Medicare

ICYMI: Important and helpful analysis of recent changes to Medicare Advantage Plan prior authorization and utilization management processes

Effective January 1, 2024, Medicare Advantage Plans are subject to new regulations governing prior authorization and utilization management.  We hope you find this analysis and checklist developed by our national affiliate, AHCA/NCAL, and the law firm, Hooper, Lundy & Bookman, helpful in navigating the new requirements and ensuring that the MA plans with which you deal are in compliance. Read More

ICYMI: Important and helpful analysis of recent changes to Medicare Advantage Plan prior authorization and utilization management processes

Effective January 1, 2024, Medicare Advantage Plans are subject to new regulations governing prior authorization and utilization management.  We hope you find this analysis and checklist developed by our national affiliate, AHCA/NCAL, and the law firm, Hooper, Lundy & Bookman, helpful in navigating the new requirements and ensuring that the MA plans with which you deal are in compliance. Read More

ICYMI: Important and helpful analysis of recent changes to Medicare Advantage Plan prior authorization and utilization management processes

Effective January 1, 2024, Medicare Advantage Plans are subject to new regulations governing prior authorization and utilization management.  We hope you find this analysis and checklist developed by our national affiliate, AHCA/NCAL, and the law firm, Hooper, Lundy & Bookman, helpful in navigating the new requirements and ensuring that the MA plans with which you deal are in compliance. Read More

CMS Issues Proposed Rule on Beneficiary Appeal Process for Reclassified Hospital Stay

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule in the Federal Register on December 27, 2023, Medicare Program: Appeal Rights for Certain Changes in Patient Status, which establishes court-ordered appeals processes for Medicare beneficiaries admitted as hospital inpatients but later reclassified as outpatients receiving observation services during their hospital stay. Read More

ICYMI: CMS Finalizes Additional SNF Transparency Requirements Regarding Ownership, Disclosable Parties, and Public Reporting

On November 15, the Centers for Medicare and Medicaid Services (CMS) issued a display copy of a final rule, titled Medicare and Medicaid Programs: Disclosures of Ownership and Additional Disclosable Parties Information for Skilled Nursing Facilities and Nursing Facilities; Medicare Providers' and Suppliers' Disclosure of Private Equity Companies and Real Estate Investment Trusts. Read More

CMS Final Rule Removes COVID-19 Testing and Staff Vaccination Requirements

On May 31, 2023, the Centers for Medicare and Medicaid Services (CMS) announced a final rule, “Medicare and Medicaid Programs; Policy and Regulatory Changes to the Omnibus COVID-19 Health Care Staff Vaccination Requirements; Additional Policy and Regulatory Changes to the Requirements for Long-Term Care (LTC) Facilities and Intermediate Care Facilities for Individuals With Intellectual Disabilities (ICFs-IID) to Provide COVID-19 Vaccine Education and Offer Vaccinations to Residents, Clients, and Staff; Policy and Regulatory Changes to the Long Term Care Facility COVID-19 Testing Requirements.” Read More

All-SNF MAC 5-Claim Audit and Education Initiative

CMS has directed Medicare Administrative Contractors (MACs) to audit 5 Medicare claim submissions from every SNF as part of a widespread review to lower the SNF improper payment rate (likely due to unintentional increases brought forth by PDPM). This will be implemented in waves over the next year beginning June 5, 2023, so be on the lookout for these record requests. Read More

New Consequences For Nursing Homes in Special Focus Facility Program

The Special Focus Facility (“SFF”) Program is an ongoing initiative in which the Centers for Medicare and Medicaid Services (CMS) selects a set number of nursing homes in each state as a Special Focus Facility. CMS generates a list of poor performing facilities in a state from recent survey results and shares that list with that state’s Survey Agency (“SA”) so that the SA can recommend which nursing homes should be made SFFs. Read More

New Consequences For Nursing Homes in Special Focus Facility Program

The Special Focus Facility (“SFF”) Program is an ongoing initiative in which the Centers for Medicare and Medicaid Services (CMS) selects a set number of nursing homes in each state as a Special Focus Facility. CMS generates a list of poor performing facilities in a state from recent survey results and shares that list with that state’s Survey Agency (“SA”) so that the SA can recommend which nursing homes should be made SFFs. Read More

What Do I Need to Know? CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency

As part of the Centers for Medicare & Medicaid Services’ (CMS) ongoing efforts to provide up-to-date information to prepare for the end of the Public Health Emergency (PHE) for COVID-19, which is expected on May, 11, 2023, we are providing a new overview fact sheet on CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency.  COVID-19 efforts have been a significant priority for the Biden-Harris Administration, and with the use of whole-of-government approach, the country is in a better place. Over the next several months, we will work to ensure a smooth transition back to normal operations. Read More

What Do I Need to Know? CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency

As part of the Centers for Medicare & Medicaid Services’ (CMS) ongoing efforts to provide up-to-date information to prepare for the end of the Public Health Emergency (PHE) for COVID-19, which is expected on May, 11, 2023, we are providing a new overview fact sheet on CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency.  COVID-19 efforts have been a significant priority for the Biden-Harris Administration, and with the use of whole-of-government approach, the country is in a better place. Over the next several months, we will work to ensure a smooth transition back to normal operations. Read More

CMS Releases Proposed Medicare Eligibility and Coverage Changes

This week, CMS published in the Federal Register a proposed rule entitled, Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules. The Notice of Proposed Rulemaking (NPRM) includes proposed changes to Medicare eligibility, including elimination of the Medicare coverage waiting period under specific circumstances, as well as new Special Enrollment Periods (SEP). Read More