C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Health Outcomes Federal Policy 52

Healthcare It News

FEBRUARY 28, 2023

The payer mix of health insurance is typical, with 35% of patients representing government insurance such as Medicare or Medicaid, 60% commercial insurance, and 6% self-pay patients. Virtual-first primary care has been shown to improve health outcomes by increasing access, he reported.

Electronic Medical Records 243

Electronic Medical Records Telemedicine Health Insurance Health Outcomes 243

Center for Health Insurance Reform

MARCH 11, 2022

In honor of Black History Month, for the February edition of CHIR’s monthly research roundup we reviewed new health policy research centering the experiences of Black people in the U.S. Continue reading → The post February Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

ACA 79

ACA Health Insurance Health Outcomes Medicaid 79

Innovaare Compliance

MARCH 24, 2024

According to the National Health Care Anti-Fraud Association, the financial losses due to healthcare fraud are estimated to be in the billions of dollars annually. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

Jane Sarashon

JANUARY 19, 2024

Elevance Health, the health plan organization comprising XXX plans serving 117 million members, launched a program to channel mobile phones and data plans into the hands of some Medicaid plan enrollees, explained in the organization’s press release on the program.

Medicaid 70

Medicaid Medicaid COVID-19 Health Outcomes 70

Compliancy Group

MARCH 19, 2024

Also, all insurance and Medicare or Medicaid claims must only include charges for services and treatments ordered and deemed necessary. Department of Health and Human Services (HHS) enforces laws relevant to patient care, healthcare delivery and billing, and workplace safety in the U.S. name, phone number).

Regulatory Compliance 52

Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

Healthcare IT Today

APRIL 13, 2023

The following is a guest article by Paul Barnes, Partner at CWH Advisors Today, there is widespread consensus that Social Determinants of Health (SDoH) have an impact on health inequities among various populations; resource scarcity in food, housing and other areas result in different health utilization and outcomes.

Medicaid 66

Medicaid Medicaid Medicare Medicare 66

MedTrainer

DECEMBER 4, 2023

Regulations in the district encompass diverse healthcare areas, including patient privacy and data security, Medicaid and Medicare compliance, health insurance marketplaces, and scope of practice for healthcare professionals. Healthcare in D.C.

Compliance 52

Compliance Health Insurance Health Outcomes Medicaid 52

Healthcare IT Today

APRIL 10, 2023

Uncle Roy’s story is not unique; the individual behaviors that people with chronic conditions perform on a daily basis are the most important determinant of future health outcomes. But, it’s estimated that 40% of health outcomes are actually attributed to our individual behavior. In the U.S.,

Health Outcomes 93

Health Outcomes Hospitals ACA Doctors 93

MedTrainer

DECEMBER 7, 2023

The Medicaid and Health program of Idaho provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities in the state, offering a range of medical and health-related services.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

MedTrainer

DECEMBER 4, 2023

The Mississippi Division of Medicaid administers health coverage programs to eligible residents, providing vital healthcare services to underserved and vulnerable populations in the state. Health insurance plans must cover telemedicine services to the same extent that services would be covered if they were provided in-person.

Compliance 52

Compliance Telemedicine Licensing Public Health 52

MedTrainer

NOVEMBER 29, 2023

The Massachusetts Health & Hospital Association (MHA) is a prominent organization representing hospitals and health systems across Massachusetts, advocating for policies and practices that support healthcare delivery and patient care.

Compliance 52

Compliance Public Health Health Insurance Hospitals 52

MedTrainer

NOVEMBER 29, 2023

The Tennessee Hospital Association (THA) is a membership organization that represents and supports hospitals and health systems across Tennessee, advocating for their interests and working to enhance healthcare quality and accessibility for all Tennesseans. TennCare is Tennessee’s managed Medicaid agency.

Compliance 52

Compliance Licensing HIPAA Medicaid 52

Health Populi

FEBRUARY 17, 2021

Those patients trying to stay medication-adherent tried various strategies such as stretching out their prescriptions, skipping doses, or reducing those doses — not sticking to the prescribed regimen, which can result in an adverse event or compromise the intended health outcome.

COVID-19 141

COVID-19 Health Insurance Health Outcomes Medicaid 141

HIT Consultant

JUNE 28, 2022

The results are one example of the gains that can be made in addressing health inequities—differences in health status or distribution of health resources by race, population, gender, income and more—by exploring the nuances that perpetuate disparities in health outcomes. Digging Deeper into Disparities in Care.

Health Outcomes 52

Health Outcomes COVID-19 Medicaid Medicaid 52

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. percent of the gross domestic product (GDP) on healthcare, which was almost two times the average of other high-income countries, while the health outcomes in the U.S. healthcare system were exorbitant.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Health Populi

JUNE 22, 2022

The last chart from the Commonwealth Fund 2022 State Scorecard talks about the rate of uninsurance by state — think ZIP code or personal GPS — calling out the fact that a dozen Governors did not expand Medicaid to accommodate ACA health plan enrollment for their health citizens.

COVID-19 112

COVID-19 ACA Public Health Health Outcomes 112

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. percent of the gross domestic product (GDP) on healthcare, which was almost two times the average of other high-income countries, while the health outcomes in the U.S. healthcare system were exorbitant.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

FEBRUARY 7, 2022

Research says that those Americans who live in rural communities have less access to care and subsequently worse health outcomes than those who live in non-rural communities. African American adults are more likely to report they cannot afford to see a doctor, leading to worse health outcomes.

Doctors 98

Doctors Health Outcomes COVID-19 Health Insurance 98

Health Populi

OCTOBER 11, 2021

Ruth Shim wrote about mental health inequities in the context of COVID-19 in JAMA in September 2020, The emergence of COVID-19 has brought renewed attention to disparities and inequities in health outcomes that exist for US residents who are most commonly oppressed and marginalized in US society.

COVID-19 77

COVID-19 Public Health World Health Health Outcomes 77

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Acquisition of BCBSLA Paused a Second Time It was the biggest health care deal in Louisiana history. What they say sets them apart.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

Medicaid 52

Medicaid Medicaid ACA Public Health 52

Health Populi

JULY 13, 2020

The Consumer Technology Association (CTA) collaborated with The Economist Intelligence Unit (EIU) on the research report, Reinvigorating Value-Based Health Care: Exploring the Role of Technology Innovation. National Health Expenditures are expected to consume 19.7% of the U.S. That would be $1 in every $5 of the American economy.

COVID-19 106

COVID-19 Medicare Medicare Hospitals 106

Health Populi

FEBRUARY 11, 2019

Patients most-trust their clinicians, physicians and nurses, as safe places in which to have an honest SDoH discussion, compared with a health insurance representative. But age is a factor in these conversations, where younger people are more comfortable talking about SDoHs with clinicians than older people.

Medicare 90

Medicare Medicare Doctors Health Insurance 90

Health Populi

NOVEMBER 19, 2019

In the past decade, I’ve been spending a lot of time considering SDoH through a variety of lenses across the health/care ecosystem, including care providers like hospitals, health insurance companies, pharma and life science, retail health care front doors, and non-profits and foundations.

Health Care Access 59

Health Care Access Medicare Medicare Health Insurance 59

Health Care Law Brief

FEBRUARY 6, 2023

The bill states that “physician practices are subject to far less oversight than [other facilities]” but that they “remain unregulated by the state outside of the licensure of the individual practitioners who practice at these sites and Medicaid enrollment.” at PHL § 4551(2). at PHL § 4554.

Patient Satisfaction 52

Patient Satisfaction Licensing Health Insurance Health Outcomes 52

HIT Consultant

OCTOBER 7, 2021

Value-based care, a model that rewards better patient health outcomes, has experienced a surge in interest amid heightened consumer awareness and among payers seeking to lower costs and stabilize reimbursement. WEDI has close working relationships with both CMS and CAQH.

COVID-19 98

COVID-19 Nurses Nursing Homes Health Insurance 98

HIT Consultant

OCTOBER 5, 2023

. – Ounce Community Health Workers (CHW) currently serve more than 2,000 D.C. residents, helping them enroll in Medicaid, apply for energy assistance, schedule PCP and pediatrician appointments, avoid eviction, and connect with community resources for transportation and nutritious food, among many other services.

Medicaid 98

Medicaid Medicaid Health Outcomes Health Insurance 98

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M operating margin, $1B net gain halfway through its first year Illinois public health officials warn of “rising COVID-19 activity” St. million to Resolve False Claims Act Allegations Michigan Pain Center Owner Pays $6.5M

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

HIT Consultant

JULY 13, 2022

has been driven by the establishment of the Center for Medicare and Medicaid Innovation (CMMI). The underlying theme across all these efforts is an acceleration toward value-based payment models that focus on driving more accountability for providers and improving health outcomes for patients.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Hall Render

NOVEMBER 4, 2022

Feds approve program for rural Arkansas health care but it will cost local taxpayers more. Governor Hutchinson Announces Expansion To Rural Health Services With ARHOME Medicaid Program. Feds OK Arkansas’ Life360 model incentivizing health outcomes. New vice president named at Baptist Health Lexington.

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nurses Nursing Homes 40

Healthcare IT Today

JANUARY 5, 2024

A population health-based approach that incorporates social determinants of health and sexual orientation and gender identity will significantly improve community health outcomes. Health plans will pay for these free phones and give them to patients in homeless communities and underserved populations.

Nurses 114

Nurses Medicare Medicare Health Outcomes 114

Hall Render

JANUARY 5, 2024

helped shape Galen College of Nursing’s culture Kentucky Association of Health Plans names 2024 officers, expands reach to improve health of all Kentucky’s registered nurse median salary ranks 38th in U.S.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

AUGUST 19, 2022

Connecticut ditches $20M health information exchange software. Two Health Insurers Grilled for Proposing Rate Increases of 20 and 25 Percent. Kaiser mental health worker strike to expand to Hawaii. Hawaii Health Department reports 2 more monkeypox cases, bringing total to 18. Novant Health patients.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40

Jane Sarashon

DECEMBER 22, 2022

Brian Klepper of Worksite Health Advisors , longtime consigliere to self-insured employers, unions, and value-oriented providers of medical services, explained the growth in value-based care he expects to see in the coming months: “Today’s descendants of the disruptor Managed Care companies of the 1980’s are value-focused and high performing….that

COVID-19 52

COVID-19 Health Insurance Public Health Hospitals 52