Archive for August 2015
In response to the concerns of hospitals, Medicare is planning changes in its hospital-acquired condition reduction program. The program, a product of the Affordable Care Act, penalizes hospitals that perform poorest on measures designed to identify medical problems their patients incur while hospitalized. Hospital performance is judged based on criteria developed by the Centers for Medicare & Medicaid Services (CMS). In the face of criticisms about the program’s design, overlapping measures, and more, CMS now plans to share more information with hospitals about how it scores their performance and also will update some of the measures upon which those scores are based. A recent article in the journal Health Affairs describes the hospital-acquired condition reduction program, the challenges it has … Read More
Three Medicare initiatives – its hospital readmissions reduction program, value-based purchasing program, and hospital-acquired condition program – were designed to improve the quality of care provided to beneficiaries while eventually reducing the cost of that care. But are they living up to their billing? That is the question considered in the Health Affairs article “Assessing Medicare’s Hospital Pay-For-Performance Programs and Whether They Are Achieving Their Goals.” Find the article here.
The Pennsylvania Department of Human Services (DHS) has announced new steps to enhance its program integrity efforts and reduce improper and fraudulent payments, including Medicaid payments. The proposed new approach will rely heavily on automation, analytics, and technology. Major changes include: Consolidation of the Office of Program Integrity and Bureau of Program Integrity Issuing a request for information for program integrity data analysis of provider payments Implementation of a customer portal for third-party liability Implementation of “identity proofing” of program recipients Automating provider enrollment Eliminating manual updating of milestone changes In the state’s 2015 fiscal year it prevented nearly $600 million in improper payments, 74 percent of which were potential provider payments. For a closer look at the state’s plans, … Read More
The Pennsylvania Health Law Project has published the July edition of Health Law News, its monthly newsletter. Included in this edition are articles about the continued expansion of Pennsylvania’s Medicaid program; the next steps in Pennsylvania’s managed long-term services and supports (MLTSS) initiative; the state’s selection of its benchmark essential health benefits insurance plan for 2017; and about how the state will phase out its current AIDS waiver while continuing to serve those covered by the waiver. Find the latest edition of Health Law News here.