Sheppard Health Law

NOVEMBER 13, 2023

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). The UM committee was established in April 2023 in the 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F).

Medicare 59

Medicare Medicaid Regulations Integration 59

HIT Consultant

DECEMBER 20, 2022

Carallel already supports more than 400,000 Medicare Advantage and commercially insured members and their caregivers nationally. The company plans to use the new funding to expand its reach in both the Medicare Advantage and commercial markets. Adoption/Traction to Date. Reducing Stress in 90% of Caregivers.

Medicare 98

Medicare Quality Improvement Accountability Healthcare Providers 98

HIT Consultant

JANUARY 22, 2024

What You Should Know: – The Centers for Medicare & Medicaid Services (CMS) has taken a bold step towards improving care for individuals with both mental health conditions and substance use disorders (SUD), announcing the “ Innovation in Behavioral Health (IBH)” Model.

Medicaid 97

Medicaid Quality of Care Integration Medicare 97

Home Health Care

NOVEMBER 22, 2022

Government Accountability Office (GAO) has signed off on the home health payment rule finalized by the Centers for Medicare & Medicaid Services (CMS) last month. In no way are these adjustments consistent with logic or the Medicare law on budget neutrality in the transition from the 2019 payment model to PDGM in 2020.

Medicare 90

Medicare Medicaid Quality Improvement Accountability 90

Sheppard Health Law

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicaid Accountability Integration 52

NCQA

OCTOBER 31, 2023

“ It’s a marathon, not a sprint ,” said Liz Fowler, Director at the Center of Medicare and Medicaid Innovation (CMMI), during a recent Fireside Chat with NCQA Executive Vice President Eric Schneider. And then we’re also developing an approach for certification based on quality improvement and patient experience.”

Primary Care 52

Primary Care Quality Improvement Medicaid Accountable Care 52

Healthcare ECONOMIST

JANUARY 14, 2022

Most individuals in its catchment area were Medicaid or Medicare beneficiaries or uninsured, representing the densest noncommercial payor communities for nonpublic hospitals in the country. Before the merger, funding was lacking for technology and infrastructure investments to support quality improvement. Information technology.

Hospitals 66

Hospitals Rehabilitation Quality Improvement Accountability 66

NASHP

MARCH 22, 2024

States are hoping to achieve a number of goals with their MLTSS programs, including increasing access to home and community-based services, promoting care coordination, enhancing quality and beneficiary satisfaction, and mitigating cost growth. The following table provides a snapshot of the states and MLTSS programs selected for this project.

Medicaid 75

Medicaid Nursing Medicare Integration 75

GoMoHealth

OCTOBER 20, 2022

By Nakecia Taffa, Quality Improvement and Health Equity Director for GoMo Health. This led me to GoMo Health, where we create, activate and scale these improvements daily. While most managed care organizations go to great lengths to comply with Medicaid and Medicare mandates, many are still struggling to meet their goals.

Quality Improvement 88

Quality Improvement Medicaid Population Health Medicare 88

p3care

MAY 2, 2022

MIPS (Merit-based Incentive Payment System) was launched by the Quality Payment Program (QPP) for the Medicare Part B healthcare providers. There are four categories in this category of QPP reporting , which are: Quality. Improvements Activities. Categories. Promoting Interoperability.

Nursing 130

Nursing Prevention Quality Improvement Regulations 130

Briggs Healthcare

OCTOBER 19, 2021

population, NH residents account for nearly 33% of all COVID-19 deaths. The Center for Medicare and Medicaid Services implemented sweeping telemedicine (TM) regulatory relief in an effort to reduce COVID-19 spread in NHs. The Pre-Proof is a 7-page document that contains some valuable information. Telemedicine activity in U.S.

Telemedicine 52

Telemedicine Nursing Health Science Quality Improvement 52

Accountable Care Doctors

NOVEMBER 17, 2020

Earlier this year, CAPP asked the Institute for Accountable Care (IAC) Executive Director Rob Mechanic to conduct a scan of the latest literature on accountable care entities, programs, and payment models in an effort to understand the factors that influence participation in such arrangements and on cost and quality performance.

Accountable Care 52

Accountable Care Accountability Medicare Integration 52

Accountable Care Doctors

NOVEMBER 17, 2020

Earlier this year, CAPP asked the Institute for Accountable Care (IAC) Executive Director Rob Mechanic to conduct a scan of the latest literature on accountable care entities, programs, and payment models in an effort to understand the factors that influence participation in such arrangements and on cost and quality performance.

Accountable Care 52

Accountable Care Accountability Medicare Integration 52

HIT Consultant

OCTOBER 21, 2022

This work occurs alongside evaluating how to integrate the medical device into the hospital system’s diagnostic paradigms, including in relation to quality improvement programs. Sepsis accounts for the highest in-patient deaths and costs and is additionally the most under-reimbursed for diagnosis and treatment.

Hospitals 98

Hospitals Quality Improvement Medicaid Clinical Practice 98

Home Health Care

APRIL 30, 2024

While some acknowledge the good in the Centers for Medicare & Medicaid Services’ (CMS) reform efforts, others are facing the grim realities tied to the 80-20 provision. This outdated system fails to account for potential savings and quality improvements achievable through alternative care models.

Home Care 103

Home Care Medicaid Accountability Quality Improvement 103

Briggs Healthcare

AUGUST 2, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The August 2023 Performance Score Reports (PSRs) for the fiscal year (FY) 2024 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). Select the MDS 3.0

Quality Improvement 40

Quality Improvement Accountability Nursing Medicare 40

Healthcare ECONOMIST

OCTOBER 4, 2021

The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS is an approach for CMS to pay physicians caring for Medicare beneficiaries based not just on volume but on value. How did Medicare physicians fare on the MIPS program? Bonus points.

Medicare 90

Medicare Quality Improvement Quality of Care Accountability 90

Briggs Healthcare

MARCH 20, 2023

and Jonathan Blum, Centers for Medicare & Medicaid Services – names you may recognize from CMS National Stakeholder Calls. As the nation’s largest payer for health care, the Centers for Medicare & Medicaid Services’ (CMS) mission in our National Quality Strategy includes ensuring everyone is safe when they receive care.

Patient Safety 40

Patient Safety Medicaid Medicare Quality of Care 40

Briggs Healthcare

OCTOBER 25, 2022

Today’s announcement is part of a series of new actions the Biden-Harris Administration is taking to increase accountability of bad actors in the nursing home industry, improve the quality of nursing homes and make them safer. Below is an excerpt from that Press Release.

Nursing 40

Nursing Accountability Quality Improvement Quality of Care 40

NASHP

APRIL 24, 2023

State Efforts to Extend Medicaid Postpartum Coverage SEE THE TRACKER In October 2022, the Centers for Medicare & Medicaid Services (CMS) approved two Georgia state plan amendments (SPAs) to increase coverage of postpartum services to 12 months. NASHP tracks state efforts to extend Medicaid postpartum coverage. deaths per 100,000 births.

Medicaid 52

Medicaid Prevention Accountability Quality Improvement 52

Briggs Healthcare

MARCH 1, 2022

million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation. Research also suggests that, despite depriving residents of quality care, private equity-owned nursing homes actually led to an uptick in Medicare costs , too. More than 1.4 Reduce Resident Room Crowding.

Quality of Care 40

Quality of Care Nursing Accountability Medicaid 40

Home Health Care

OCTOBER 28, 2022

How did you measure the quality of that data and quantify those values in a comparable and accessible way? Longo : There are nearly 11,000 home health agencies that report data to the Centers for Medicare and Medicaid Services. The relationship between higher star ratings and accreditation seems to reflect that commitment to quality.

Patient Safety 80

Patient Safety Performance improvement Quality Improvement Accountability 80

Briggs Healthcare

APRIL 5, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare On April 17, 2023, the Centers for Medicare & Medicaid Services (CMS) will transition to the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) record submissions and reports.

Accountability 52

Accountability Nursing Medicare Quality Improvement 52

NASHP

JUNE 22, 2023

paid for by Medicaid, there is growing interest in exploring how Medicaid service delivery systems can be adapted to help improve maternal health outcomes.[5] 6] VBPs, or alternative payment models, focus on reimbursement based on the quality of care provided as well as rewarding lower cost. Accessed May 1, 2023.

Medicaid 59

Medicaid Prevention Accountability Medicare 59

NASHP

AUGUST 31, 2023

State leaders play a critical role in convening key internal and external partners, implementing engagement and input processes that foster shared ownership and accountability toward goals at the state and community levels.

Medicaid 52

Medicaid Accountability Public Health services Population Health 52

NASHP

OCTOBER 20, 2022

In spite of these barriers, and to help address them, states have implemented innovations to improve integrated care coordination for CYSHCN. For example, the Centers for Medicare & Medicaid Services Innovation Center is currently supporting the Integrated Care for Kids (InCK) model across seven sites in six states.

Medicaid 98

Medicaid Integration Accountability Quality Improvement 98

Sheppard Health Law

JANUARY 5, 2022

First, issuers may only count provider incentive and bonus payments as claims expense if they are “tied to clearly defined, objectively measurable, and well-documented clinical or quality improvement standards.” Second, issuers only may count expenditures directly related to activities that improve healthcare quality.

Primary Care 52

Primary Care Quality Improvement Healthcare Quality Accountability 52

HIT Consultant

OCTOBER 26, 2021

In fact, 57% of Medicare patients are released from the hospital without any post-discharge monitoring. With RPM, care can be moved into the home: value-based care here means delivering quality healthcare in the setting that works best for patients that both improve lives and lowers costs. Another benefit of RPM?

Remote Care 52

Remote Care Healthcare Doctors Primary Care 52

NASHP

MARCH 22, 2024

This includes alignment across the state Medicaid and behavioral health administrations, including shared systems and shared accountability, and a unified contracting approach across all relevant state agencies to create a unified network. Colorado Colorado is engaged in multi-pronged behavioral health reform.

Medicaid 52

Medicaid Urgent Care Primary Care Hospitals 52

NASHP

AUGUST 23, 2021

Lack of Access to Specialists Associated with Mortality and Preventable Hospitalizations of Rural Medicare Beneficiaries.” Payment to improve capabilities. Regional accountable entities. Using payment to create incentives to improve performance. iv] Johnston, K. Wen, and K. Joynt Maddox. Laditka JN, Laditka SB, Probst JC.

Primary Care 64

Primary Care Medicaid Accountability Quality Improvement 64

NASHP

MARCH 28, 2022

A certified nurse assistant (CNA) is qualified to work in a Medicare-certified nursing facility. A Medicare-certified HHA is qualified to provide services through a Medicare-certified home health agency. A Medicare-certified HHA is qualified to provide services through a Medicare-certified home health agency.

Nursing 98

Nursing Medicaid Home Care Rehabilitation 98

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. Monitor and evaluate quality improvement and outcomes and address barriers to care. Determine structure of benefit.

Medicaid 59

Medicaid Nursing Regulations Hospitals 59

NASHP

MAY 26, 2023

States understand that an individual’s care plan should not be a snapshot in time, but rather malleable to account for unexpected changes in a care recipient’s life. While the value-added service is not required, MCOs and Medicare-Medicaid Plans (MMPs) contracted to provide STAR+PLUS services offer respite as a value-added service.

Medicaid 121

Medicaid Nursing Regulations Integration 121

NASHP

MARCH 22, 2024

North Carolina’s comprehensive behavioral health approach included efforts to increase uptake of CoCM through additional training and practice supports and Medicaid rate increases to 120% of Medicare rates for behavioral health providers. An action plan dashboard tracks targets. CMS’s Birth to 5: Watch Me Thrive!

Medicaid 52

Medicaid Integration Primary Care Nursing 52

NASHP

APRIL 15, 2022

In January 2021, the Centers for Medicare and Medicaid Services (CMS) released a roadmap for states to address social determinants of health that includes several options for supportive housing services. ECM will be delivered through the managed care 1915(b) waiver and contracting with MCPs and is accounted for in capitation rates.

Medicaid 59

Medicaid Public Hospital Hospitals Nursing 59

NASHP

DECEMBER 20, 2022

Now, Oregon’s specialty court program and its staff will receive state-specific guidance, education, training, and peer review, among other quality improvement strategies. Specialty court standards will also be customized based on the type of each court, with different components for family treatment, mental health, etc.

Medicaid 52

Medicaid Prevention Integration Hospitals 52