How CMS’ 2024 Risk Adjustment Rules May Affect Palliative Care Companies

Depending on how stakeholders play their cards, the U.S. Centers for Medicare & Medicaid Services’ (CMS) updated risk adjustment policy could lead to tightened belts — or a golden opportunity — for palliative care providers in Medicare Advantage. Much of the palliative care delivered to U.S. patients is now reimbursed through risk-based models like Medicare […]

SCAN CEO Jain: Don’t Glorify Fee-for-Service to Improve Medicare Advantage

When stakeholders consider ways to improve Medicare Advantage, they should take care not to romanticize fee-for-service Medicare in the process, SCAN Health Plan CEO Dr. Sachin Jain cautions. Medicare Advantage (MA) is a growing force in health care. More MA plans emerge each year and the size of their beneficiary populations continues to grow. While […]

Federal Officials Call for Stronger Medicare Advantage Oversight

Congressional legislators are casting doubts on regulatory oversight of Medicare Advantage (MA) plans over concerns about spending, claims denials and end-of-life care. Several lawmakers expressed these reservations during a House Energy and Commerce Committee’s Oversight and Investigation subcommittee hearing that focused on the MA program. “Improper claim denials and increased use of prior authorizations are […]

Payers Can ‘Feed Their Own Machine’ With Hospice, Home Health Deals

Recent acquisitions of large hospice and home health providers by insurance companies suggest a drive among payers to reduce financial risk and improve cost outcomes in value-based care arrangements. These deals include two of the largest in recent memory for the home-based care space. UnitedHealth Group (NYSE: UNH) recently agreed to purchase LHC Group (NASDAQ: […]

Patients Praise Medicare Advantage as Hospice Carve-In Takes Effect

Beneficiaries participating in Medicare Advantage give high ratings to the coverage and services they receive, with as many as 98% reporting satisfaction, according to a recent Better Medicare Alliance poll. This feedback comes shortly after the Jan. 1 inception of the value-based insurance design demonstration, often called the Medicare Advantage hospice carve-in. Payers and hospice […]

HHS Secretary Azar: Medicare Advantage Will Grow Telehealth Beyond COVID-19

Telehealth will be a cornerstone of future health care policy following the COVID-19 pandemic, with Medicare Advantage plans as one engine for growth. Expansion of telehealth services across the health care continuum accelerated rapidly due to efforts to stem the spread of the novel coronavirus. These developments will likely shape health care for years to […]

Humana CMO: Lack of Medicare Advantage Coverage a Barrier to Hospice

Patients covered by Medicare Advantage plans who are faced with the decision of whether to elect hospice may be discouraged by the need to transition off their health plan for most of their care. This practice that has the potential to change through the forthcoming value-based insurance design model demonstration, often called the Medicare Advantage […]

Forthcoming Legislation Seeks to Delay Medicare Advantage Hospice Carve-In

Legislation will likely be forthcoming in Congress this week or next to delay implementation of the value-based insurance design (VBID) model demonstration project, commonly called the Medicare Advantage hospice carve-in. If enacted, the bill would move the program’s start date to 2023.  Currently, the carve-in is slated to begin Jan. 1, 2021. While hospice industry […]

Congress Members Call on CMS to Delay Hospice Carve-In

Members of the Ways and Means Committee in the U.S. House of Representatives have called for a one-year delay for the value-based insurance design model hospice demonstration, commonly called the Medicare Advantage carve-in. Reps. Adrian Smith (R-Neb.), Jackie Walorski (R-Ind.) and Terri Sewell (D-Ala.) sent a letter to Seema Verma, administrator of the U.S. Centers […]

Calls Grow Louder to Delay Hospice Medicare Advantage Carve-In

Stakeholders in the hospice space are calling on the U.S. Centers for Medicare & Medicaid Services (CMS)  to delay the inclusion of hospice in the agency’s value-based insurance design model, commonly called the Medicare Advantage hospice carve-in, on the grounds that providers will not be able to prepare due to the pressures brought on by […]