The state’s Medicaid managed care rolls dipped 1 percent in June, according to recent data from the Illinois Department of Healthcare and Family Services.
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The Centers for Medicare & Medicaid Services (CMS) has released the CY 2025 Home Health proposed rule. The proposed rule includes a significant permanent cut of over 4% with an estimated overall impact of -1.7% to reimbursement, or $280 million. Want to learn more and prepare for upcoming changes? Join our experts Jeff Aaronson and Lisa Selman-Holman as they discuss the implications of the proposed rule in our upcoming webinar. Register now: https://okt.to/mKYFIQ National Association for Home Care & Hospice Partnership for Quality Home Healthcare #HomeHealth #StopHomeHealthCuts
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The Centers for Medicare & Medicaid Services has changed the way it reimburses for #PrimaryCare services and more changes are on the horizon. InHealth Advisors put together a video summarizing: 📜 The principles behind the reimbursement changes 💲 Examples of new payment policies matching these principles 💡 Key takeaways for primary care practices View the full video here: https://lnkd.in/dBcsy-zw
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It's not news to us! Frankly, these standards are table steaks for Cohere and will do little to truly transform Prior-auth or UM flows. Make sure you're choosing an IT partner who sees UM as an opportunity to improve quality, healthcare affordability AND remove abrasion and administrative waste. Otherwise, you'll make a capital investment to check a compliance box, put yourself at risk for poor decision quality (potentially gamification), and will likely watch the CRD/DTR/PAS services rust on the shelf due to low adoption. Coheres proven that advanced ML/AI decisioning, "right next step" clinical intelligence, and deep trend and policy analytics are crucial to improving the overall Auth/UM capability. With the right investment, UM programs can become strategic assets driving overall quality and patient outcomes improvement. Coheres proven that 15% incremental Medical Cost savings with 63% LESS denials is possible and replicable across specialties. Let’s think big, let's think future and let’s not get bogged down by another mandate that falls short of greatness. #CMSfinalrule #priorauthorization #letsbegreat #patientcare #aiapplications
ICYMI, here’s what health plans need to know about the Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule. 🚨 → Who the rule impacts 🖐️ → What’s required ⚙️ → When it takes effect ⏳ → Why it matters 💡 Lastly, find out how your plan can start preparing 👉 https://lnkd.in/eQAmXntC
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ICYMI, here’s what health plans need to know about the Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule. 🚨 → Who the rule impacts 🖐️ → What’s required ⚙️ → When it takes effect ⏳ → Why it matters 💡 Lastly, find out how your plan can start preparing 👉 https://lnkd.in/eQAmXntC
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The Centers for Medicare and Medicaid Services (CMS) is set to launch the Transforming Episode Accountability Model (TEAM) beginning in January 2026. Here we share five strategies that can help healthcare organizations align with the new model's requirements. https://pwc.to/3TOdC3d
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Experience with local, state, and federal regulations. PMP, Leadership, RFP, Procurement, Implementation, Quality, Compliance, Waiver, EVV, MCO start up, CM, business analytics, healthcare, dental, and Medicaid.
Accessible care is huge! More focus is needed on meeting the member where they are. Holistic approaches to treating as a whole is critical in today’s world. Value based care, telehealth, rural health focus, SDOH, NHS Frameworks, HEDIS measures, etc. The list goes on and on and it’s imperative that members are being identified and receiving appropriate care and services. Many states have waiver waitlists years long. Changes are coming and need to happen.
Only 10% of those eligible for both Medicare and Medicaid are in integrated managed care plans, leaving many to navigate disjointed services. With the Centers for Medicare and Medicaid Services (#CMS) Medicare-Medicaid Program (#MMP) demonstration ending in 2025, the #MLTSS Association proposes building on the existing Dual-Eligible Special Needs Plan (#DSNP) framework to overcome integration barriers and boost enrollment. By focusing on necessary statutory and regulatory changes, we pinpoint priority areas and short- and long-term solutions in our proposal to increase more holistic and accessible care, enhancing the care experience for our most vulnerable populations. Read more about our policy proposals to advance integrated care: https://lnkd.in/eARMaV8m
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🚨🚨🚨 PSG is announcing our expansion of our government program services. The new services include: “New offerings include enhanced vendor oversight, policy clarifications for Medicare, Medicaid, and Federal Employee Health Benefits (FEHB) programs, staffing solutions, and crisis management. PSG’s customizable services aim to help healthcare organizations navigate complex government regulations, optimize operations, and plan for future success in an ever-evolving landscape. Additionally, PSG can provide qualifying plans with a health equity specialist to annually conduct a health equity analysis of the plan’s prior authorization use and support public posting of this analysis to meet upcoming Medicare Advantage compliance requirements.”
We are excited to announce the expansion of our Government Pharmacy Program Services as well as the addition of Michelle Juhanson, CHC, CHPC, and Dawn Shojai, who augment our team with years of expertise helping payers in the government program space. Learn how we can help support your Medicare, Medicaid, and Federal Employee Health Benefits (FEHB) program needs! Read the press release here >> https://lnkd.in/gFiwVBKB
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This is REAL!! CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process! Time to start planning - #Cohere is here to help you every step of the way. Reach out to learn more!
ICYMI, here’s what health plans need to know about the Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule. 🚨 → Who the rule impacts 🖐️ → What’s required ⚙️ → When it takes effect ⏳ → Why it matters 💡 Lastly, find out how your plan can start preparing 👉 https://lnkd.in/eQAmXntC
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The Centers for Medicare and Medicaid Services (CMS) is set to launch the Transforming Episode Accountability Model (TEAM) beginning in January 2026. Here we share five strategies that can help healthcare organizations align with the new model's requirements. https://pwc.to/3ZNfyg4
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Public Health and Healthcare System Strategy; Global Health Diplomacy; Former CA Dept Public Health Deputy; DrPH (Global Infectious Disease) Candidate; Public Speaker
Looking forward to the conversation with Evan Shulman from Centers for Medicare & Medicaid Services on Monday at the LTC 100 conference to discuss data-driven, risk-based approaches to improving quality and safety within healthcare facilities. Access to safe and high-quality healthcare is vital to every community. #qualityandsafety #datadriven #riskbased
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