CMS Delays Primary Care First Until 2021
CMS has delayed the start of Primary Care First Until 2021. The program was originally scheduled to begin next year. Primary Care First is a set of voluntary five-year payment model …
Insights and News
OIG: Nursing Home Complaints Increased in 2018
OIG has published an interactive map that displays details on nursing home complaint trends in 2018. 6,540 high-priority grievances that were not investigated within the required 10-day period, which equals a 23% increase. …
Review Choice Demonstration for Texas is Delayed Until March 2, 2020
From CMS’ Review Choice Demonstration website: To allow Home Health agencies to transition to the Patient-Driven Groupings Model (PDGM), which becomes effective on January 1, 2020, CMS is rescheduling the …
Healthcare.gov Premiums Are Down, but Are Still Unaffordable for Many
CMS announced that the average premium for the second lowest cost silver plan on HealthCare.gov for a 27 year-old will drop by 4 percent for the 2020 coverage year. Additionally, …
Medicare Advantage Plans Ramp Up Marketing for Supplemental Benefits
Medicare Advantage enrollment has begun. Plans are taking advantage of the option to offer supplemental benefits to consumers. These benefits will likely be a significant source of growth as more …
Medicare and Medicaid Payment Cuts Reach a Tipping Point for Hospitals
Reductions in federal payments to hospitals will total $252.6 billion from 2010 through 2029, reflecting the impact of a series of legislative and regulatory actions, according to a new study …
CMS Updates the SPSS to Ensure More Oversight and Surveys for SNFs
Today, CMS announced it is strengthening the State Performance Standards System (SPSS). Under the changes announced in a memo to states today, CMS will, through the updated SPSS assessment tools, more rigorously and …
Private Equity Home Health Purchases Slow Down Ahead of PDGM
The home health industry has been experiencing record amounts of merger and acquisition activity over the past few years. However, there are signs that the market may be cooling off, …
New Demand Letter Process Affecting Auto-Cancelled RAPs
CMS issued Change Request (CR) 10776, which implemented a new demand letter process affecting auto-cancelled RAPs. Effective October 1, 2019, a demand letter is issued when an overpayment exists as …
New Performance Data for Medicare Part C and D Programs
The number of Medicare Part D prescription drug plan members who will be in plans with four stars or higher increased to 27.6% for 2020, according to a new report …