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https://www.readbyqxmd.com/read/28102985/medicare-program-changes-to-the-medicare-claims-and-entitlement-medicare-advantage-organization-determination-and-medicare-prescription-drug-coverage-determination-appeals-procedures-final-rule
#1
(no author information available yet)
This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals...
17, 2017: Federal Register
https://www.readbyqxmd.com/read/28102984/medicare-and-medicaid-program-conditions-of-participation-for-home-health-agencies-final-rule
#2
(no author information available yet)
This final rule revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. These changes are an integral part of our overall effort to achieve broad- based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers...
13, 2017: Federal Register
https://www.readbyqxmd.com/read/28102893/the-evolving-health-policy-landscape-and-suggested-geriatric-tenets-to-guide-future-responses
#3
Robert L Kane, Debra Saliba, Peter Hollmann
Speculation is rampant about what the new leadership in the White House and continued Republican leadership of both houses of Congress will do about health care. The concordance in party affiliation between President Trump and the congressional majority makes revisions in policy that is relevant to the health of older adults a virtual certainty. Past Republican legislative proposals and the current appointments to lead Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) presage several potential areas of change...
January 19, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28102652/changing-rural-and-urban-enrollment-in-state-medicaid-programs
#4
Abigail R Barker, Kelsey Huntzberry, Timothy D McBride, Keith J Mueller
Purpose. From October 2013—before implementation of the Affordable Care Act (ACA)—to November 2016, Medicaid enrollment grew by 27 percent. However, very little attention has been paid to date to how changes in Medicaid enrollment vary within states across the rural-urban continuum. This brief reports and analyzes changes in enrollment in metropolitan, micropolitan, and rural (noncore) areas in both expansion states (those that used ACA funding to expand Medicaid coverage) and nonexpansion states (those that did not use ACA funding to expand Medicaid coverage)...
2017: Rural Policy Brief
https://www.readbyqxmd.com/read/28102648/2016-rural-enrollment-in-health-insurance-marketplaces-by-state
#5
Abigail R Barker, Kelsey A Huntzberry, Timothy D McBride, Leah M Kemper, Keith J Mueller
Purpose. In this brief, cumulative county-level enrollment in Health Insurance Marketplaces (HIMs) through March 2016 is presented for state HIMs operated as Federally Facilitated Marketplaces (FFMs) and for those operated as Federally Supported State-Based Marketplaces (FS-SBMs). Enrollment rates in metropolitan and non-metropolitan areas of each state, defined as the percentage of “potential market” participants selecting plans, are presented. Monitoring annual enrollment rates provides a gauge of how well state outreach and enrollment efforts are proceeding and helps identify states with strong non-metropolitan enrollment as models for other states to emulate...
2017: Rural Policy Brief
https://www.readbyqxmd.com/read/28101955/prescription-drug-monitoring-programs-produce-a-limited-impact-on-painkiller-prescribing-in-medicare-part-d
#6
Courtney R Yarbrough
OBJECTIVE: To measure the impact of prescription drug monitoring programs (PDMPs) on prescribing of opioid and nonopioid painkillers. DATA SOURCE: 2010-2013 physician-level Medicare Part D prescribing data released by the Centers for Medicare and Medicaid Services and Propublica. STUDY DESIGN: Using difference-in-differences models with physician-level fixed effects, the study compares prescribing in states with and without PDMPs for opioid and nonopioid analgesics, oxycodone, hydrocodone, and opioids by controlled substances Schedules II-IV...
January 18, 2017: Health Services Research
https://www.readbyqxmd.com/read/28099378/acs-level-i-trauma-centers-outcomes-do-not-correlate-with-patients-perception-of-hospital-experience
#7
Bellal Joseph, Asad Azim, Terence O'Keeffe, Kareem Ibraheem, Narong Kulvatunyou, Andrew Tang, Gary Vercruysse, Randall Friese, Rifat Latifi, Peter Rhee
INTRODUCTION: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services (CMS) as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level-1 trauma centers correlate with actual hospital performance...
January 17, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28099060/understanding-medicaid-managed-care-investments-in-members-social-determinants-of-health
#8
Laura Gottlieb, Sara Ackerman, Holly Wing, Rishi Manchanda
Despite widespread interest in addressing social determinants of health (SDH) as a means to improve health and to reduce health care spending, little information is available about how to develop, sustain, and scale nonmedical interventions in diverse payer environments, including Medicaid Managed Care. This study aimed to explore how Medicaid Managed Care Organization (MMCO) leaders interpret their roles and responsibilities around SDH, how they garner resources to develop and sustain interventions to address SDH, and how they perceive the influences of external organizations on related activities...
January 18, 2017: Population Health Management
https://www.readbyqxmd.com/read/28098496/real-world-adherence-assessment-of-lurasidone-and-other-oral-atypical-antipsychotics-among-patients-with-schizophrenia-an-administrative-claims-analysis
#9
Krithika Rajagopalan, Sally Wade, Nicole Meyer, Antony Loebel
OBJECTIVE: To compare adherence with lurasidone to other oral atypical antipsychotics among Medicaid- and commercially-insured patients with schizophrenia. RESEARCH DESIGN AND METHODS: Administrative claims of patients with schizophrenia treated with atypical antipsychotics (lurasidone, aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone) from October 2010-September 2011 were identified from MarketScan Commercial and Medicaid Databases, and were classified by the first (index) antipsychotic...
January 18, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28094189/medicaid-payer-status-is-linked-to-increased-rates-of-complications-after-treatment-of-proximal-humerus-fractures
#10
Vani J Sabesan, Graysen Petersen-Fitts, Daniel Lombardo, Daniel Briggs, James Whaley
BACKGROUND: Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012...
January 13, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28093464/socioeconomic-status-smoke-exposure-and-health-outcomes-in-young-children-with-cystic-fibrosis
#11
Thida Ong, Michael Schechter, Jing Yang, Limin Peng, Julia Emerson, Ronald L Gibson, Wayne Morgan, Margaret Rosenfeld
BACKGROUND: Lower socioeconomic status (SES) and environmental tobacco smoke (ETS) exposure are both associated with poorer disease outcomes in cystic fibrosis (CF), and children with low SES are disproportionately exposed to ETS. We analyzed a large cohort of young children with CF to distinguish the impact of SES and ETS on clinical outcomes. METHODS: The Early Pseudomonas Infection Control Observational study enrolled Pseudomonas-negative young children with CF <13 years of age...
January 16, 2017: Pediatrics
https://www.readbyqxmd.com/read/28093060/follow-up-care-after-emergency-department-visits-for-mental-and-substance-use-disorders-among-medicaid-beneficiaries
#12
Sarah Croake, Jonathan D Brown, Dean Miller, Nathan Darter, Milesh M Patel, Junqing Liu, Sarah Hudson Scholle
OBJECTIVE: This study examined whether characteristics of Medicaid beneficiaries were associated with receipt of follow-up care after discharge from the emergency department (ED) following a visit for mental or substance use disorders. METHODS: Medicaid fee-for-service claims from 15 states and the District of Columbia in 2008 were used to calculate whether adults received follow-up (seven and 30 days) after being discharged from the ED following a visit for mental disorders (N=31,952 discharges) or substance use disorders (N=13,337 discharges)...
January 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28093059/insurance-coverage-and-treatment-use-under-the-affordable-care-act-among-adults-with-mental-and-substance-use-disorders
#13
Brendan Saloner, Sachini Bandara, Marcus Bachhuber, Colleen L Barry
OBJECTIVE: Many adults who have mental or substance use disorders or both experience insurance-related barriers to care, contributing to low treatment utilization. Expanded insurance under the Affordable Care Act (ACA) could improve coverage and access. The study identified changes in coverage and treatment use following 2014 ACA insurance expansions. METHODS: Data from the National Survey on Drug Use and Health were used to identify individuals ages 18-64 screening positive for any mental disorder (N=29,962) or substance use disorder (N=19,243) for two periods: 2011-2013 and 2014...
January 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28093055/low-rates-of-hiv-testing-among-adults-with-severe-mental-illness-receiving-care-in-community-mental-health-settings
#14
Christina Mangurian, Francine Cournos, Dean Schillinger, Eric Vittinghoff, Jennifer M Creasman, Bernard Lee, Penelope Knapp, Elena Fuentes-Afflick, James W Dilley
OBJECTIVE: This research aimed to characterize HIV testing rates among Medicaid recipients with severe mental illness who received public specialty mental health services. METHODS: This retrospective cohort study examined California Medicaid records from October 1, 2010, to September 30, 2011 (N=56,895). Study participants were between age 18 and 67, utilized specialty mental health care services, were prescribed antipsychotic medications, and were not dually eligible for Medicare...
January 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28091796/preferences-for-smoking-cessation-support-from-family-and-friends-among-adults-with-serious-mental-illness
#15
Kelly A Aschbrenner, John A Naslund, Lydia Gill, Stephen J Bartels, A James O'Malley, Mary F Brunette
Engaging natural supports may be a promising strategy to promote the use of evidence-based smoking cessation treatment for individuals with serious mental illness (SMI) who smoke. This qualitative study explored preferences for support for quitting from family and friends among individuals with SMI who participated in cessation treatment. Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. Open-ended questions asked during a social network interview explored participants' preferences for more support for quitting smoking from family and friends...
January 16, 2017: Psychiatric Quarterly
https://www.readbyqxmd.com/read/28089387/treatment-of-men-with-high-risk-prostate-cancer-based-on-race-insurance-coverage-and-access-to-advanced-technology
#16
Robert Steven Gerhard, Dattatraya Patil, Yuan Liu, Kenneth Ogan, Mehrdad Alemozaffar, Ashesh B Jani, Omer N Kucuk, Viraj A Master, Theresa W Gillespie, Christopher P Filson
PURPOSE: We characterized factors related to nondefinitive management (NDM) of patients with high-risk prostate cancer and assessed impact from race, insurance status, and facility-level volume of technologically advanced prostate cancer treatments (i.e., intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome. METHODS: We identified men with high-risk localized prostate cancer (based on D׳Amico criteria) in the National Cancer Database (2010-2012)...
January 12, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28089185/joint-replacement-volume-positively-correlates-with-improved-hospital-performance-on-centers-for-medicare-and-medicaid-services-quality-metrics
#17
Rachel A Sibley, Vanessa Charubhumi, Lorraine H Hutzler, Albit R Paoli, Joseph A Bosco
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP)...
December 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28088321/surgeon-pathologist-and-hospital-level-variation-in-suboptimal-lymph-node-examination-after-colectomy-compartmentalizing-quality-improvement-strategies
#18
Adan Z Becerra, Christopher T Aquina, Mariana Berho, Francis P Boscoe, Maria J Schymura, Katia Noyes, John R Monson, Fergal J Fleming
BACKGROUND: The goals of this study were to characterize the variation in suboptimal lymph node examination for patients with colon cancer across individual surgeons, pathologists, and hospitals and to examine if this variation affects 5-year, disease-specific survival. METHODS: A retrospective cohort study was conducted by merging the New York State Cancer Registry with the Statewide Planning & Research Cooperative System, Medicaid, and Medicare claims to identify resections for stages I-III colon cancer from 2004-2011...
January 11, 2017: Surgery
https://www.readbyqxmd.com/read/28087902/a-review-of-the-preventability-of-maternal-mortality-in-one-hospital-system-in-louisiana-usa
#19
James J Morong, Jane K Martin, Robert S Ware, Alfred G Robichaux
OBJECTIVE: To determine preventability of in-hospital maternal mortality in the Ochsner Health System (OHS) in the US state of Louisiana. METHODS: A retrospective study was undertaken of all known cases of in-hospital maternal death (during pregnancy or within 42 days of termination) that occurred within OHS facilities in 1995-2013. Associations between characteristics and mortality and preventability were investigated. Incidence rate ratios (IRRs) were calculated in view of varying reference values...
December 9, 2016: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28080012/medicaid-s-future-what-might-aca-repeal-mean
#20
Sara Rosenbaum, Sara Rothenberg, Rachel Gunsalus, Sara Schmucker
Issue: Republicans in Congress are expected to repeal portions of the Affordable Care Act (ACA) using a fast-track process known as budget reconciliation. Goals: This issue brief examines how repeal legislation could affect Medicaid, the nation’s health care safety net, which insured 70 million people in 2016. Findings and Conclusions: Partial-repeal legislation that passed Congress but was vetoed by President Obama in 2016 offers some insight but new legislation could go further. It could repeal the ACA’s Medicaid eligibility expansions for adults and children but also roll back other provisions, such as simplified enrollment and improvements in long-term services and supports for beneficiaries with disabilities...
2017: Issue Brief of the Commonwealth Fund
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