PA: Community HealthChoices MCOs

CHC was developed for Pennsylvanians who are eligible for Medicare and Medicaid, or eligible for Medicaid-funded LTSS. This new initiative is a managed care program by the departments of Human Services (DHS) and Aging (PDA) to: (1) enhance access to and improve coordination of physical health care and; (2) create a person-driven, long-term support system[…]


CMS Proposes Six-Month Delay for Home Health CoPs

The Centers for Medicare & Medicaid Services (CMS) has proposed delaying the implementation date for the new home health Conditions of Participation (CoPs) until January 2018. The proposal comes after home health industry associations and providers pushed back against the original implementation timeline for the CoPs, which were finalized in early January 2017. Instead of[…]


Survey: Mail-order program reduces access

Medicare’s national mail-order program for diabetes testing supplies has sharply reduced beneficiary access, says a new survey from the America Association of Diabetes Educators. The “secret shopper” survey found that: The number of manufacturers making diabetes testing supplies available under the mail-order program has fallen 50% since the program started; The number of diabetes testing[…]


RAC Integration for Medicare Advantage Audits

Section 6411(b) of the Patient Protection and Affordable Care Act of 2010 (PPACA) requires the expansion of the Recovery Audit Contractor (RAC) program to Medicare Part C. While we may refer to either MA as Medicare Advantage (or a more accurate acronym, MAO, for Medicare Advantage Organizations), the simple fact is that the RACs (or[…]

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Six-Figure HIPAA Penalty for Home Care Agency due to PHI Access by Spouse of Employee

A recent ruling by a U.S. Department of Health and Human Services Administrative Law Judge (“ALJ”) in the case of Director of the Office for Civil Rights v. Lincare, Inc., (Decision No. CR4505, Jan. 13, 2016), underscores the substantial penalties that a health care provider can face, even for relatively small-scale HIPAA violations, particularly if[…]


NC Medicaid remake hits benchmark

The effort to privatize North Carolina’s Medicaid program made its first substantive deadline last week, but Department of Health and Human Services officials warned lawmakers that putting the plan in place will face at least one big obstacle: presidential politics. For years, North Carolina’s health insurance program for the poor and disabled has been based[…]


Medicaid reform in NC has health care systems juggling best path for services

The state’s largest health care systems have been caught in a logistical tug-of-war after legislators proposed a hybrid strategy for handling the biggest piece of Medicaid reform. Do the systems pursue a statewide Medicaid coverage role, whether individually or collaboratively, which carries both revenue opportunities and risk, or do they focus on serving their own[…]