This article is part of the HHCN+ membership Providing behavioral health services in patients' homes can make services more effective and make patients more comfortable, but the already complicated regulatory and reimbursement situation for these services is set to be even more challenging. With the Senate considering cutting large portions of Medicaid, there is a greater possibility that states will cut funding for home and community-based services. This puts home behavioral healthcare reimbursement at even greater risk. Advocates of home care are pushing to wipe out regulatory reforms to protect access and ensure critical services are meeting increasing demand. “Behavioral…
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This week's pledge Healthcare Industry and Ministry of Health and Human Services (HHS) The pre-authorization (PA) was a positive public relations message masked as a fundamental declaration of a game-changing policy commitment. In summary, the insurance company group is AHIP Blue Cross Blue Shield Association I agreed to address some topics: Standardization of electronic pre-authentication Reduce the scope of claims covered by prior permission Ensures continuity of care when patients change plans Improved communication and transparency in decisions Enlarge real-time response Ensure medical reviews for unapproved requests There are critics of the PA process throughout the healthcare industry. Doctors, hospitals,…
The Royal College of Nursing (RCN) has invited its members to share their thoughts on the recent UK Supreme Court judgment on biological sex, warning the decision had caused “upset, worry, confusion and concern” for many nurses. The college will next month hold online and in-person sessions for members to share their thoughts on how the judgment may impact their employment and clinical practice, as well as how to protect patient privacy and dignity. “These sessions will be carefully facilitated to allow open, informed and respectful conversation” Patricia Marquis It comes as the UK Supreme Court ruled in April that the…
Disabled nurses are the most likely staff group to report incidents of harassment, bullying or abuse at work, as levels of abuse continue to outstrip that of non-disabled colleagues, according to a new report. The Workforce Disability Equality Standard (WDES) report for 2024 was released by NHS England this week. “For too many, discrimination and inequality in the NHS remain” Nicola Ranger It found that more employers were making reasonable adjustments to ensure disabled staff can carry out their work, but that there was still progress needed to ensure this staff group do not suffer discrimination, bulling, harassment or abuse. As…
A man has been charged with the murder of a retired nurse from the Midlands. Christina Alexander, 60, was found dead at a property in Dosthill, Staffordshire, on Monday (23 June). Officers from Warwickshire Police were called to the scene on Ascot Drive in the early hours of Monday morning. The force has now released a statement confirming that Ms Alexander’s death is being treated as a murder. Robert Alexander, 65, of Ascot Drive, Dosthill, was charged with Ms Alexander’s murder in the days after her death. Nursing Times understands that he was due to appear at Coventry Magistrates Court…
The UK Covid-19 Inquiry will place the adult social care sector under intense scrutiny when its highly anticipated public hearings commence next week, marking a critical moment for the industry that bore the brunt of the pandemic’s impact. The hearings will take place from Monday 30 June – Thursday 31 July 2025 at Dorland House in London, representing the most comprehensive examination to date of how government decisions affected care homes, domiciliary care providers, and the vulnerable residents they serve. Module 6 of the Inquiry will cast a spotlight on both publicly and privately funded adult social care across England,…
Despite the continued pressure from a challenging regulatory environment, Bayada Home Health Care sees progress in ensuring increased state-by-state rates through its sustained advocacy efforts. Earlier this month, Bayada fired 10% of its staff and cited the issue of refunds. Still, the company reported significant interest rate increases in several states in its latest 2024 annual report. This also details employee development strategies and growth outcomes. In Delaware, the company locked down $2.9 million, increasing its personal care reimbursement rate by an estimated 5%. In Pennsylvania, the company saw an 8% increase in interest rates, resulting in an increase in…
This article is part of the HHCN+ membership This week, the Centers for Medicare & Medicaid Services promoted new contracts with numerous health insurance plans to reduce the number of advance approvals and to promote the entire previous approval process. However, the nature of contracts, other recent Medicare advantage moves, and the modifiable philosophy of CMS leadership related to MA makes us feel wary of the future, if not pessimistic, at least for home care. I write about providers that denounce complex and time-consuming pre-authentication processes. And I'm in healthcare that involves reaching the pharmacy counter just to be told…
Two Republican senators are urging the Centers for Medicare and Medicaid Services (CMS) to maintain the interests of Medicare Home Health Organizations (HHAs) to “use full authority under the law.” Senators Marsha Blackburn (R-Tennessee) and Susan Collins (R-Main) wrote to CMS administrator Dr. Mehmet Oz to raise concerns about the future of profits, including payment cuts that could shut down more HHAs. Home-based care advocates praised the message, saying policymakers must take action to protect their interests. In 2018, the Bipartisan Budget Act (BBA) directed the CMS to develop a new payment model for the HHA from January 2020. Congress…
One big beautiful bill considers historic Medicaid reduction, job requirements The Senate version of One Big Beautiful Bill Act (OBBBA) has cleared a significant hurdle, but it is not without substantial changes that have sent concerns through the healthcare industry. While the initial fear of wiping out Medicare cuts appears to have been avoided, the bill's impact on Medicaid funding and eligibility requirements poses considerable challenges for healthcare providers and patients. An important focus for industry watchers is the bill's stance on provider tax. Although not completely ruled out as some people fear, the Senate version of the bill takes…