p3care

SEPTEMBER 26, 2023

Medicare and Medicaid are the two biggest healthcare insurance programs in the United States. The federal government has made different rules and regulations applicable to eligible populations. Let’s get started with a little introduction to Medicare and Medicaid programs in general.

Medicaid 130

Medicaid Medicare Regulations Prevention 130

Home Health Care

SEPTEMBER 19, 2024

have set their sights on lifting age-based restrictions in the Medicaid buy-in program. On Wednesday, the policymakers introduced the Ensuring Access to Medicaid Buy-In Programs Act. If enacted, the legislation would eliminate a restriction that blocks people living with disabilities from buying into Medicaid once they reach age 65.

Medicaid 105

Medicaid Regulations Home Care Prevention 105

Fierce Healthcare

APRIL 23, 2024

Interoperability mandates from the Centers for Medicare and Medicaid Services (CMS) have required major investments by health plans in recent years and will continue to be critical in informing ove | Facing new CMS mandates, MVP Health Care Chief Strategy Officer offers considerations to align your compliance strategy with innovation goals.

Regulations 130

Regulations Medicaid Medicare 130

Home Health Care

FEBRUARY 13, 2024

The issue is that — due to the caregiver shortage, the rising cost of care, Medicaid qualifications and a number of other factors — many of them won’t be able to afford it. Seniors not supported by Medicaid or Veterans Affairs (VA) are left to pay out of pocket for services that can often be very expensive.

Regulations 116

Regulations Home Care Law Firms Medicaid 116

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

HIT Consultant

APRIL 19, 2024

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule.

Regulations 102

Regulations Nursing Medicare Medicaid 102

Home Health Care

NOVEMBER 22, 2023

Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver was a major boost for organizations hoping to implement or expand hospital-at-home programs. With this in mind, some are wondering if state Medicaid agencies could be a way to further the hospital-at-home movement.

Medicaid 119

Medicaid Hospitals Medicare Regulations 119

NCQA

JUNE 28, 2024

The Centers for Medicare & Medicaid Services (CMS) recently announced two major updates to Medicaid regulations. The Impact on Medicaid Beneficiaries CMS recognizes that outdated regulations and inconsistent delivery systems hinder access to quality care. Report on 1915(c) HCBS W aiver W ait L ists.

Medicaid 59

Medicaid Regulations Care Transition Primary Care 59

Home Health Care

NOVEMBER 8, 2021

Since the Centers for Medicare & Medicaid Services (CMS) released its interim emergency regulation relating to the federal government’s vaccine mandate last Thursday, more clarity has come to the surface. The post ‘Layer Upon Layer of Regulation’: Breaking Down the CMS Vaccination Mandate appeared first on Home Health Care News.

Regulations 98

Regulations Medicaid Medicare 98

Fierce Healthcare

DECEMBER 8, 2023

A House vote on transparency regulations in healthcare could occur next week, potentially having substantial ramifications on how PBMs and hospitals operate. | Bipartisan anticipation is in the air for a potential vote in the House this week that would bring transparency to PBMs and ban spread pricing in Medicaid, but hospital groups are firmly opposed (..)

Regulations 296

Regulations Medicaid Hospitals Healthcare 296

Home Health Care

AUGUST 14, 2023

Centers for Medicare & Medicaid Services (CMS) – which would require at least 80% of Medicaid reimbursement for home- and community-based services go toward worker compensation – received over 2,100 submissions during its public comment period. A proposed rule from the U.S.

Medicaid 98

Medicaid Regulations Home Care Medicare 98

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

Readiness Rounds

OCTOBER 3, 2023

The Tightening Grip of CMS Regulations 2. The rules of unannounced visits from regulatory bodies have been significantly tightened by the Centers for Medicare & Medicaid Services (CMS) making it crucial for healthcare facilities to be constantly prepared. Headlines: 1. Key Takeaways 5.

Regulations 52

Regulations Performance improvement Patient Safety Hospitals 52

Home Health Care

FEBRUARY 14, 2024

One way to do so would be by mirroring the regulatory model state Medicaid programs use for home- and community-based services. The report suggests that the Medicaid model is the answer. Medicaid] has always kind of relied on that regulated agency model that the states have kind of set up around caregivers entering the home.

Home Care 80

Home Care Medicaid Regulations Medicare 80

Home Health Care

MAY 11, 2023

Centers for Medicare & Medicaid Services (CMS) recent proposed rule for Medicaid may cap business for certain providers , but industry experts believe the government agency is likely foreshadowing its intentions for the final rule. Industry advocates do not believe the 80% threshold will stand in the final rule. “I

Medicaid 97

Medicaid Nursing Regulations Home Care 97

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

Home Health Care

APRIL 22, 2024

The White House teased the finalized Medicaid Access Rule early Monday, and the Centers for Medicare & Medicaid Services (CMS) later revealed more intricate details attached to the rule. Firstly, the timeline of the rule is now clear. Ultimately, providers’ ability to operate is obviously paramount to greater access to HCBS.

Medicaid 85

Medicaid Home Care Quality of Care Medicare 85

NASHP

JUNE 30, 2023

During the COVID-19 public health emergency (PHE), states instituted Appendix K amendments to 1915(c) home-and community-based waivers and 1115 demonstration waivers to ensure that Medicaid beneficiaries were able to receive needed services during the pandemic. Information was collected between May 9 and June 23, 2023. Hartford Foundation.

Medicaid 105

Medicaid Regulations Home Care Nursing 105

HKLaw

NOVEMBER 11, 2024

The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute).

Medicare 98

Medicare Regulations Medicaid 98

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

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

Briggs Healthcare

FEBRUARY 21, 2022

The Informational Letter is directed to Iowa Medicaid Providers, but it contains a message that I thought was worth sharing. Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare. The Iowa Department of Human Services issued IL 2315-MC-FFS-CVD on Sunday, February 20, 2022.

Regulations 104

Regulations Medicaid Healthcare 104

Healthcare It News

DECEMBER 29, 2023

This past week, New York Governor Kathy Hochul signed Senate Bill 1196a/Assembly Bill 1673a into law directing all state-regulated health plans, including Medicaid, to cover comprehensive biomarker testing, clearing the path for more patients to access precision medicine treatments.

Medicaid 279

Medicaid Regulations Integration Healthcare 279

Home Health Care

JULY 11, 2022

Many Pennsylvanians with physical disabilities are covered by Medicaid, which pays for at-home caregivers. Pennsylvania has three Medicaid managed care organizations, which receive state funding to pay for the caregivers. What the proposal does. I think it’s going to be something that SEIU attempts in other states.”.

Home Care 98

Home Care Regulations Medicaid Nursing 98

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

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

HIT Consultant

OCTOBER 22, 2024

This provided agencies with broad discretion to create and enforce regulations that often filled gaps left by legislators. Implications for Cybersecurity in Healthcare Vulnerability of Existing Regulations The immediate impact of this ruling is the increased vulnerability of existing cybersecurity regulations to legal challenges.

Healthcare 139

Healthcare Regulations Medicaid Medicare 139

Triage Health Law

JANUARY 11, 2023

Pursuant to federal regulations that took effect on January 1, 2023, individuals who lose Medicaid coverage will be granted a special enrollment right to enroll in Medicare Part B coverage. [1] This is however changing and Ohio is an example.

Medicaid 59

Medicaid Medicare Regulations Doctors 59

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 98

Medicaid Accountability Quality Assurance Home Care 98

Healthcare ECONOMIST

NOVEMBER 21, 2021

Where does the Centers for Medicare and Medicaid Services see Medicaid and the Children’s Health Insurance Program (CHIP) heading in the future. Medicaid coverage is a difficult proposition. Not only that, 70% of Medicaid beneficiaries are covered by private plans that States pay to administer the benefit.

Medicaid 69

Medicaid Regulations Medicare 69

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

NASHP

AUGUST 19, 2022

Emerging State Innovations in Developing a Medicaid Community-Based Palliative Care Benefit August 19, 2022 / by Salom Teshale and Wendy Fox-Grage. Research has found relationships between palliative care consultation and lower hospital costs for Medicaid beneficiaries, indicating that palliative care can contain costs.

Medicaid 59

Medicaid Regulations Medicare Integration 59

NASHP

APRIL 15, 2022

Midwife Medicaid Reimbursement Policies by State April 15, 2022. You can also download the charts on Certified Nurse-Midwife State Medicaid Reimbursement Policy and Midwife Licensing and State Medicaid Reimbursement Policy. Certified Nurse-Midwife State Medicaid Reimbursement Policy. Medicaid Reimbursement.

Medicaid 64

Medicaid Nursing Medical Practitioners Regulations 64

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

Healthcare It News

DECEMBER 16, 2022

What does 2023 hold for healthcare technology, as innovation continues at rapid speed, policymakers and regulators try to keep up with the pace of change – and health systems large and small deal with significant budgetary shortfalls that could hamper their ability to build out their digital transformation efforts?

Healthcare Finance 310

Healthcare Finance Regulations Patient Safety Patient Experience 310

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

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