Fierce Healthcare

APRIL 11, 2024

Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid Services (CMS) said Thursday that the | Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid (..)

Accountable Care 277

Accountable Care Accountability Medicaid Medicare 277

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

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 115

Medicaid Pharmaceuticals Accountability 115

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

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 100

Medicaid Accountability 100

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 111

Home Care Medicaid Accountability Quality Improvement 111

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 207

Accountable Care Accountability Medicaid Medicare 207

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 276

Accountable Care Medicare Accountability Medicaid 276

NASHP

NOVEMBER 8, 2024

A growing trend in state health policy is developing capitated managed care programs to provide long-term services and supports (LTSS) to Medicaid beneficiaries who are older and/or have disabilities. Cardinal Care currently enrolls 90 percent of all Medicaid beneficiaries into MCOs.

Medicaid 52

Medicaid Nursing Quality Improvement Accountability 52

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 111

Medicaid Home Care Accountability Medicare 111

Etactics

JULY 23, 2024

These programs include Medicare, Medicaid, and many more. Two of the most well-known health programs are Medicaid and Medicare. This is because Medicare and Medicaid are crucial systems that provide coverage to millions of Americans. Table of Contents What is Medicaid? What is the Medicaid Exclusion List?

Medicaid 52

Medicaid Medicare Regulations Integration 52

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 111

Home Care Medicaid Law Firms Quality of Care 111

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

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 63

Medicaid Accountability Pharmaceuticals 63

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

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

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

HIT Consultant

APRIL 16, 2024

What You Should Know: – inVio Health Network and CVS Accountable Care Organization, a division of CVS Health , have announced a collaboration to participate in the new Medicare Accountable Care Organization (ACO) REACH program. CVS Accountable Care contributes its extensive experience and resources.

Accountable Care 52

Accountable Care Accountability Medicare Population Health 52

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

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 159

Primary Care Accountable Care Accountability Medicaid 159

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

NASHP

SEPTEMBER 27, 2024

8] Because Medicaid and the Children’s Health Insurance Program (CHIP) cover 44 percent of this population, [9] states can play an important role in improving access to respite care for children with chronic and complex needs and their families by covering this service through HCBS authorities and Section 1115 Medicaid Demonstrations.

Medicaid 59

Medicaid Nursing Medicare Quality Improvement 59

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 111

Accountability Home Care Medicaid Regulations 111

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 105

Medicaid Home Care Accountability Integration 105

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 95

Medicaid Regulations Accountability Medicare 95

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 82

Accountability Medicaid Medicare 82

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

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

AUGUST 5, 2024

CHWs are key to engagement, care coordination, and increasing access to clinical and support services for Medicaid enrollees from their communities. As such, states increasingly are pursuing Medicaid reimbursement options as part of a comprehensive CHW service financing approach, which is currently reliant on expiring grant programs.

Medicaid 52

Medicaid Primary Care Prevention Accountability 52

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

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

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

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 Hospitals 52

Home Health Care

NOVEMBER 15, 2024

Medicaid standards should reflect the unique work of nurses who provide complex one-on-one care to individuals at home. Specifically, this legislation addresses continuous skilled nursing services under Medicaid. HCAOA believes that the bill is a step in the right direction. “By

Nursing 119

Nursing Quality Improvement Home Care Medicaid 119

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