Jul 22, 2019 | Medicare, Outpatient
In 2018, CMS started to allow total knee replacement surgeries to occur at hospital outpatient settings. Using Medicare FFS claims data, BRG found that 18% of total knee replacements covered by Medicare FFS in 2018 were performed in the HOPD. Click to read more.
Jul 19, 2019 | Managed Care Friday
1. 319: The number of high school students in our poll of 500 who said they have a friend who vapes. 2. In-Home Behavioral Coverage Kick Off: Starting this month, Blue Massachusetts now covers in-home behavioral health monitoring and therapy for those under 19, as well as intensive care coordination, community based treatment, mobile crisis intervention. 3. Transgender Boost: Transgender employees with the University of Michigan will now have new medical services covered starting this fall under a new BCBS policy here – procedures now covered include face and neck hair removal, facial...
Jul 16, 2019 | Autism, Medicaid
Florida's state Agency for Health Care Administration (AHCA) proposed several changes to Medicaid-covered behavior analysis services, including reimbursement reductions for providers who treat children with autism. However, after receiving strong feedback from providers, parents and advocacy groups, AHCA has announced it is postponing its proposed rate reductions. This brief reviews rates as well as the proposed stronger clinic licensure requirement, new multidisciplinary team approach, combined coverage policy, new electronic visit verification system, and provider enrollment moratorium...
Jul 15, 2019 | Home Care, Home Health, Medicare
HHS OIG recently audited and found that a home health agency (HHA) incorrectly billed Medicare for beneficiaries who were not homebound and did not require skilled services. This OIG action provides an instructive example of OIG program integrity efforts across Medicare and particularly in the home health sector. Click to read more.
Jul 10, 2019 | Ambulance, Ground, Medicaid
Ride-sharing company, Lyft, has been approved to provide Non-Emergency Medical Transportation to eligible Medicaid beneficiaries in Arizona, following new state regulations for non-emergency medical transportation. Click to read more
Jun 28, 2019 | Managed Care Friday
1. 50: The percent of all lifetime cases of mental illness that begin by age 14. And 75% develop by age 24, according to the National Alliance on Mental Illness. Talkspace, an online therapy company, now has a service for teens rather than just adults. With parental consent, teens can be connected with a licensed therapist in their state. By 2022 we think that the national telehealth community will get behind a change in policy to allow credentialed/licensed therapists to treat a patient outside their region. Full story here. 2. Surprising Episodes: There are some episodes that catch you by...
Jun 27, 2019 | Legislation/ Budgets/ Macro
The Congressional Budget Office has published their updated budget projections for 2019 to 2029. This is an annual publication that is likely to become increasingly relevant to the policy agenda as the deficit and debt position of the federal government worsens. Click to read more.
