 2024

Authority refers to the section of Medicaid regulations that the state used for the SPA. Eligible primary care practices must engage CHWs starting in 2024. All six SPAs include language requiring that CHWs complete state-sponsored certification or standardized core skills training. CHW services are reimbursed at a rate of $70/hour.

Medicaid 52

Medicaid Primary Care Prevention Accountability 52

NASHP

NOVEMBER 29, 2021

The Department of Health Care Policy and Financing (the Medicaid program administrator) does not specifically require the Regional Accountable Entities (RAEs), care coordinating entities contracted with Colorado’s Medicaid program, or other managed care entities to cover CHW services, nor does the Department pay for CHW services under FFS.

Medicaid 52

Medicaid Primary Care Prevention Nursing 52

Home Health Care

DECEMBER 2, 2024

These closures often stem from unique challenges, including difficulties in complying with Medicare regulations and reimbursement policies. These actions included upfront payments to specific accountable care organizations (ACOs) to help them expand care to rural areas and serve historically underserved populations.

Telemedicine 96

Telemedicine Home Care Medicare Nursing 96

Health Populi

MAY 22, 2018

The recent announcement of the prescription drug cost regulation blueprint, “American Patients First,” speaks to President Trump’s and Secretary Azar’s focus on regulatory reforms targeting the prices of medicine. Last year’s rate of growth was 4.6%.

Accountable Care 91

Accountable Care Hospitals Accountability Regulations 91

HIT Consultant

APRIL 7, 2023

Additionally, digitized health records have been used to make patient information more easily accessible, first to meet Health Insurance Portability and Accountability Act (HIPAA) and HITECH mandates, and now, increasingly, to meet the 21st Century Cures Act ‘Final Rule’ mandate, requiring timely and standardized access to all patient data.

Hospitals 52

Hospitals Life Sciences Accountability Integration 52

Home Health Care

MAY 23, 2022

Out of those creations came the Biden administration’s accountable care organization (ACO) “REACH” Model, which stands for “Realizing Equity, Access and Community Health.” The third, the Geographic Direct-Contracting Model, was completely done away with.

Medicare 115

Medicare Accountable Care Accountability Doctors 115