Noteworthy News

Archive for February, 2014


CMS Seeks to Shape Provider Networks

Insurers offering qualified health plans in the federally facilitated marketplace will soon be required to meet federal standards for the adequacy and breadth of their provider networks. According to a letter issued by the Centers for Medicare & Medicaid Services (CMS) to insurers, the agency will seek to require qualified health plans to include in their provider networks at least 30 percent of the essential community providers in the region the plan serves and at least one of each type of essential community provider. Essential community providers include disproportionate share  hospitals, children’s hospitals, sole-community hospitals, rural referral centers, critical access [&hellip

Observation Status, the “Two-Midnight Rule,” and Continuing Controversy

Amid continuing complaints from hospitals, the Centers for Medicare & Medicaid Services (CMS) has delayed implementation of its so-called Medicare two-midnight rule for another six months.  Implementation of the rule, originally scheduled for October 1, 2013 and delayed for six months, is now slated for October 1, 2014. With hospitals calling for greater guidance on how to determine whether to classify patients as inpatient admissions or on observation status, CMS proposed using a two-midnight standard:  hospitals could safely classify patients who spent two midnights in the hospital as inpatient admissions. But when hospitals objected to the standard, sued to prevent [&hellip

ACOs Show Encouraging Signs

Provider groups that just completed their first year in Medicare’s ACO programs are showing encouraging signs of producing health care savings. In all, the Centers for Medicare & Medicaid Services (CMS) reports $380 million in savings for first-year participants.  Nearly half of the ACOs participating  in the Shared Savings Program had lower spending than projected but less than half of those  saved enough to qualify to keep any of their savings – one of the program’s main incentives for participants. Pioneer ACOs, which take greater risks, generated $147 million in savings, with nine of the 23 participating groups spending less [&hellip

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