CMS’ Daniel Tsai Stands Behind ‘80-20’ Provision, Medicaid Access Rule In Congressional Hearing

A senior Centers for Medicare & Medicaid Services (CMS) official stood behind the “80-20 rule” — which has drawn major pushback from the home-based care industry — during a congressional hearing Tuesday. Last week, the “Ensuring Access to Medicaid Services” rule was finalized. The impetus behind the rule is to strengthen access to home- and […]

How The Sausage Gets Made: Inside CMS’ Home Health Payment Rulemaking Process

Every year, industry stakeholders anticipate the U.S. Centers for Medicare & Medicaid Services’ (CMS) release of the home health proposed payment rule and the final rule. The final rule’s provisions and updates determine what the Medicare home health landscape will look like for the foreseeable future, but sometimes providers aren’t well-versed on the ins and […]

‘We Will Be Paying For This For Years’: 8 Home Health C-Suite Leaders Sound Off On ‘Alarming’ Medicare Cuts

At the end of last month, the U.S. Centers for Medicare & Medicaid Services (CMS) published its home health proposed payment rule for 2024. The proposal, almost immediately, drew a negative response from key home health stakeholders. The main headline was CMS’ decision to propose a home health payment decrease of 2.2%. The proposal also […]

Final Rule ‘Blunts Immediate Impact,’ But CMS-Home Health Industry Core Disagreement Remains

Nearly five months after the unveiling of the proposed payment rule caused a stir among home health stakeholders and advocates, the U.S. Centers for Medicare & Medicaid Services (CMS) released its final payment rule on Monday. Back in June, CMS proposed a 4.2% aggregate decrease for 2023, a cut the industry at large felt would […]

Home- And Community-Based Services Make Up $69.5 Billion Of Fee-For-Service Medicaid Expenditures

Total Medicaid managed care spending across all 50 states saw an increase last year. In fact, spending checked in at $420.5 billion in 2021, compared to $359.6 billion in 2020, according to data collected in the annual CMS-64 Medicaid expenditure report. Additionally, home and community-based services make up a big chunk of this spending. At […]

A Top Performer Of The ‘Independence at Home’ Demonstration Explains Its ‘Secret Sauce’ For Success

The Centers for Medicare & Medicaid Services’s (CMS) Independence at Home demonstration aims to find out if delivering comprehensive, home-based primary care can lead to positive outcomes and lowered costs. One demonstration participant, Northwell Health, has been able to realize this goal. Broadly, the Independence at Home demonstration allows Medicare beneficiaries who have multiple chronic […]

CMS Administrator Chiquita Brooks-LaSure Reemphasizes Home- and Community-Based Services Focus

On Tuesday, the U.S. Centers for Medicare & Medicaid Services (CMS) took the time to map out the federal agency’s strategic plans and key initiatives moving forward. During the national stakeholder call, CMS Administrator Chiquita Brooks-LaSure, CMS Chief Operating Officer Jon Blum and Deputy Administrator and Director of Center for Medicaid and CHIP Services Dan […]

Home Health Sector Remains Area of Focus For Fraud Watchdogs

The federal government saw a return of nearly $1.9 billion in health care fraud settlements and judgments in 2021. Of this $1.9 billion, the Medicare Trust Funds received $1.2 billion, and the U.S. Centers for Medicare & Medicaid Services (CMS) received roughly $98.7 million. The Health & Human Services Office of Inspector General’s (HHS-OIG) annual […]

Home-Based Care Providers Sue CMS, HHS Over COVID-19 Relief Funds

A group of New York home-based care providers are taking aim at the Department of Health and Human Services (HHS), the New York State Department of Health (NYSDOH) and the U.S. Centers for Medicare & Medicaid Services (CMS) in a lawsuit filed Friday. Broadly, the case alleges unfair distribution of funds from the American Rescue […]