As a 2019 strategic priority, Centers for Medicare & Medicaid Services (CMS) is redoubling efforts to better serve older adults and people with disabilities dually eligible for Medicaid and Medicare. The goal is to create a more seamless experience across the two programs while ensuring that incentives are aligned and pointed toward lower cost and better outcomes.
On April 24, CMS sent a letter to State Medicaid Directors inviting states to partner on testing innovative approaches to better serve those who are dually eligible for Medicare and Medicaid. Many of these 12 million beneficiaries have complex healthcare issues and often have socioeconomic risk factors that can lead to poor outcomes. This letter opens new ways to address those needs, align incentives, encourage marketplace innovation through the private sector, lower costs, and reduce administrative burdens.
The Administration for Community Living and the Centers for Medicare & Medicaid Servicesannounce the launch of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS).
During the past 30 years, systems for people with disabilities and older adults with long-term service and support needs have generally shifted to embrace person-centered principles, premised on the belief that people should have the authority to define and pursue their own vision of a good life. Yet, the degree to which these systems have fully adopted person-centered practices varies, and many continue to grapple with how to effectively implement them.
The goal of NCAPPS is to promote systems change that makes person-centered principles not just an aspiration, but a reality in the lives of people who require services and supports across the lifespan. NCAPPS will assist states, tribes, and territories to transform their long-term care service and support systems to implement U.S. Department of Health and Human Services policy on person-centered thinking, planning, and practices. It will support a range of person-centered thinking, planning, and practices, regardless of funding source. Activities will include providing technical assistance to states, tribes, and territories; establishing communities of practice to promote best practices; hosting educational webinars; and creating a national clearinghouse of resources to support person-centered practice.
CMS is seeking comments on an interim final rule that increases payments to suppliers for some DME and enteral nutrition in areas of the country that are not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DEMPOS) Competitive Bidding Process (CBP). These include rural areas, and Alaska, Hawaii and the territories. From June 1 through December 31, 2018, payments will return to the blended rates that were in effect in 2016.
The change is in response to stakeholder concerns about significant financial challenges created by the current rates for suppliers, as well as concerns that the number of suppliers in certain areas continues to decline. It is projected to result in a $70 million dollar Medicare cost-sharing increase to beneficiaries. This increase may be covered by supplemental insurance programs like Medigap, and for dual eligible beneficiaries, Medicaid pays the cost sharing. However, beneficiaries who do not have supplemental insurance or who are not dual eligible will have increased cost sharing.
Republican lawmakers on Monday told the CMS they are concerned the agency may not be doing enough to prevent patient abuse in skilled-nursing facilities.
In a letter to CMS Administrator Seema Verma, members of the House Energy and Commerce Committee highlighted recent media reports describing instances of abuse, neglect and patient harm occurring at nursing facilities across the country.
“These reports raise serious questions about the degree to which the CMS is fulfilling its responsibility to ensure federal quality of care standards are being met, as well as its duty to protect vulnerable seniors from elder abuse and harm in facilities participating in the Medicare and Medicaid programs,” the letter stated.
A group of Johns Hopkins physicians and researchers has published an article in the Journal of Hospital Medicine suggesting that data on mortality and hospital readmission used by the United States Centers for Medicare and Medicaid (CMS) suggest a potentially problematic relationship.
Daniel J. Brotman, M.D., and his colleagues examined three years of CMS’s publicly available data from hospitals across the US. They looked at nearly 4,500 acute-care facilities’ hospital-wide readmission rates and compared them with those facilities’ mortality rates in six areas used by CMS: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease (COPD) and coronary artery bypass.
The researchers found that hospitals with the highest rates of readmission were actually more likely to show better mortality scores in patients treated for heart failure, COPD and stroke.
Hospital readmission, an important measure of quality care, costs the United States an estimated $17 billion each year. And according to the Centers for Medicare and Medicaid Services (CMS), about half of those readmissions could be avoided.
Therefore, there is significant interest in identifying factors that influence readmission rates, especially those that can be identified prior to discharge. To pinpoint which stroke patients are most at risk, researchers at Wake Forest Baptist Medical Center undertook a retrospective case-control study to determine factors associated with readmission within 30 days. The study is published in the June 11 online edition of the American Journal of Medical Quality.