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CMS Posts Tentative List of Essential Community Providers

The Centers for Medicare & Medicaid Services has posted on its web site a draft list of essential community providers for 2018. To qualify as essential community providers, organizations must serve predominantly low-income, medically underserved patients.  Qualified health plans must contract with at least 30 percent of the essential community providers in their markets and must offer contracts in good faith to at least one such provider in each of six categories, including federally qualified health centers, hospitals, and family planning providers. Providers that believe they have mistakenly been excluded from the list may petition for inclusion. Find the draft list [&hellip

Amid Rising Improper Medicaid Payments, CMS Offers Help

With improper Medicaid payments nearly twice as high as they were just a few years ago, the Centers for Medicare & Medicaid Services is reaching out to state Medicaid programs with suggestions for how to reduce those improper payments. The problem? According to CMS, States are facing greater challenges keeping pace with stricter enrollment requirements, tracking providers who have been excluded from other States’ or Federal health care programs, and generally adapting to changing regulations for qualifications of certain provider types. In a new e-alert, CMS identifies factors that contribute to improper payments – things like ineligible and excluded providers, provider [&hellip

There’s More to Quality Than Readmissions, Study Suggests

Hospitals with high readmissions rates may also have lower mortality rates for some conditions, according to a new study. The study, published in the Journal of Hospital Medicine, found that patients suffering from heart failure, stroke, and chronic obstructive pulmonary disease who are served in hospitals with higher readmission rates have a slightly better chance of survival than if they were treated in hospitals with lower readmission rates. Such findings call into question the value of focusing on readmissions as a measure of the quality of care hospitals provide – a focus exemplified by Medicare’s hospital readmissions reduction program. Find the [&hellip

CMS Urges Improvements in Care for Physically, Mentally Disabled

New guidance issued by the Centers for Medicaid Services outlines how states can make better use of home care in serving physically and mentally disabled Medicaid beneficiaries. Those steps include establishing open registries of home care workers; establishing qualifications for such workers; and paying wages that will help foster continuity of care for the clients of those home care workers. In making these recommendations, CMS seeks to make greater use of managed long-term services and supports and home- and community-based services when serving individuals who might otherwise need costly nursing home care. Learn more about CMS’s recommendations and why it [&hellip

A Closer Look at Socio-Economic Risk Factors

The National Association of Urban Hospitals often points to the socio-economic status of the patients its members serve as constituting one of the greatest challenges urban safety-net hospitals face. That challenge typically takes two major forms: how to serve such patients more effectively and how to encourage public officials to shape government (Medicare and Medicaid) reimbursement policies that reflect this distinct challenge and treat such caregivers fairly. Now, the National Academy of Medicine has taken a closer look at the social determinants that play such a major role in community health and in the health of the residents of the [&hellip

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