Category: CMS

Pennsylvania advocates challenge the penalties and premium costs in Gov. Tom Corbett’s proposed Medicaid expansion plan. Meanwhile, more than 70,000 low-income Wisconsin adults would keep their state BadgerCare Plus coverage for three months and a larger and poorer group would wait the same 90 days to enter the program, under a GOP plan expected to…

California licensed midwives will have increased independence and authority in attending births, potentially giving more pregnant women access to their services under a new law that goes into effect in January. Assembly Bill 1308 removes an unworkable clause that required all licensed midwives to be supervised by a physician. Licensed midwives had been unable to…

News outlets report on various developments related to two state efforts to expand the health insurance program for low-income people. …read more

The Centers for Medicare & Medicaid Services has confirmed that physicians who assign their reimbursement and billing to a critical access hospital (CAH) under “Method II” are now able to participate in the Medicare incentive program as eligible professionals. read more …read more

The philosophy that healthcare is local — and therefore, care needs to be local and community-based — forms the core of WellCare’s efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare’s vice president of advocacy and community-based programs. The Tampa-based healthcare company takes a culturally competent approach to assessing duals’…

If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and…

Federal investigators are looking into whether former leaders of the District’s Options Public Charter School committed Medicaid fraud by, among other things, exaggerating the needs of its disabled students and paying students with gift cards to ride school buses, according to several people familiar with the criminal investigation (Brown and Marimow, 12/16). …read more

And, The Washington Post profiles Nevada Gov. Brian Sandoval, a Republican whose state is expanding Medicaid and has its own insurance exchange. …read more

Congressman Erik Paulsen (R-MN) recently introduced legislation that would ensure clinical decision support (CDS) systems were put into place for physicians ordering diagnostic imaging tests such as MRIs and CT Scans for Medicare patients. Congressman Erik Paulsen (R-MN) recently introduced legislation that would ensure clinical decision support (CDS) systems were put into place for physicians…

The Department of Health and Human Services (HHS) should require more evidence of improved quality and efficiency of care for Medicare patients in implementing its program for clinical data… read more …read more