Marisa Consulting’s Post

Another rule just dropped from US Medicaid Program at Centers for Medicare & Medicaid Services on Managed Care https://lnkd.in/eth8A4vb Strengthens standards for timely access to care and states’ monitoring and enforcement efforts; enhances quality and fiscal and program integrity standards for state directed payments (SDPs); specifies the scope of in lieu of services and settings (ILOSs) to better address health-related social needs (HRSNs); further specifies medical loss ratio (MLR) requirements; and establishes a quality rating system (QRS) for Medicaid and CHIP managed care plans

This is a very important update on #sdoh. Please read!

The Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system will be revised for calendar year 2024. The final rule with comment period describes changes to the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. The Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Rural Emergency Hospital Quality Reporting (REHQR) Program will also be updated and refined. Starting January 1, 2024, a payment for certain intensive outpatient services under Medicare will be established. Additionally, hospitals will be required to make their standard charge information public and enforce hospital price transparency. The community mental health center (CMHC) Conditions of Participation (CoPs) will be updated to provide requirements for furnishing intensive outpatient (IOP) services, and personnel qualifications for mental health counselors (MHCs) and marriage and family therapists (MFTs) will be established. The annual IPPS rulemakings will no longer include discussion of the inpatient prospective payment system (IPPS) Medicare Code Editor (MCE) starting with the fiscal year (FY) 2025 rulemaking. Finally, there will be a technical correction to the Rural Emergency Hospital (REH) CoPs under the standard for the designation and certification of REHs. To be assured consideration, comments must be received at one of the addresses provided by January 1, 2024. Effective date for the provisions of this rule is January 1, 2024. cms.gov mlmatters.gov

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments and policies for inpatient hospitals and long-term care hospitals in fiscal year (FY) 2025. The rule focuses on improving health outcomes for Medicare beneficiaries by addressing social determinants of health, emergency preparedness, and maternal health. Key Proposals include: - Payment Increases: Acute care hospitals under IPPS with successful quality reporting and meaningful electronic health records would see a 2.6% increase in operating payment rates, translating to a projected $3.2 billion increase. Long-term care hospitals can expect a 1.6% increase, or $41 million. - Focus on Equity: Improved payment adjustments for hospitals treating individuals experiencing homelessness and the inclusion of social determinants of health data in long-term care hospital quality reporting. - Strengthening Emergency Preparedness: Permanent streamlined data reporting for COVID-19, influenza, and RSV. New measure assessing hospitals' commitment to patient safety during emergencies. - Transforming Episode Accountability Model (TEAM): Mandatory model testing episode-based payments for five common procedures to reduce Medicare costs while maintaining quality. Incentivizes care coordination between providers during and after surgery. Supports climate change resilience through data collection and technical assistance. - Maternal Health Improvements: Request for public feedback on potential solutions to address maternal health disparities and access to care issues. Specifically seeks input on a possible obstetrical services Conditions of Participation (CoP). Learn more: https://hubs.ly/Q02tb9vT0

Great news for kids! The final Medicaid and CHIP rule enhances standards for access to care, state monitoring, and program integrity, and establishes a quality rating system for #Medicaid and #CHIP managed care plans. This, along with the "Ensuring Access to Medicaid Services" rule, highlights a positive step toward improving access to coverage and care. #Enroll365 #EnrollKidsNow #EnrollTeens #Innovate4Kids #Medicaid #CHIP Anna Dunn Ryan Nolan Gordon Schatz Learn more, share, and get the word out: https://lnkd.in/etUp5kiq

How do you know, until you know? And how do you know, in more real-time, and then take action to support your members? Healthmine knows. We know, and we want to help you know too! #digitalengagement #pulsesurveys

In their new Forefront article, Laura B. Attanasio and Kimberley H. Geissler from UMass Chan Medical School discuss how improving maternal health in the United States is an urgent public health concern, and Medicaid ACOs represent the type of comprehensive intervention that has the capacity to address barriers to progress multiple levels. "Many state Medicaid programs have been experimenting with financing and delivery system reforms that may have implications for perinatal health care. In particular, a number of states have implemented accountable care organizations (ACOs) in their Medicaid programs. In ACOs, a group of clinicians—generally primary care clinicians—provides care for a specified set of patients and has responsibility for the quality and cost of care for those patients. This arrangement is intended to incentivize higher-quality care while reducing costs. ACOs aim to improve care quality by improving coordination in patient care and emphasizing appropriate primary care to avoid potentially preventable and costly emergency department visits and inpatient hospitalizations. ACOs were launched in Medicare following the implementation of the Affordable Care Act, and research has found that Medicare ACOs can have positive effects on quality and may moderately lower costs. Research on the effects of Medicaid ACOs broadly, while limited, has found some evidence of improved quality and lower costs." Read the full article here: https://bit.ly/3yahhQY

Long-term and post-acute care (LTPAC) providers are crucial in our healthcare system, especially for complex patient populations like those needing LTPAC. Medicare spends a significant amount on post-acute care, nearly $57 billion, which is about 15% of its total spending. About 40% of hospital discharges are followed by LTPAC services, with nearly 2 million skilled nursing facility (SNF) stays yearly. Improving and coordinating post-acute care can lead to better quality and lower costs. LTPAC providers can lead the way in value-based care, but current models like accountable care organizations don't fully accommodate their unique challenges. Only a small percentage of SNFs participate in ACOs, and the Centers for Medicare & Medicaid Services (CMS) aims to have all Medicare beneficiaries in an accountable care relationship by 2030. Improving models to align with LTPAC providers can enhance care and lower costs. Abigail Barreto, Nisha Hammel, Aisha T Pittman, David Pittman, and Sarah Sugar, MPH, are the authors of this report published in Fierce Healthcare. #LTPAC #Medicare #ValueBasedCare https://lnkd.in/g2gzAi9w

🚨New paper alert 🚨 Our paper entitled “Effects of the Medicaid coverage cliff on low-income elderly Medicare beneficiaries” is now out at Health Economics. Summary: - We examined the effects of losing eligibility for supplemental Medicaid coverage among low-income elderly Medicare beneficiaries and identified 4 key findings. - First, while total healthcare spending remained unchanged, out-of-pocket expenses rose by 25%, and the likelihood of experiencing difficulties in paying medical bills increased by 44.4%. - Second, the use of high-value diagnostic and preventive testing increased by 8.8%, whereas there were no changes in the utilization of low-value care. - Third, as a result of this financial shock, enrollment in Medicare Advantage, which is considered more affordable, increased by 12.2%. - Finally, although this financial strain may encourage individuals to adopt healthier behaviors, we found no significant changes in such behaviors. Implications: - The current income eligibility thresholds for supplemental Medicaid coverage (100% of FPL) may be too low to provide support for near-poor Medicare beneficiaries who encounter significant financial challenges in accessing health care services. Thus, policymakers are currently contemplating whether to increase the income eligibility thresholds for supplemental Medicaid coverage to alleviate the financial burden of health care for near-poor Medicare beneficiaries. - Given that low-income Medicare beneficiaries frequently face challenges in accessing health care services, our findings suggest that raising the income eligibility thresholds for supplemental Medicaid coverage could serve as a social safety net without causing significant moral hazard. Find more details at https://lnkd.in/gZviCcAq #healtheconomics #medicare #medicaid #healthinsurance