|
|
Providers Want More from CMS on Prior Authorization Reform After Proposed Changes
Fierce Healthcare | By Robert King
Provider groups say new reforms proposed by the Biden administration to streamline prior authorization are a good start.
But much more needs to be done—including creating gold-card programs that let providers skip prior authorization if they have a high volume of requests, they say.
Several provider and payer groups submitted comments on a proposed rule outlining policy changes for Medicare Advantage (MA) and Part D set to take effect in 2024. One of the biggest changes is to clarify when and how MA plans can use prior authorization, a cost containment tool that requires physicians to get insurer approval before doling out certain items and services but has morphed into a major source of administrative burden for providers.
“Physician groups point to delays in prior authorization decisions, resubmission of prior authorization, inconsistent payer payment policies … and prior authorizations for routinely approved items and services as some of the most challenging aspects of prior authorization,” wrote the Medical Group Management Association (MGMA) in comments to the proposed rule that were due Monday.
If finalized, the Centers for Medicare & Medicaid Services' (CMS’) rule would mandate that a granted prior authorization approval remains valid for the entire course of treatment for a patient in MA. If an MA plan denies coverage for a request, it must rely on a physician or expert that has expertise in the appropriate field of medicine, CMS added.
The agency also proposed prior authorization must be limited to only confirming the presence of a diagnosis.
But provider groups say this still doesn’t address the problem that any prior authorization process “inherently delays patient care,” MGMA wrote. “CMS must establish guardrails to prevent high volumes of prior authorization requests by MA plans.”
One of these strategies could be gold-carding programs that exempt certain clinicians from prior authorization if they have an approval rating over a period of time. This would help ease the number of requests a physician must face.
Read Full Article |
|
CMS, Insurers Clash Over Whether Medicare Advantage is Going to be Cut in Proposed Rule
Fierce Healthcare | By Robert King
Health insurers and the Biden administration are at loggerheads over whether Medicare Advantage (MA) plans will see a pay cut next year, the ramifications of which come amid increased regulatory scrutiny for the popular program.
Insurer groups and some politicians charge that the latest 2024 payment rule will wind up being a 2.27% cut to MA plans after considering risk adjustment changes and other factors. The Centers for Medicare & Medicaid Services (CMS) has pushed back, arguing that isn’t true.
The debate comes amid increasing scrutiny of MA and after CMS has proposed an overhaul to plan audits to curb overpayments.
“We think it is important not to cherry-pick the numbers,” said CMS Administrator Chiquita Brooks-LaSure during a call with reporters last week. “When we look at all the elements, we do see a net positive so an increase of little over 1%.”
At issue is the proposed advance notice released earlier this month that details the payments to MA and Part D plans for the 2024 coverage year. The proposed rule lays out the payment policies and changes to MA capitation rates for the upcoming year as well as outlining key changes to risk adjustment.
When the rule was announced Feb. 1, CMS expected a 1.03% increase for plans. The agency came to this number after factoring in a decline in payments when taking in risk adjustment changes.
Since the rule was released, the insurance industry has pushed back that it will actually result in a 2.27% cut to plans if finalized.
The advocacy group Better Medicare Alliance (BMA) said that the rule “would raise costs and cut benefits for 30 million American seniors who rely on Medicare Advantage, a vital part of Medicare,” said BMA President and CEO Mary Beth Donahue in a statement.
Read Full Article |
Beyond Medicare and Social Security: Cutting Medicaid After the Pandemic Would be Political Madness
STAT News | By Arielle Kane
During his State of the Union address, President Biden called out Republican proposals to cut Social Security and Medicare in their quest to reduce federal spending. Republican lawmakers in the chamber protested loudly, knowing these programs are political third rails — too controversial to discuss — and they have been sparring over it ever since.
But the president and Democrats in Congress should not miss the opportunity to make Medicaid the third rail. If they want to capitalize on the popularity of the program and protect families’ health care, Medicaid cuts must be off the table because it:
- Covers 91 million Americans, making it the largest source of health care coverage in the country
- Covers 42% of all births
- Pays for 54% of long-term care and covers 6.9 million people ages 65 and older
Provides coverage to more than 10 million people with disabilities who rely on Medicaid for their health care
Several Republicans have said they want to use the upcoming legislative battle over raising the debt ceiling as an opportunity to cut overall spending, particularly in programs like Medicaid.
But politically savvy lawmakers would be wise to remember the health care fights of 2017 — and the results of the 2018 midterm elections that followed — proving that cutting coverage for pregnancy and childbirth, for older adults, and for people with disabilities is a pathway to political collapse. Even in deep red states like South Dakota, Idaho, and Missouri, the electorate has approved Medicaid expansion even when their elected lawmakers opposed it. That’s because Medicaid is a lifesaver for millions of families.
That’s never been clearer than over the past three years when Medicaid protected families during an enormous public health crisis. The Covid-19 pandemic upended the economy and tripled the unemployment rate. But largely because of Medicaid, the rate of uninsured reached an all-time low in 2022. That is a stark difference from the last economic upheaval during the Great Recession of 2008-2009, when 9.3 million people lost their jobs and, subsequently, their health insurance. Millions more families now know firsthand how essential Medicaid is for their health and financial well-being and they will not look favorably if their elected representatives decide to cut that lifeline.
The Medicaid program faces a daunting challenge in the coming months as the process of checking the eligibility for Medicaid of its 91 million enrollees starts back up again April 1. At the same time, 1 in 4 state Medicaid programs report staff vacancy rates greater than 20%. Millions of people are likely to lose coverage because of administrative hurdles during the eligibility determination process, and they will be hard-pressed to get someone on the phone to assist with their application. It’s political madness to cut Medicaid generally, but particularly so during this herculean lift across all state Medicaid agencies.
Read Full Article |
SNFs Retook Higher Hospital Discharge Share Than HHAs In Early 2022
Home Health Care News | By Andrew Donlan
After the public health emergency was declared in March of 2020, hospital discharges bottomed out the following month. While they ticked back up in 2021 and 2022, they still remain 25% lower than they were in February of 2020.
And while home health care gained a greater share of post-acute referrals compared to skilled nursing facilities (SNFs) early on in the pandemic, there’s been normalization since then.
This is according to a new data analysis conducted by the Washington, D.C.-based advisory and research firm ATI Advisory. The analysis took into account Medicare fee-for-service patients from January 2019 to February 2022, and paid through March 2022.
Specifically, from November 2021 to February 2022, SNFs consistently received a higher share of discharges than home health care agencies. Those months looked more similar to pre-pandemic months.
In fact, while SNF discharges dropped by 2% year over year from 2020 to 2021, they ticked up by 1.2% from February 2021 to 2022, the largest gain of any post-acute setting. Meanwhile, home health agencies’ share of discharges dropped by 1.7% from February 2021 to February 2022.
Overall, from March 2020 to February 2022, home health agencies scored 18% of hospital discharges. For COVID-19 patients, that number fell to 14%. Meanwhile, SNF share was at 16% and 18%, respectively.
SNF discharge normalization was expected by most in the post-acute space, even during the height of COVID-19. After all, some patients’ acuity levels are too high to be cared for in the home.
More SNF-at-home and even hospital-at-home programs could change that, but in all likelihood, that would be much further down the line.
Plus, despite the Medicare fee-for-service data displayed, there are still signs to suggest that home health referrals are much higher overall than they were prior to the pandemic.
Even if demand for home health services is increasing, that demand coming to fruition for agencies’ bottom lines is all based on staffing capacity. In January 2022, the industry’s referral rejection rate had reached 58%, according to WellSky.
|
Public Health Emergency Resource Update
On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. The Centers for Medicare & Medicaid Services has resources available to help you prepare for the end of the PHE, some of which have been updated based on recent action by Congress.
On December 29, 2022, H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023 was signed into law. This legislation included an extension of the major telehealth waivers and the Acute Hospital Care at Home (AHCaH) individual waiver that were initiated during the PHE.
We will continue to execute the process of a smooth operational wind down of the flexibilities enabled by the COVID-19 emergency declarations. The following materials reflect recent changes and are currently available on the CMS Emergencies Page:
Updates will continue to be provided as we approach the end of the PHE. We encourage you to regularly visit the CMS Emergencies Page for the most up to date information. |
|
|
|
|
<< first < Prev 51 52 53 54 55 56 57 58 59 60 Next > last >>
|
|
Page 59 of 108 |
