Healthcare ECONOMIST

JULY 3, 2024

[link] [link] Masia then examines the impact of 340B on Medicaid cost: Our regression estimates suggest that the increase in 340B hospital and grantee participation from 2014 to 2021 increased overall Medicaid spending by $391 per enrollee, or over $32 billion per year.

Medicaid 119

Medicaid Pharmaceuticals Hospitals Accountability 119

Healthcare ECONOMIST

FEBRUARY 19, 2024

For manufacturers, they are hoping that the CGT access model will expedite access for patients and reduce transaction costs since manufacturers would have to negotiate with much fewer than 50 State Medicaid Agencies. What types of rebates could State Medicaid Agencies receive under the CGT Access Model? million per patient.

Medicaid 122

Medicaid Pharmaceuticals Accountability 122

Home Health Care

APRIL 28, 2023

Centers for Medicare & Medicaid Services (CMS) proposed a new rule that would make major changes to the way that home care workers are compensated under Medicaid. The bulk of its business is in Medicaid. Anderson also noted that home care agencies working under Medicaid often vary in size. On Thursday, the U.S.

Medicaid 91

Medicaid Accountability Quality Assurance Home Care 91

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 111

Medicaid Accountability 111

HIT Consultant

JULY 13, 2022

has been driven by the establishment of the Center for Medicare and Medicaid Innovation (CMMI). Historically, CMS models have focused on enabling providers to increase accountability for patients’ health through ACO condition-specific models and payer-supported models like Medicare Advantage.

Accountability 98

Accountability Accountable Care Primary Care Medicare 98

Fierce Healthcare

AUGUST 2, 2024

The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting one industry group to react to the modifications. Accountable care organizations are evaluating the impacts of the new requirements for the ACO REACH program. So far, the changes are a mixed bag, says NAACOS.

Accountable Care 188

Accountable Care Accountability Medicaid Medicare 188

HIT Consultant

JULY 16, 2024

Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We But there’s a lot of reasons to be optimistic.

Medicaid 105

Medicaid Digital Care Accountability Prevention 105

Home Health Care

DECEMBER 10, 2024

However, a recent study found that despite an increase in Medicaid spending on home- and community-based services (HCBS), the wages for home care workers have not changed. “We find no association between changes in Medicaid HCBS expenditures and wages, researchers wrote in the study.

Medicaid 86

Medicaid Home Care Accountability 86

Healthcare It News

JANUARY 18, 2022

Social determinants of health are major contributors to health inequity and rising healthcare costs in vulnerable populations such as Medicaid beneficiaries. For example, training a predictive model on the general population may be inaccurate when used in a Medicare or Medicaid population.

Pharmaceuticals 332

Pharmaceuticals Accountable Care Accountability Medicaid 332

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 256

Telemedicine Primary Care Medicaid Urgent Care 256

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

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 248

Accountability Medicaid Prevention 248

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 145

Primary Care Accountable Care Accountability Medicaid 145

Home Health Care

APRIL 30, 2024

This article is a part of your HHCN+ Membership Now that the Medicaid Access Rule has been finalized , home-based care’s company leaders have had time to digest it, and consider what it means for the future of the space. Here’s what six of them had to say.

Home Care 98

Home Care Medicaid Accountability Quality Improvement 98

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 79

Medicaid Accountability Pharmaceuticals 79

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 100

Accountability Home Care Medicaid Regulations 100

Home Health Care

APRIL 23, 2024

This article is a part of your HHCN+ Membership On Tuesday, Centers for Medicare & Medicaid Services (CMS) officials vehemently backed the thought process behind the “80-20” wage mandate in home- and community-based services (HCBS). Providers and advocates, on the other hand, continued to argue that the policy could be disastrous.

Home Care 99

Home Care Medicaid Law Firms Quality of Care 99

p3care

NOVEMBER 1, 2024

Various government organizations like the Centers for Medicare and Medicaid Services (CMS) and CDC’s National Center for Health Statistics (NCHS) govern these processes to ensure smooth operations. Improved Revenue It will reduce your days in accounts receivable management (AR) by reducing the claim denials ratio and boosting revenue.

Doctors 245

Doctors Accountability Patient Experience Medicaid 245

NASHP

APRIL 24, 2023

As part of the three M’s (Medicaid, Marketplace, and Medicare) of coverage, the marketplaces will be a critical source of coverage for individuals who no longer qualify for Medicaid. The SBMs bring all of this experience in supporting Medicaid agencies with the Medicaid unwind process for millions of individuals across states.

Medicaid 84

Medicaid Accountability Medicare Integration 84

Home Health Care

MAY 3, 2024

This article is a part of your HHCN+ Membership When the “Ensuring Access to Medicaid Services” rule was finalized last week, the 80-20 provision stole the show, due to its unpopularity among home-based care leaders. Terzaghi believes that this new requirement will hold states accountable regarding rates.

Medicaid 93

Medicaid Home Care Accountability Medicare 93

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

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 96

Medicaid Home Care Accountability Integration 96

p3care

FEBRUARY 10, 2021

From the next performance year (2021), Accountable Care Organizations (ACOs) expect different reporting requirements under the Medicare Shared Savings Program. CMS (Centers for Medicare and Medicaid Services) has recommended changes for ACO reporting criteria. The requirements are somewhat the same as for QPP MIPS.

Medicare 246

Medicare Accountable Care Accountability Medicaid 246

Fierce Healthcare

SEPTEMBER 24, 2024

The Centers for Medicare & Medicaid Services (CMS) finalized a rule (PDF) Tuesday to limit the impact of fraudulent bi | Hoping to help accountable care organizations turn the page on a messy urinary catheter scandal, CMS released a final rule to hold ACOs financially harmless.

Accountable Care 130

Accountable Care Accountability Medicaid Medicare 130

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 Regulations Integration 102

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

NASHP

MAY 26, 2023

It is one of the most desired caregiver services , and Medicaid is one policy lever to fund it. Through Medicaid’s federal-state partnership and under a variety of home and community-based services (HCBS) coverage authorities, states have the flexibility to design HCBS to meet the long-term care needs of their populations.

Medicaid 121

Medicaid Nursing Regulations Integration 121

Healthcare ECONOMIST

SEPTEMBER 13, 2024

In fact, these three large PBMs (CVS Caremark, Optum Rx, and Express Scripts) account for 73.6% …CVS Caremark alone accounted for 39.2% of PBM services in the Medicaid managed care market, 28.5% in Medicare Part D, while Express Scripts accounted for 28.0% …CVS Caremark alone accounted for 39.2%

Accountability 103

Accountability Medicaid Medicare 103

p3care

NOVEMBER 25, 2020

In the last quarter of 2020, CMS (Centers for Medicare & Medicaid Services) announced the performance scores for clinicians of QPP MIPS 2019 on its official site. It accounts for quality healthcare services, that CMS recognizes and rewards for. Check Points for Performance Review.

Medicare 238

Medicare Accountability Doctors Medicaid 238

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

Healthcare It News

MARCH 29, 2022

With a shortage of physicians to address the growing need for care, a lack of providers who accept Medicaid, and access issues due to transportation or office hour challenges, healthcare organizations are looking to technology to help bridge the gap. Addressing the increasing need for behavioral health services is a nationwide challenge.

Rehabilitation 181

Rehabilitation Nursing Accountability Medicaid 181

Healthcare It News

JANUARY 4, 2022

Progress toward accountable care is halting. "The adoption of hospital-at-home programs across the country has been rapid, with nearly 200 hospitals participating in the Centers for Medicare and Medicaid Services’ Acute Hospital Care at Home program in only a year since its launch," said Majmudar.

Hospitals 335

Hospitals Nursing Accountable Care Clinical Practice 335

Home Health Care

JUNE 26, 2024

Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule Wednesday. With it, the agency signaled that more significant cuts could be on the way for providers. For CY 2023 and CY 2024, CMS previously applied a 3.925% reduction and a 2.890% reduction, respectively.

Medicare 123

Medicare Medicaid Accountability 123

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 106

Medicaid Accountability Medicare Nursing 106

Healthcare It News

JULY 19, 2022

“Today, 98% of our members have created accounts; and in the last week alone, 92% of our members logged into the app. But consider this – 70% of our members are on Medicaid today. Yet 98% have created accounts for the mobile app.”

Integration 237

Integration Accountability Telemedicine Medicaid 237

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 113

Home Care Medicaid Accountability Regulations 113

Healthcare It News

MARCH 30, 2022

With the temporary flexibilities from HHS and the Centers for Medicare and Medicaid Services, as well as the impact of the pandemic on telehealth use, we really wanted to kind of do a deep dive and to see, "OK, how many beneficiaries are using telehealth?

Medicare 239

Medicare Medicaid Integration Quality of Care 239