Archive for the ‘Medicaid’ Category

Removing Fraud and Improving Point-of-Care Compliance in Healthcare

July 12, 2013

Special Report from CellTrak

Home and community care’s distributed delivery environment makes accountability of visits and services more challenging than in centralized, facility-based care models. The benefits of home-based care delivery are extreme, from both a cost savings and a patient results perspective. Electronic Visit Verification (EVV), when combined with manageable policies and procedures can significantly improve accountability to assure that services are being delivered to care recipients when and where providers claim they are and providers are able to manage this service delivery with reasonable, sustainable expense.

Today the biggest challenge for the healthcare systems is that the vast majority of care planning and visit verification along with transaction processing, payments, tracking and payroll is done via paper. (more…)

Advocates Urge More Government Oversight of Medicaid Managed Care

July 9, 2013

By Jenni Bergal, Kaiser Health News

When the federal government recently gave Florida the green light to vastly expand its experiment with privatizing Medicaid, patient advocates quickly raised an alarm.

They cited serious problems with the state’s five-county pilot managed care program and urged close monitoring of the companies that run private Medicaid plans to ensure that they don’t scrimp on care.

Advocates and experts say that the need for oversight is growing nationally as states have increasingly contracted out the huge state-federal program for the poor to insurance companies, aiming to control costs and improve quality through close management of patient care. About 30 million people are in these plans now. Under the federal health law that launches Jan. 1, eligibility will be expanded and about 7 million more will be covered by Medicaid. Many will be placed in managed care. (more…)

Fraud-Fighters Being Laid Off

July 1, 2013

By 

Florida, one of the nation’s hotspots for Medicare and Medicaid fraud, is at particular risk as budget changes in Washington combine to force the layoff this year of 400 employees of the Inspector General’s office at the Department of Health and Human Services.

The Center for Public Integrity reports that the staff-shedding began in January and resulted in 1,200 complaints going without investigation last year. The sequester – automatic across-the-board cuts that went into effect because of Congress’ inability to resolve its internal disputes – is only part of the reason. (more…)

CMMI Issues Second Round of Health Care Innovation Awards

June 24, 2013

On May 15, the Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) announced that it will be awarding up to $900 million in new funding for a second round of Health Care Innovation Awards. These awards will be made to applicants who propose new payment and service delivery models that have high likelihood of improving care and reducing costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, with a strong focus on Medicaid and CHIP populations.

The second round of awards will build on an earlier round of funding awarded in 2012. The first round of Innovation Awards supports 107 models, ranging from $1 million to $26.5 million over a three year period. This round included a wide range of models, including models that enhance primary care, coordinate care across multiple settings, deploy new types of health care workers, help patients and providers make better decisions, and test new service delivery technologies. (more…)

Tampa Bay Times: One Month Later, Florida Lawmakers No Closer to Medicaid Deal

June 17, 2013

By Tia Mitchell, Tampa Bay Times

TALLAHASSEE — Two House Republicans unwittingly revived hopes this month that lawmakers could compromise on a proposal to expand Medicaid.

“Lawmakers say Medicaid expansion not dead” read the headline in the Sarasota Herald-Tribune,highlighting comments from Manatee County Reps. Greg Steube and Jim Boyd.

But the reality is no different today than it was when the legislative session ended last month:

Medicaid expansion, or some alternative, remains a long shot.

“All I was simply trying to say was, we all agree it’s an important issue,” Boyd told the Times/Herald about his remarks at a June 6 luncheon. “We thought we had a pretty good plan.”

That plan, championed by House Speaker Will Weatherford, included saying no to $51 billion in federal money over 10 years. Instead, House Republicans proposed using up to $300 million in state funding to subsidize basic coverages for about 130,000 people. (more…)

AHCA Announces Telephony Program Provider Meetings

June 14, 2013

The Agency for Health Care Administration and Sandata invite home health service (visits, personal care services and private duty nursing) providers that are participating in the Florida Medicaid Home Health Services Telephonic Delivery Monitoring and Verification (DMV) Program to attend a meeting in their region as follows: (more…)

OIG Exclusions & Sanctions Listing Updated for June

June 13, 2013

HCAF has posted the latest exclusion and reinstatements that were released by CMS’ Office of the Investigator General (OIG) on June 11, 2013. The list includes physicians and other provider types in Florida.

Health care providers must be careful not to make payments to sanctioned entities or employ sanctioned individuals. No payment will be made by any federal health care program for any items or services furnished, ordered, or prescribed by an excluded individual or entity. Federal health care programs include Medicare, Medicaid, and all other plans and programs that provide health benefits funded directly or indirectly by the United States. (more…)

OIG Exclusions & Sanctions Listing Updated for May

May 22, 2013

HCAF has posted the latest exclusion and reinstatements that were released by CMS’ Office of the Investigator General (OIG) on May 15, 2013. The list includes physicians and other provider types in Florida.

Health care providers must be careful not to make payments to sanctioned entities or employ sanctioned individuals. No payment will be made by any federal health care program for any items or services furnished, ordered, or prescribed by an excluded individual or entity. Federal health care programs include Medicare, Medicaid, and all other plans and programs that provide health benefits funded directly or indirectly by the United States. (more…)

Long-Term Care Medicaid Patients Start Enrolling

May 20, 2013

Phone counselors are now available to help long-term care Medicaid recipients choose their health plans. State officials say the call centers went live Monday. Long-term care Medicaid recipients can call the hotline and ask questions about what doctors and medications are covered in different plans. (more…)

BREAKING: Gov. Scott Vetoes Medicaid Home Health Rate Increases

May 20, 2013

Gov. Rick Scott today vetoed Medicaid rate increases for home health services and private duty nursing services that were included in the final budget proposed by the Florida Legislature. As we reported earlier this month at the adjournment of the annual legislative session, the $74 billion state budget for the 2013-14 fiscal year included 10% rate increases for home health services provided by an RN and LPN, and private duty nursing services provided by an LPN. The cost for the two increases would have been $213,652 and $9,384,984, respectively. We do recognize that Gov. Scott opted to keep the 322-slot expansion of the Nursing Home Diversion Waiver program.

We can only surmise why such a small but much needed increase was not granted. It shows yet still how much work has to be done to convince the powers that be of what should be obvious to all. The cost effectiveness of home care is critical to answering every health care problem that the nation and the state of Florida faces, however we cannot meet those needs unless funding is adequate. We will continue trying to help them realize what they will be forced to accept eventually, which is that health care delivered in the community and in the home is the only way to adequately address the growing health care needs of Floridians.