Colorado Issues Final Rules on Benefits and Employer Participation Requirements for Paid Family and Medical Leave Insurance Program, Clarifies Private Plan Option

Colorado’s rule making process regarding its new paid family and medical leave insurance program (“FAMLI”) continues. On August 26, 2022, the state published final regulations on benefits and employer participation requirements (“Benefits Rules”), which provide the most concrete guidance to date regarding the benefits to which employees will be entitled under the FAMLI program as of January 1, 2024. 

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LTHH Medicaid Stakeholder Meeting Announced on the OCL email Blast

OCL is initiating stakeholder engagement for Long-Term Home Health through an introductory meeting. The meeting will convene Long-Term Home Health stakeholders and Office of Community Living leadership. The discussion will include stakeholder engagement preferences, identify topic areas and priorities, etc.

The meeting will be held:
Thursday, Sept. 29, 2022
1:30-2:25 p.m. MT

Join via Google Meet

Join by Phone:
1-336-948-0083, PIN: 528 778 875 #

Home Health Stakeholders Voice Their Concerns To CMS Over Medicare Advantage Program

Home Health Care News | By Joyce Famakinwa
 
Home health stakeholders – and many others – recently had the opportunity to weigh in on the way Medicare Advantage (MA) is currently administered by the U.S. Centers for Medicare & Medicaid Services (CMS).
 
The National Association for Home Care & Hospice (NAHC) and Moving Health Home are among the two groups that answered CMS’ request for information.
 
In July, CMS released that request for information seeking public comment on the MA program. Comments were to be submitted by Aug. 31, 2022.
 
“The significance is that CMS is beginning to evaluate the plans more closely in terms of provider relations and approaches to health care delivery for enrollees and how the plans can improve health care services for these beneficiaries,” Mary Carr, vice president of regulatory affairs at NAHC, told Home Health Care News in an email.
 
Broadly, the comment period gave home health stakeholders the opportunity to affect potential future rulemaking on various aspects of the MA program. This is notable because Medicare Advantage enrollment continues to grow — having more than doubled over the last decade.
 
In fact, Medicare Advantage has 28.4 million beneficiaries, or 45% of the Medicare population. By 2030, Medicare Advantage is expected to have over 52% of total Medicare enrollment, according to data from the research and advocacy organization Better Medicare Alliance.
 
With enrollment on the rise, it’s likely that providers will become even more entangled with health plans offering Medicare Advantage. And as this happens, it’s the responsibility of providers and plans to work together, NAHC President William A. Dombi wrote in the organization’s comments to CMS.
 
“It is imperative that the [MA] plans and the provider community work together to ensure patient-centered, high quality health care is provided to all beneficiaries,” he said.
 
This comment period is also significant because it gives home health stakeholders the floor to share their point of view. In the past, providers have been vocal about the challenges surrounding MA.
 
Specifically, providers have struggled with receiving fair rates for the services they deliver. 

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House Passes Bill to Install Electronic Prior Authorization in Medicare Advantage Plans

Fierce Healthcare | By Robert King

 The House passed key legislation that creates an electronic prior authorization process for Medicare Advantage (MA) plans and other reforms aimed at a major headache for providers. 

The House unanimously passed the Improving Seniors’ Timely Access to Care Act on Wednesday via a voice vote. The legislation, which has new transparency requirements for MA plans, now heads to the Senate.

Lawmakers behind the legislation said in a joint statement the bill will “make it easier for seniors to get the care they need by cutting unnecessary red tape in the healthcare system,” said Reps. Suzan DelBene, D-Washington, Mike Kelly, R-Pennsylvania, Ami Bera, M.D., D-California, and Larry Bucshon, M.D., R-Indiana.

Prior authorization—where providers must first get insurer approval before performing certain services or making prescriptions—has increased in recent years much to the chagrin of providers who charge the process causes a massive administrative burden.

The House bill aims to require the establishment of an electronic prior authorization process for all MA plans to hasten the approval of requests. It would also require the Department of Health and Human Services (HHS) to create a process for faster, “real-time” decisions on the items or services that already get routinely approved.

Another new requirement is that MA plans must report to the federal government on how they use prior authorization, as well as the rate that such requests are approved and denied. The requirement comes as HHS’ watchdog found that MA plans have denied prior authorization claims for services that met Medicare’s coverage requirements.

The overwhelming House vote earned plaudits from several provider groups. 

“At a time when group practices face unprecedented workforce shortage challenges, 89% of [Medical Group Management Association] members report they do not have adequate staff to process the increasing number of prior authorizations from health insurers,” the Medical Group Management Association said in a statement. “By streamlining and standardizing the overly cumbersome and wildly inefficient MA prior authorization process, this legislation will return a focus to the physician-patient relationship.”

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