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Medicaid eligibility checks beginning in April will likely curb hospital revenue and enrollment growth for payers, Moody's Investors Service said in a report.
Image by freepik What You Should Know: – A new analysis by the Urban Institute, supported by the Robert Wood Johnson Foundation , reveals that healthcare providers in 41 states that expanded Medicaid eligibility would face significant financial losses if federal funding for Medicaid expansion programs is cut.
Under the new definition, hospitals can only receive disproportionate share hospitalMedicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.
Dramatic growth in an opaque Medicaid funding mechanism is exacerbating concerns about the program’s fiscal integrity — while spurring financial gains for the hospital industry.
Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. You are passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. Hospitals are faced with impossible decisions.
The incentive program offers hospitals a carrot for relieving debt that health systems were unlikely to recover anyway, with experts labeling the program a “win-win” for patients and providers.
As a first step to protecting incarcerated individuals’ right to health, Congress should repeal the Medicaid Inmate Exclusion Policy (MIEP). The MIEP, established in 1965, prohibits Medicaid from covering incarcerated individuals, despite any prior eligibility. Specifically, states that have expanded Medicaid could save $4.7
The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards in a bid to improve maternal mortality.
Inflation and high expenses are placing a burden on hospitals as they recover from COVID-19 challenges. Hospital labor expenses rose 3% in April from March, according to Kaufman Hall.
In two final rules issued Monday, the CMS also moved to crack down on financing gimmicks used by states and hospitals to increase federal Medicaid funding — though not until 2028.
WHY IT MATTERS By offering programs such as medically-tailored meals, prescribing fresh produce and generally offering better nutrition education, hospitals and health systems can better address diet-related chronic medical conditions, the organizations say, and reduce down-the-line healthcare costs. economy $1.1
Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)
Lurie Children's Hospital of Chicago had only two entry points for patients looking to receive care – calling the centralized access center or walking into the emergency room. Lurie Children's Hospital of Chicago. Prior to the growth, adoption and use of its patient portal, Ann & Robert H.
The latest wave of COVID cases and hospitalizations has raised concerns about the financial resilience of many hospitals in the United States. Large hospitals in metropolitan areas have, for the most part, weathered the storm. Rural hospital financial stress and resulting closures are nothing new.
Texas had the highest ratio of for-profit to nonprofit unreimbursed Medicaid costs to expenses, while New York and the District of Columbia had the lowest ratios, according to research published in JAMA Network Open.
Hospital patients with conditions like pneumonia, dehydration and heart failure have been shown to experience shorter recovery times with fewer complications when they receive more cost-effective healthcare at home – and many health systems have been preparing for this future.
Mayo Clinic and Kaiser Permanente announced this week that they will collaborate to build capacity for hospital-at-home care. Technology aimed at blurring the lines between at-home care and in-hospital services has taken on a renewed spotlight amidst the COVID-19 pandemic, when patients and providers have sought to avoid potential spread.
Under a final rule issued by the Centers for Medicare and Medicaid Services, outpatient hospital facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from | Under a final rule issued by CMS, outpatient hospital facilities and ambulatory surgical centers will get a 2.9%
Medicaid disproportionate share hospital (DSH) payments are being cut by $8 billion annually during the current and next four federal fiscal years under a new Centers for Medicare and Medicaid Serv | Published Tuesday and set to go into effect in two months, the final rule limits the calculation of a hospitalsMedicaid shortfall to beneficiaries with (..)
One way hospitals dealt with staffing shortages and the need for beds during COVID-19 was to use flexibilities allowed by the Centers for Medicare and Medicaid Services to treat acute care patients at
WHY IT MATTERS Food as medicine programs, designed for patients with complex health and social needs, may reduce avoidable hospitalizations and emergency room visits. KFF's online Medicaid Waiver Tracker has information on which state Medicaid programs are granted 1115 waivers.
Retain important “Hospital without Walls” site of care flexibility to support home-based hospital services. They also point to research showing home-based care to reduce likelihood of hospital readmissions. " Among the group's policy priorities: Expand the services covered in a home-based setting.
The Centers for Medicare and Medicaid Services just released data on its Acute Hospital Care at Home initiative , which thus far has admitted 11,159 patients suffering from respiratory infections, heart failure and severe sepsis. You contend CMS's Acute Hospital Care at Home program needs scalability to survive.
The budget request includes proposals for “Medicaid-like” coverage in non-expansion states and future penalties for hospitals that don’t implement cybersecurity standards.
Now more hospitals and health systems are looking to expand their efforts beyond video visit-based virtual care, and push for expanded remote patient monitoring programs – up to and including the provision of acute care at home. Telehealth proved its mettle this past year. And then the big one being the waiver that came out in November.
The Centers for Medicare & Medicaid Services on Wednesday took several new steps to help U.S. hospitals manage the crush of new patients as the COVID-19 crisis worsens. Among them are new allowances for telehealth and remote monitoring, for what CMS is calling the Acute Hospital Care at Home program. WHY IT MATTERS.
In November, the Centers for Medicare and Medicaid Services took several new steps to help U.S. hospitals manage the crush of new patients as the COVID-19 crisis worsens. Among them were new allowances for telehealth and remote monitoring, for what CMS is calling the Acute Hospital Care at Home program. Keeping patients at home.
Below are three key steps health systems, hospitals, and physician practices should take to effectively prepare for the upcoming HEDIS season. HEDIS audits are important for Medicare and Medicaid health plans because data is used to determine the efficacy of a payer to care for its members. Utilization and Risk Adjusted Utilization.
Intermountain Healthcare announced this week that it is expanding the scope and services of its hospital at home program, more than a year since it was first launched in May 2020. The initiative now serves patients at 12 hospitals across Utah, with new locations soon to come. WHY IT MATTERS. Other value-based payers will be added.
The recent ransomware attack on OneBlood , a blood center that serves hundreds of hospitals in the south, is just the latest example of a cyberattack having a real-world impact. taxpayer dollars, such as Medicaid and Medicare, if the requisite cybersecurity baseline is not met. medical claims.
As artificial intelligence rapidly makes inroads in healthcare, federal agencies already have the authority to regulator AI at the hospital bedside, according to some healthcare researche | An article published in JAMA Health Forum argues that through the conditions of participation in Medicare and Medicaid, CMS has the authority to oversee how hospitals (..)
Threatened with steep sanctions and loss of its agreement with Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.
The new solution addresses the significant issue of hospital readmissions among Medicare beneficiaries. Coupled with the Centers for Medicare & Medicaid Services’ (CMS) increased focus on seamless care transitions, Medicare Advantage plans are under pressure to intervene quickly and effectively to prevent avoidable readmissions.
A group of healthcare organizations announced this week the launch of the Advanced Care at Home Coalition, an advocacy effort aimed at creating a pathway toward safeguarding access to hospital-level services. "We're going to need to have a few different ways of measuring this." "There's no vanity here.
The Centers for Medicare & Medicaid Services (CMS) finalized a six-year mandatory model to increase access to kidney transplants, the agency announced Nov. CMS made some concessions to hospitals who strongly criticized the kidney transplant model proposed rule in May.
Orlando Health on Monday announced that it's been approved by Florida's Agency for Health Care Administration to start delivering hospital-level acute care in adult patients’ homes. " Here are some tips for how health systems should be preparing now for the future of hospital-at-home. WHY IT MATTERS. ON THE RECORD.
As the country gears up for November elections, health systems say they are keeping an eye on, but not severely concerned about, potential major changes in the Affordable Care Act exchanges or Medi | Regardless of who takes charge in Washington, the heads of America's largest for-profit health systems are downplaying the likelihood of major political (..)
The virtual care services will be delivered without copays, out-of-pocket costs or deductibles for families with active insurance or Medicaid coverage. Before the pandemic, patients had to be in a rural area in a hospital or clinical setting to receive reimbursement for telehealth. WHY IT MATTERS. THE LARGER TREND.
The day her Medicaid coverage ended, Beverly Likens was in the hospital after a scary trip to the emergency room. Millions of people nationwide have lost Medicaid benefits after a pandemic-era mandate for coverage expired in March—most of them for administrative reasons unrelated to their actual eligibility.
A "perfect storm" of financial stress for hospitals and health systems. Up to 18 million people could lose Medicaid coverage after COVID-19 PHE. Subscribe to the podcast on Apple Podcasts , Spotify or Google Play ! Talking points: The future of the Public Health Emergency and the flexibilities it allows.
Within the HITRUST-certified ecosystem, providers across sectors identify social care needs, make and receive referrals, report on results and manage payments from paid social care programs, government funding, grants, philanthropic investments and hospital community benefit dollars, according to the company's website. THE LARGER TREND.
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