HIT Consultant

JANUARY 27, 2025

Personalized Treatment Plans Traditional treatments often rely on standardized protocols that fail to account for the unique characteristics of individual patients. Lets explore how AI is enabling this evolution and what it means for patients, providers, and the broader healthcare ecosystem.

Healthcare 99

Healthcare Life Sciences Pharmaceuticals Public Hospital 99

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. The heightened attention on personal care services leads to necessary sophistication, oversight and regulation.

Medicaid 95

Medicaid Regulations Accountability Medicare 95

Home Health Care

DECEMBER 7, 2021

Mostly, though, the Obama-era regulation has ended up decreasing the amount of live-in care that home care agencies provide. For now, home care providers are stymied by Medicaid wages, which do not match the pay that would be needed for live-in care. The administration’s goal at the time was to raise caregiver wages.

Regulations 98

Regulations Home Care Law Firms Accountability 98

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

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 116

Home Care Medicaid Accountability Regulations 116

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

Home Health Care

JULY 22, 2024

Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No.

Regulations 116

Regulations Home Care Medicaid Medicare 116

NCQA

DECEMBER 18, 2024

Lack of standardized performance measures makes it difficult to hold health systems and clinicians accountable for equitable care. Goal 4: Ensure adequate resources to enforce existing laws and build systems of accountability that explicitly focus on eliminating health care inequities and advancing health equity.

Quality Assurance 52

Quality Assurance Accountability Quality Improvement Pharmaceuticals 52

p3care

MAY 20, 2022

Each performance category accounts for a particular percentage of the overall score, which determines how much payment adjustment a clinician will receive for the following MIPS year’s performance. The rules and regulations relating to each category also change or are updated every year.

Prevention 246

Prevention Doctors Healthcare Providers Regulations 246

NASHP

NOVEMBER 17, 2023

The National Academies of Sciences, Engineering, and Medicine (NASEM) published a critical report during the pandemic , finding that “the way the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.”

Nursing 105

Nursing Medicaid Accountability Home Care 105

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

NCQA

JUNE 27, 2023

More states are contracting with managed care organizations (MCO) to provide Medicaid long-term services and supports (LTSS). In July, NCQA will update these programs to further align with best practices and federal regulations. Increase Alignment with Federal Provisions: LTSS Distinction helps MCOs meet HCBS waiver regulations.

Medicaid 52

Medicaid Care Transition Quality Improvement Regulations 52

Home Health Care

JANUARY 22, 2025

The expanded HHVBP model builds on the success of the original model, which improved total performance scores among home health agencies by an average of 4.6%, according to the Center for Medicare and Medicaid Services (CMS).

Medicare 77

Medicare Hospitals Quality of Care Nursing 77

NASHP

AUGUST 30, 2023

The Centers for Medicare and Medicaid Services (CMS) promulgated final regulations for REHs at 87 Fed.Reg. As of June 2023, fourteen states passed legislation and/or adopted emergency regulations to allow hospitals in their state to become eligible for the new REH designation. 1395x(kkk)(2). 58640 (August 28, 2023).

Hospitals 121

Hospitals Regulations Medicare Medicaid 121

p3care

MAY 31, 2024

An ACO (Accountable Care Organization) works for the better care of patients. Regulatory Compliance ACOS must adhere to rules set forth by government bodies such as CMS (Centers for Medicare and Medicaid Services). Complying with all these regulations helps in avoiding penalties.

Quality of Care 130

Quality of Care Doctors Medicare Patient Experience 130

HIT Consultant

MAY 2, 2023

For decades, the industry lacked a patient-centric approach focused on efficiency, reliability, and accessibility for all populations, especially those enrolled in Medicare Advantage and Medicaid plans. In a recent study , 21% of U.S. adults without access to a vehicle or public transportation skipped needed medical care last year.

Medicaid 96

Medicaid Regulations Medicare Integration 96

Sheppard Health Law

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. 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]

Medicaid 52

Medicaid Regulations Prevention Accountability 52

Home Health Care

NOVEMBER 7, 2023

Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030. Currently, roughly 13.2 million Medicare fee-for-service beneficiaries are assigned to an ACO.

Medicare 114

Medicare Accountable Care Home Care Accountability 114

Home Health Care

MAY 24, 2024

Though home health care helps nearly 36 million 65+ and permanently disabled Americans recover at home and avoid costlier placements in institutions, the Centers for Medicare & Medicaid Services (CMS) has initiated deep cuts to the Medicare home health industry, totaling $25 billion in cuts over the next decade.

Medicare 122

Medicare Medicaid Nursing Home Care 122

HIT Consultant

JULY 22, 2024

HIPAA (Health Insurance Portability and Accountability Act) stands as a sentinel, guarding the security and privacy of patient information, but its limitations in supporting contemporary information-sharing needs must be acknowledged. Non-covered entities are not subject to HIPAA requirements, and therefore cannot technically violate them.

Healthcare 105

Healthcare Regulations Accountability Medicaid 105

NASHP

DECEMBER 10, 2021

The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches?to?integrating?CHWs ACO Accountable Care Organizations. MHP Medicaid Health Plans. RAE Regional Accountable Entity. Medicaid Reimbursement.

Medicaid 122

Medicaid Primary Care Prevention Nursing 122

Home Health Care

AUGUST 23, 2023

Centers for Medicare & Medicaid Services (CMS) decides to do with its home health final payment rule , industry experts believe providers need to drastically improve their cost reporting data. Over the years, Maxim said she has seen providers cutting corners firsthand when hiring accountants to put together cost reports.

Law Firms 98

Law Firms Medicaid Hospice Care Regulations 98

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

OCTOBER 18, 2024

It’s past time for legislators and regulators to hold plans accountable and protect patient care.” “The report today puts an exclamation point on what we’ve been saying for a long time,” Federation of American Hospitals (FAH) President and CEO Chip Kahn said in a statement. Founded in 1966, the Washington D.C.-based

Rehabilitation 111

Rehabilitation Regulations Medicare Hospitals 111

Home Health Care

FEBRUARY 8, 2024

The Centers for Medicare & Medicaid Services (CMS) wants 100% of traditional Medicare beneficiaries and the “vast majority of Medicaid beneficiaries” in accountable care relationships by 2030. Oak Street Health, which is now also owned by CVS Health, is one of these risk-bearing delivery organizations.

Medicare 122

Medicare Accountable Care Accountability Primary Care 122

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

Bill Of Health

OCTOBER 28, 2022

Each month, members of the Program On Regulation, Therapeutics, And Law (PORTAL) review the peer-reviewed medical literature to identify interesting empirical studies, policy analyses, and editorials on health law and policy issues. Holding Pharmaceutical and Medical Device Executives Accountable as Responsible Corporate Officers.

Pharmaceuticals 96

Pharmaceuticals Regulations Accountability Medicaid 96

Home Health Care

JUNE 17, 2022

Centers for Medicare & Medicaid Services (CMS) released its FY 2023 home health proposed payment rule late Friday. It comes with a decrease to payment rates by 4.2%, or $810 million less compared to 2022 rates. That has been made clear to CMS in the 2021 rulemaking and in multiple discussions since.”

Accountability 111

Accountability Medicaid Home Care Medicare 111

Home Health Care

DECEMBER 23, 2022

In September, CityBlock teamed up with MDwise, the second-largest Medicaid managed care organization in Indiana. We are purposefully partnering with entities that are working with patients who are on Medicaid or dual-eligible beneficiaries,” Matthews said. “We’re I’m very nervous about that.

Primary Care 105

Primary Care Medicaid Regulations Accountability 105

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

Home Health Care

JANUARY 26, 2022

Centers for Medicare and Medicaid Services (CMS) stopped reimbursing InnovAge for new clients. We are committed to restoring trust with our regulators to being the leading steward of the PACE program. PACE is a Medicare and Medicaid program that helps keep people in their communities instead of nursing homes.

Regulations 98

Regulations Care Transition Medicaid Medicare 98

Healthcare Success

JULY 5, 2022

You're selling a product or service regulated by the state (or county). Understanding how these compensation models may influence your target doctors and account for them is essential. You’re selling a product or service with significant state or local competition.

Doctors 148

Doctors Private Practices Accountability Hospitals 148

Etactics

FEBRUARY 14, 2025

Including the claims data from the Centers for Medicare and Medicaid Services (CMS). Even the most honest of mistakes can lead to compliance penalties, such as a Health Insurance Portability and Accountability Act (HIPAA) violation. Keep CMS regulations, commercial payer policies, and NCCI edits at your companys forefront.

Prevention 52

Prevention Integration Healthcare Providers Regulations 52

Home Health Care

FEBRUARY 1, 2023

The state then told Medicaid providers that it was committed to compensating them for the added costs associated with the wage increase, which could be as much as $5 billion in 2023, per the New York state government. “It I think they’re also vulnerable to abuse and an overuse of the Medicaid benefit.

Home Care 98

Home Care Medicaid Law Firms Nursing 98

HIT Consultant

NOVEMBER 29, 2022

For example, the Coronavirus Aid, Relief, and Economic Security (CARES) Act included a payment parity requirement for Medicare; and many private insurers followed suit implementing similar regulations in their commercial plans. get their health coverage through Medicaid, this is absolutely essential to ensure healthcare equity.

Telemedicine 98

Telemedicine Medicaid Regulations Medicare 98

Home Health Care

MARCH 7, 2025

But some questions have been swirling around private equity activity in health care, with the federal and state governments holding hearings, issuing scathing reports about how care quality declines under PE ownership, and taking action to regulate this type of investment in light of spectacular failures such as the implosion of Steward Health Care.

Home Care 59

Home Care Medicare Regulations Quality of Care 59

Home Health Care

OCTOBER 25, 2024

How many more examples does Congress need before they do something to hold managed care companies accountable for these outrageous practices that threaten patient care?” It’s past time for legislators and regulators to hold plans accountable and protect patient care,” Kahn said in a separate statement.

Medicare 105

Medicare Accountability Hospitals Regulations 105