Healthcare, Senior Living, Economics
A complex area for providers, especially with respect to their compliance programs, are the concepts of fraud and abuse. Central to current requirements for compliance programs, all post-acute providers are REQUIRED to have compliance programs that, Include policies and procedures to define, test for, and mitigate any issues pertaining to fraud and abuse. In this … Read more
On November 1, CMS issued the final PPS rule for Home Health (2024). The majority of provisions within this rule, especially those related to payment, take effect on January 1, 2024. The Final Rule as published is available for download here: Home Health 2024 Final Rule In July I wrote a post on the proposed … Read more
An issue that has been tied to AI (artificial intelligence) and specifically, to Medicare Advantage plans, involves coverage denials. I wrote about this in a post earlier this year at https://rhislop3.com/2023/05/01/medicare-advantage-part-d-final-rule/ Coverage denials have been a fairly hot topic around Medicare Advantage plans. The core of the issue is that Medicare Advantage plans are required … Read more
Seema Verma, former CMS head, spoke out yesterday regarding the proposed staffing mandate (hours and type of staff, per resident per day) proposed rule, indicating her opinion that the approach was flawed. A recap article on her comments is here: https://www.mcknights.com/news/former-cms-chief-verma-regulators-over-their-skis-with-staffing-mandate/?utm_source=newsletter&utm_medium=email&utm_campaign=NWLTR_MLT_DAILYUPDATE_110223&hmEmail=IjP1GPaY%2BJ2uvsLxTJ79bVeRWY7ycbnr&sha256email=aa4cb7c695037c31a216b9562788596b6fcd012145d566f31440b6fcd139c8a9 Regular readers know that I have covered various topics on healthcare staffing, particularly as … Read more
As COVID-19 has moved to an endemic phase (constant presence, not spreading out of control or taxing health care resources), I’ve started to look back at what transpired since early-2020 and what was learned, known, and now, embedded (perhaps) in our culture and our health care industry. Suffice to say, the review is somewhat mind … Read more
Value-Based Care is kind of a vogue term, one that I encounter quite often. I also have used it when speaking or writing and know most people have no idea what it means or how it can be developed and/or applied. Value-based care is not a new concept. Medicare tried a foray into it back … Read more
Surprise! Surprise! Surprise! This morning, CMS dropped a proposed rule for a staffing mandate for SNFs. On Wednesday, I wrote about the delays (staffing mandate) and the information from a CMS contracted study completed by Abt and Associates. That post is here: https://wp.me/ptUlY-LM The consensus around the staffing mandate issue is that CMS was bogged … Read more
Happy Hump Day! Another Wednesday with news too heavy to ignore. I’ll try to return to some levity and light in future Wednesday features. For a number of years, CMS has been playing with developing a staffing level mandate. The first CMS study from 20 years ago recommended a 4.1 hours per day benchmark. Recently, … Read more
Back a few weeks ago I did a post summarizing the 2024 Final PPS Rule for Skilled Nursing Facilities. Recall, these rules come out yearly, updating payment rates and other provisions impacting payment and some, impacting policy. Typically, the initial or proposed rule starts in spring and then after comments, etc., becomes final during the … Read more
Last week, the 2024 Presidential campaign season kicked into full swing with the first candidate debate. Arguably, momentum has been building ahead of the debate, especially in Iowa, during the State Fair, where candidates roamed, gave speeches, and pressed the flesh. I was there one day and enjoyed seeing Tim Scott and few other notables, … Read more