California revises Medicaid contract awards, adding 2 insurers
Healthcare Dive
JANUARY 4, 2023
Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country's largest Medicaid market.
Centene’s 2024 outlook hampered by Medicaid redeterminations
Healthcare Dive
JULY 28, 2023
The payer lost 262,700 Medicaid members in the second quarter, dropping its total Medicaid lives to just over 16 million.
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Medicaid enrollment to decrease by 8.6% in 2024: KFF
Fierce Healthcare
NOVEMBER 14, 2023
Medicaid enrollment is projected to slide further next year, according to an annual budget survey of Medicaid officials conducted by KFF and Health Management Associates in collaboration with the N | State Medicaid directors once again see redeterminations as one of the biggest challenges they face heading into next year.
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CES 2024: Elevance Health launches program to provide digital health-enabled smartphones to Medicaid members
Fierce Healthcare
JANUARY 10, 2024
Elevance Health is launching a new initiative that aims to put smartphones in the hands of Medicaid members who otherwise cannot connect to virtual services. In the wake of the COVID-19 pandemic, virtual care and digital health tools are more popular than ever.
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2024 Brings Expansion to Medicaid in New York State
Healthcare Law Blog
FEBRUARY 12, 2024
CMS approved $500 million in infrastructure spending for NYS to establish social care networks (“ SCNs ”) to provide HRSN screening and referral services to Medicaid beneficiaries that are targeted populations for HRSN services. Medicaid Hospital Global Budget Initiative CMS authorized up to $2.2
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Payer Roundup—Iowa extends postpartum Medicaid coverage; Aetna settles fertility lawsuit
Fierce Healthcare
MAY 10, 2024
Below is a roundup of payer-centric news headlines you may have missed during the month of May 2024. This month, Iowa signed into a law a postpartum Medicaid expansion, L.A. Care Health commited $3 million to providers, Aetna settled a lawsuit alleging fertility discrimination, a former NBA champion was sentenced to prison and more.
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Molina to challenge Medicaid contract losses in Florida, Virginia
Healthcare Dive
APRIL 25, 2024
Despite business growth in the first quarter, Molina reiterated its prior 2024 guidance out of caution that it won’t be able to reprocure the contested contracts.
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Centene lowers 2024 earnings guidance as Medicaid redeterminations roll out
Healthcare Dive
APRIL 25, 2023
The payer beat Wall Street expectations in the first quarter on both earnings and revenue, which reached $39 billion.
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3 New Additions to the OIG’s Work Plan in September 2024
Healthicity
OCTOBER 8, 2024
Stay ahead of compliance risks with these September 2024 OIG Work Plan updates including FDA safety signals, Medicaid MLRs, & hospital price transparency.
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Payer Roundup–Humana confirms layoffs; Medicaid expansion linked to lung cancer survival
Fierce Healthcare
JANUARY 18, 2024
2024 | This week, Humana announced workforce reductions, a study associated Medicaid expansion with reduced lung cancer mortality and Bright Health moved its corporate headquarters. Below is a round-up of payer-centric news for the week of Jan.
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Over 19M could enroll in ACA plans for 2024, CMS says
Healthcare Dive
DECEMBER 21, 2023
Enrollment in the Affordable Care Act exchanges could be boosted by extended subsidies and the effects of Medicaid redeterminations.
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Biomarker legislation could improve patient access in 2024
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.
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Crossing the Digital Divide to Serve Medicaid Populations
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.
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What’s New for 2024 Marketplace Enrollment?
Center for Health Insurance Reform
OCTOBER 19, 2023
A number of new and ongoing policy changes will impact the Marketplace in 2024, including special enrollment opportunities tied to the Medicaid “unwinding,” continuing enhanced financial assistance, and administrative flexibilities designed to reduce barriers to enrollment.
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Centene posts $1.1B in Q2 profit as it faces down Medicaid headwinds
Fierce Healthcare
JULY 26, 2024
Centene beat the Street even as Medicaid redeterminations pose a significant headwind heading into the back half of 2024, according to its
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Weekly Roundup – November 16, 2024
Healthcare IT Today
NOVEMBER 16, 2024
More Insights From the Experts at HLTH 2024. Read more… Healthcare IT Today Podcast : RSNA 2024 Conference Preview. Read more… Tackling Out-of-State Medicaid Claims and Credentialing Challenges. We hope this gives you a chance to catch up on anything you may have missed during the week.
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State Medicaid officials project enrollment nosedive next year amid unwinding
Healthcare Dive
NOVEMBER 14, 2023
in the 2024 fiscal year — the largest year-over-year drop since 1998, according to KFF. Enrollment in the safety-net insurance program could plummet 8.6%
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CMS: Most Medicare Advantage beneficiares won't see premiums rise in 2024
Fierce Healthcare
SEPTEMBER 26, 2023
Expect premiums, benefits and plan choices for Medicare Advantage (MA) and the Medicare Part D prescription drug program to look similar in 2024, the Centers for Medicare & Medicaid Services (C | CMS announced that nearly three-quarters of MA plan beneficiaries will not see their premiums rise.
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Top 5 Takeaways from CMS’s New 2024 Medicare Physician Payment Rule
HealthIT Answers
AUGUST 29, 2023
By Chris Emper - On July 13, the Centers for Medicare & Medicaid Services released a 1,920-page proposed rule that would update payment policies and programs regarding Medicare payments to physicians and other providers under the Physician Fee Schedule on or after January 1, 2024.
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CMS Radiation Oncology Billing Guidelines 2024
Medisys Compliance
AUGUST 21, 2024
In 2024, the Centers for Medicare & Medicaid Services (CMS) introduced several crucial updates to radiation oncology billing guidelines. In 2024, CMS has updated several areas to reflect changes in medical practices and technological advancements in radiation therapy.
October 2024 Regulatory Compliance Updates
Verisys
OCTOBER 8, 2024
Compliance Updates: October 2024 Overlook: Licensure Compacts Other Legislation Board Updates Interstate Medical Licensure Compact (IMLC): Pennsylvania has reached a partial implementation of the Interstate Medical Licensure Compact. DORA anticipates accepting Natural Medicine license applications no later than December 31, 2024.
October 2024 Regulatory Compliance Updates
Verisys
OCTOBER 8, 2024
Compliance Updates: October 2024 Overlook: Licensure Compacts Other Legislation Board Updates Interstate Medical Licensure Compact (IMLC): Pennsylvania has reached a partial implementation of the Interstate Medical Licensure Compact. DORA anticipates accepting Natural Medicine license applications no later than December 31, 2024.
Chutes & Ladders—Nevada BCBS Medicaid taps president; Cleveland Clinic hires AI officer; Bamboo Health brings on executives
Fierce Healthcare
AUGUST 2, 2024
Chutes & Ladders—Nevada BCBS Medicaid taps president; Cleveland Clinic hires AI officer; Bamboo Health brings on executives ebeavins Fri, 08/02/2024 - 09:57
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Agencies Call on Group Health Plan Sponsors to Extend Special Enrollment Period for Medicaid Redeterminations
Compliance Now
AUGUST 10, 2023
As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”
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Agencies Call on Group Health Plan Sponsors to Extend Special Enrollment Period for Medicaid Redeterminations
Compliance Now
AUGUST 10, 2023
As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”
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March 2024 Regulatory Compliance Updates
Verisys
MARCH 12, 2024
Compliance Updates: March 2024 Overlook: Board Updates Georgia : The Georgia Medical Board has extended tele-prescribing flexibility until May 1, 2024. As of May 1, 2024, licensees should refer to the Medical Practice Act and Board Rules to ensure compliance with telemedicine practices. MD BOP Regulations 10.34.34.04
Telehealth Satisfaction: A Mixed Bag Despite Growing Adoption, J.D. Power 2024 Study Reveals
HIT Consultant
SEPTEMBER 27, 2024
Power 2024 U.S. Power 2024 U.S. The data is based on responses from 4,070 healthcare customers who utilized telehealth services in the past year, collected between September 2023 and July 2024. Telehealth Satisfaction Study. Study Background/Methodology The J.D.
Telehealth and VR – 2024 Health IT Predictions
Healthcare IT Today
JANUARY 4, 2024
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. We believe that trend will accelerate further in 2024 as obesity medication options and supply grow. In 2024, nurse leaders will drive the paradigm shift toward AI-enabled virtual nursing.
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Spring Forward With 2024 Compliance Changes
MedTrainer
JANUARY 10, 2024
It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024. It may seem a little early to do some spring cleaning, but not when it comes to compliance!
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Standards for Provider Network Adequacy in Medicaid and the Marketplaces
Center for Health Insurance Reform
JUNE 3, 2022
Beginning in 2023, CMS will require QHP provider networks for plans sold on the federal marketplace to meet minimum time-and-distance standards and, beginning in 2024, minimum standards for appointment wait times.
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Value Based Care – 2024 Health IT Predictions
Healthcare IT Today
JANUARY 5, 2024
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. With legislation currently being drafted for nurses to receive the same reimbursement doctors and physicians do, this will likely become a top-of-mind topic in 2024.
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February 2024 Regulatory Compliance Updates
Verisys
FEBRUARY 8, 2024
The updated rules are effective January 2, 2024. NLC Final Rules Effective 1/2/2024 A new rule included in the Nurse Licensure Compact update affects nurses moving residence from one compact state to another compact state. Effective January 2, 2024. If the license is not renewed, it will expire on 8/2/2024.
Recent Changes in Medicare/Medicaid Billing for Behavioral Health
Medisys Compliance
JULY 19, 2024
Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Expanded Telehealth Services One of the most notable changes in Medicare/Medicaid billing for behavioral health is the expanded coverage for telehealth services. All rights reserved.
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CMS outlines 2.8% pay increase for outpatient facilities, ASCs in 2024 proposed rule
Fierce Healthcare
JULY 13, 2023
The Centers for Medicare & Medicaid Services has released its proposed Medicare payment rates and policy updates under the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory S | The CY 2024 OPPS and ASC Payment System Proposed Rule includes a 2.8%
CMS issues final nursing home Medicare pay rule for 2024
Modern Healthcare
JULY 31, 2023
Skilled nursing faciltiies will receive a higher Medicare pay bump in fiscal 2024 than proposed by the Centers for Medicare and Medicaid Services in April.
Patients – 2024 Health IT Predictions
Healthcare IT Today
JANUARY 16, 2024
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. Florian Otto, CEO and Co-founder at Cedar Healthcare Affordability: Healthcare affordability will always be a problem, and it remains to be seen if 2024 will be better or worse than 2023.
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2024 CMS Program Audit Updates: Summary and Insights
Innovaare Compliance
DECEMBER 25, 2023
Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit. Prepare for both routine and focused audits to be conducted in 2024 by CMS.
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Alliance Health, Cityblock Partner to Deliver Integrated Care for Medicaid Members in North Carolina
HIT Consultant
JULY 10, 2024
What You Should Know: – Alliance Health , a managed care organization serving over 137,000 Medicaid beneficiaries in North Carolina, announced a new partnership with Cityblock , a value-based healthcare provider for Medicaid and dually eligible individuals. Reducing avoidable inpatient admissions. ”
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Recent Changes in Medicare Billing for Internal Medicine in 2024
Medisys Compliance
JULY 15, 2024
In 2024, several significant updates have been introduced that directly impact the billing processes for internal medicine. In 2024, Medicare will continue to expand telehealth coverage, particularly for internal medicine. Key Changes in Medicare Billing for Internal Medicine 1.
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CMS puts forward meager offering for digital health in final Medicare physician fee schedule rule
Fierce Healthcare
NOVEMBER 4, 2024
Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)
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January 2024 Bad Actors Roundup
Verisys
FEBRUARY 9, 2024
January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 The post January 2024 Bad Actors Roundup appeared first on Verisys.
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Healthcare Workforce – 2024 Health IT Predictions
Healthcare IT Today
JANUARY 10, 2024
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. Jason Considine, Chief Commercial Officer at Experian Health Staffing shortages will continue to be a major pain point for providers in 2024 and have a direct impact on their bottom line. Morgenstern.
Cityblock, Sunshine Health Partner to Deliver Care to Florida Medicaid Members in Central Florida
HIT Consultant
MAY 21, 2024
What You Should Know: – Cityblock , a value-based healthcare provider specializing in Medicaid, announced a new partnership with Sunshine Health , a Florida managed care plan. This collaboration aims to provide high-quality primary care and care coordination services to Medicaid beneficiaries with complex needs in Central Florida.
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