Insurance and Nursing Homes - Pharmacy Technician Pulse

CMS unveils managed care rule, refutes nursing home rule complaints

Fierce Healthcare

APRIL 23, 2024

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 nursing home staffing as well as explained its thoughts behind Medicaid access and managed care rules.

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STAT+: Medicare Advantage insurers ramped up use of technology to deny claims, Senate investigation shows

STAT

OCTOBER 17, 2024

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.

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STAT+: UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients

STAT

DECEMBER 28, 2023

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 nursing homes or suffered from cognitive impairment, according to internal documents obtained by STAT.

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Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

STAT

MARCH 13, 2023

days, it estimated, she would be ready to leave her nursing home. 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.

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STAT+: As pharmaceutical companies bemoan Medicare’s drug negotiations, hospitals and doctors stay mum

STAT

AUGUST 31, 2023

The American Health Care Association, which lobbies on behalf of nursing homes, did not comment on the list of 10 drugs or Medicare’s negotiating power. The Federation of American Hospitals offered no statement.

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STAT+: Complications spiked 25% in hospitals bought by private equity

STAT

DECEMBER 26, 2023

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 nursing homes , hospice care , and physician practices.

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STAT+: UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans

STAT

NOVEMBER 14, 2023

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 nursing homes. Continue to STAT+ to read the full story…

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STAT+: Private equity’s Welsh Carson, casting itself as a noble force, relentlessly pursues profits in health care

STAT

OCTOBER 31, 2022

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 nursing homes and hospitals. Continue to STAT+ to read the full story…

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STAT+: Health care CEOs hauled in $4 billion last year as inflation pinched workers, analysis shows

STAT

AUGUST 17, 2023

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.

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What Pharmacists Should Know About Medicare Open Enrollment 2023

Digital Pharmacist

OCTOBER 5, 2022

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, nursing home care, hospice care, and home health services.

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STAT+: Extensive review finds private equity owners jack up the cost of medical care

STAT

JULY 20, 2023

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.

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What Pharmacists Should Know About Medicare Open Enrollment 2024

Digital Pharmacist

SEPTEMBER 20, 2023

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.

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Guide to Medicaid in Illinois

The Checkup by Singlecare

FEBRUARY 28, 2024

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

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Guide to Medicaid in New York

The Checkup by Singlecare

NOVEMBER 30, 2023

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.

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What is Medicare Part A?

The Checkup by Singlecare

DECEMBER 14, 2022

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 .

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Guide to Medicaid in Florida

The Checkup by Singlecare

AUGUST 30, 2023

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

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Medicare is going to cap patients’ spending on drugs. But there’s no such limit for hospital or doctor bills

STAT

OCTOBER 21, 2022

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 nursing home care, leaving them exposed to potentially unlimited costs if they become seriously ill and don’t have supplemental coverage.

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STAT+: Democrats push government to police algorithms in Medicare Advantage

STAT

NOVEMBER 3, 2023

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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Pharmacy Technician Pulse

CMS unveils managed care rule, refutes nursing home rule complaints

STAT+: Medicare Advantage insurers ramped up use of technology to deny claims, Senate investigation shows

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STAT+: UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

STAT+: As pharmaceutical companies bemoan Medicare’s drug negotiations, hospitals and doctors stay mum

STAT+: Complications spiked 25% in hospitals bought by private equity

STAT+: UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans

STAT+: Private equity’s Welsh Carson, casting itself as a noble force, relentlessly pursues profits in health care

STAT+: Health care CEOs hauled in $4 billion last year as inflation pinched workers, analysis shows

What Pharmacists Should Know About Medicare Open Enrollment 2023

STAT+: Extensive review finds private equity owners jack up the cost of medical care

What Pharmacists Should Know About Medicare Open Enrollment 2024

Guide to Medicaid in Illinois

Guide to Medicaid in New York

What is Medicare Part A?

Guide to Medicaid in Florida

Medicare is going to cap patients’ spending on drugs. But there’s no such limit for hospital or doctor bills

STAT+: Democrats push government to police algorithms in Medicare Advantage

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