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Medicaid managed care plans and the Children’s Health Insurance Program (CHIP) will be subject to new wait time standards and quality ratings requirements, the Centers for Medicare & Medicaid S | CMS defended implementing stronger rules over nursinghome staffing as well as explained its thoughts behind Medicaid access and managed care rules.
The nation’s three largest Medicare Advantage insurers increasingly refused to pay for rehabilitative care for seniors in the years after adopting sophisticated technologies to aid in their coverage decisions, a Senate investigation found. The report, conducted by the U.S.
days, it estimated, she would be ready to leave her nursinghome. On the 17th day, her Medicare Advantage insurer, Security Health Plan, followed the algorithm and cut off payment for her care, concluding she was ready to return to the apartment where she lived alone.
Health insurance giant UnitedHealth Group used secret rules to restrict access to rehabilitation care requested by specific groups of seriously ill patients, including those who lived in nursinghomes or suffered from cognitive impairment, according to internal documents obtained by STAT.
The American Health Care Association, which lobbies on behalf of nursinghomes, did not comment on the list of 10 drugs or Medicare’s negotiating power. The Federation of American Hospitals offered no statement.
The findings add to an accumulating body of literature underscoring the harm that occurs when financial investors take over health care providers — not only hospitals, but nursinghomes , hospice care , and physician practices.
District Court of Minnesota accuses UnitedHealth and its subsidiary, NaviHealth, of using the computer algorithm to “systematically deny claims” of Medicare beneficiaries struggling to recover from debilitating illnesses in nursinghomes. Continue to STAT+ to read the full story…
Before the allegations of neglect, before the lawsuits, before the government investigations, the health care nonprofit InnovAge had a simple mission: Help the sickest and poorest seniors live comfortably in their communities, beyond the confines of nursinghomes and hospitals. Continue to STAT+ to read the full story…
Similar to last year, STAT analyzed executive compensation found in the annual proxy filings of more than 300 companies across all health care sectors — drugmakers and biotech firms, health insurers, hospitals, other providers, medical device firms, health tech companies, suppliers, and more.
This leaves very little time before patients need to re-evaluate their insurance. . Below is a quick summary to help your eligible patients prepare: Medicare Part A: Hospital insurance that includes inpatient and overnight hospital care, skilled nursing facility services, nursinghome care, hospice care, and home health services.
The team of researchers found that private equity ownership generally means higher costs for patients, insurance companies, and government programs. A new BMJ systematic review rounded up 55 studies on the effects of private equity buyouts in health care globally to flesh out an overarching conclusion.
This leaves very little time before patients need to re-evaluate their insurance. Medicare Part B: Medical insurance for outpatient services to prevent, diagnose, and treat medical conditions, like doctor’s appointments, tests, immunizations, durable medical equipment (DME), mental health services, and limited prescription drugs.
The Illinois Medicaid program is an essential health insurance plan for Illinois residents and a leader in the nation for its expansive service coverage, especially its coverage for families. If you have health insurance through your employer, you are not eligible for Medicaid in Illinois. It now covers more than 3.9
These include the following: Adults 19-64 years of age who are not eligible for Medicare Children 1-18 years of age Infants (younger than 1) Youth in foster care and former foster care youth Children not eligible for Medicaid may be able to get coverage through Child Health Plus , an expanded health insurance program.
This article will focus on Medicare Part A , which covers inpatient hospital stays, among several other services such as subacute rehabilitation in a skilled nursing facility. When it comes to inpatient services or hospital insurance for people with Medicare , Medicare Part A provides that coverage. Medicare Supplement Insurance .
This vital program aims to assist individuals with low incomes who may struggle to afford health insurance independently. However, the state does offer a children’s health insurance program (CHIP) to provide coverage to kids without other forms of health insurance. At the beginning of 2023, the state of Florida had more than 3.9
But the 35 million people who are enrolled in the traditional Medicare program still won’t have that same relief anytime soon for their hospital, outpatient, home health, and nursinghome care, leaving them exposed to potentially unlimited costs if they become seriously ill and don’t have supplemental coverage.
House Democrats are raising concerns with the Biden administration that Medicare Advantage plans need better oversight, citing recent STAT investigations that found insurance companies are using artificial intelligence and algorithmic software to deny care even when people still need it. On Friday, Rep. Judy Chu of California and Rep.
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