Archive for November 2015

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid-covered services. According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services. State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers. Interested parties have 60 days to submit comments to CMS about the new regulation. For a closer look at the regulation, see this CMS fact sheet … Read More

Posted in Uncategorized

Readmissions Down But Observation Status Up

New research suggests that the general decline in hospital readmissions may be leading to increased use of observation status. According to new research in the journal Health Affairs, Our independent analysis of Medicare data published by CMS revealed that the top 10 percent of hospitals with the largest drop (16 percent on average) in readmission rates between 2011 and 2012 also increased their use of observation status for Medicare patients returning within 30 days by an average 25 percent over the same time period. The practice appears to be affecting privately insured patients, too, with the report noting that …hospitals that reduced readmissions within 30 days also increased their share of returning observation patients in private plans. The top third of … Read More

Posted in Medicare

Slight Decline in Uninsured Children in PA

The number of uninsured children in Pennsylvania fell from 147,303 in 2013 to 139,000 in 2014, according to a new study released by the Pennsylvania Partnerships for Children and the Georgetown University Center for Children and Families. The decline was driven part by the expansion of the state’s Medicaid program, which was enabled by the federal Affordable Care Act. Pennsylvania’s Medicaid expansion began in early 2014. Learn more about uninsured children in Pennsylvania in this Pittsburgh Post-Gazette article.

Posted in Uncategorized

CMS Proposal Would Mandate Hospital Discharge Planning

Hospitals that participate in Medicare and Medicaid would be required to develop discharge plans for all inpatients and many outpatients under a new regulation proposed by the Centers for Medicare & Medicaid Services (CMS). According to a CMS news release, …hospitals, including inpatient rehabilitation facilities and long-term care hospitals, critical access hospitals, and home health agencies would be required to develop a discharge plan based on the goals, preferences, and needs of each applicable patient . Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. This would apply to … Read More

Posted in Medicare
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