CMS seeks comments on new approach to Innovation Center

AHA News Now

The Centers for Medicare & Medicaid Services seeks comments through Nov. 20 on a “new direction” for its Innovation Center that will approach new model design through six guiding principles: choice and competition in the market; provider choice and incentives; patient-centered care; benefit design and... read more

Topic: Advocacy and Public Policy
Tags: quality, physicians, Program Integrity, Medicare, Medicaid, price, transparency, Mental health, Behavioral health

CMS seeks comments on inappropriate steering to individual market plans

AHA News Now

The Centers for Medicare & Medicaid Services yesterday issued a request for information as it develops regulatory or operational changes to address concerns, based on anecdotal reports, that some health care providers or provider-affiliated organizations may be steering people eligible for or receiving... read more

Topic: Advocacy and Public Policy
Tags: Program Integrity, Medicare, Coverage, Medicaid

CMS proposes changes to Medicaid, CHIP eligibility review programs

AHA News Now

The Centers for Medicare & Medicaid Services today proposed changes to the Payment Error Rate Measurement and Medicaid Eligibility Quality Control programs to reflect how states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program under the Affordable Care Act. The proposed... read more

Topic: Advocacy and Public Policy
Tags: child health, Program Integrity, Medicaid, regulation

GAO recommends HHS take steps to reduce Medicare appeals

AHA News Now

The Department of Health and Human Services should take certain steps to reduce the number of Medicare appeals and strengthen oversight of the Medicare fee-for-service appeals process, the Government Accountability Office said in a report issued today. “Without more reliable and consistent information,... read more

Topic: Advocacy and Public Policy
Tags: RACs, Program Integrity, Medicare

CMS to initiate Medicare home health pre-claim review in five states

AHA News Now

The Centers for Medicare & Medicaid Services yesterday announced a pre-claim review demonstration for all Medicare fee-for-service home health services in Illinois, Florida, Texas, Michigan and Massachusetts. Start dates will be determined in the coming months, but will be no earlier than Aug. 1 in... read more

Topic: Advocacy and Public Policy
Tags: Program Integrity, Medicare, regulation, home health

Senate subcommittee approves Labor-HHS funding bill

AHA News Now

A Senate appropriations subcommittee today approved legislation that would provide $161.9 billion in base discretionary funding for the departments of Labor, Health and Human Services, Education and related agencies in fiscal year 2017, $270 million less than this year. HHS programs would receive $76.9... read more

Topic: Advocacy and Public Policy
Tags: RACs, Program Integrity, rural, Mental health, appropriations, teaching hospitals, opioids

The Joint Commission seeks to clarify 'misperceptions' of its pain standards

AHA News

The Joint Commission’s pain standards are unfairly blamed for the current prescription opioid epidemic because of “misperceptions” of what it requires hospitals and other accredited institutions to do, says David Baker, M.D., The Joint Commission’s executive vice president for health care quality... read more

Topic: Quality and Patient Safety
Tags: quality, measurement, Program Integrity, Behavioral health, chronic conditions, advanced illness care

AHA comments on proposed changes to Medicare enrollment requirements

AHA News Now

The AHA today recommended changes to the Centers for Medicare & Medicaid Services’ proposed rule on program integrity enhancements to the provider enrollment process to protect well-meaning providers from inappropriate delays, denials or revocation. While the association strongly supports efforts to... read more

Topic: Advocacy and Public Policy
Tags: Program Integrity, Medicare, regulation

CMS issues program integrity rule for Medicare providers, suppliers

AHA News Now

The Centers for Medicare & Medicaid Services today issued a proposed rule that would implement additional program integrity requirements for health care providers and suppliers who participate in Medicare, as authorized by the Affordable Care Act. According to a CMS factsheet, the rule would allow the... read more

Topic: Advocacy and Public Policy
Tags: Program Integrity, Medicare, regulation

House holds hearing on AHA-supported bill to standardize merger review process

AHA News

The House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law today held a hearing on the Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act, AHA-supported legislation that would standardize the merger review process for the Department of Justice (DOJ) and... read more

Topic: Advocacy and Public Policy
Tags: consolidation, Program Integrity, administrative simplification

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