Model is designed to give states flexibilities in Medicaid, Medicare approaches

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) unveiled a new payment model that will give states  more flexibilities in how they manage health care, and could ultimately shift focus to home- and community-based services. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health and other medical conditions.

In a 36-page document, the National Association for Homecare and Hospice outlined issues with the 2024 federal home health payment proposed rule.

WASHINGTON—The methodology chosen to determine future home health payment rates "will eventually destroy the value of the home health services benefit," the National Association for Homecare and Hospice (NAHC) said in a letter sent to the Centers for Medicare & Medicaid Services (CMS). 

CMS has assigned HCPCS Level II code A2025, ‘Miro3d, per cubic centimeter,’ to Miro3D

MINNEAPOLIS, Minnesota—Reprise Biomedical, Inc., an innovator in medical biotechnology for wound care, announced the Centers for Medicare and Medicaid Services (CMS) has assigned a Level II Healthcare Common Procedure Coding System (HCPCS) code to its Miro3D wound matrix, effective Oct. 1, 2023.

CMS will extend flexibilities approved in the states' section 1915(c) home- and community-based services (HCBS) waiver Appendix K amendments.

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) released updated guidance that will extend COVID-19 public health emergency (PHE) flexibilities approved in the states' section 1915(c) home- and community-based services (HCBS) waiver Appendix K amendments.

CMS notified those potentially involved beneficiaries & providing information on free credit monitoring

WASHINGTON—The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have responded to a May 2023 data breach in Progress Software’s MOVEit Transfer software on the corporate network of Maximus Federal Services, Inc. (Maximus), a contractor to the Medicare program, that involved Medicare beneficiaries’ personally identifiable information (PII) and/or protected health information (PHI). No HHS or CMS systems were impacted.

The Breast Cancer Patient Equity Act would provide Medicare coverage of custom breast prostheses to breast cancer survivors

WATERLOO, Iowa—U.S. Representatives Judy Chu (D-CA) and Mariannette Miller-Meeks (R-IA) have reintroduced the bipartisan H.R. 4779: Breast Cancer Patient Equity Act, which would provide Medicare coverage of custom breast prostheses to breast cancer survivors. Since most private insurance companies follow Medicare coverage standards, passage of this legislation would allow hundreds of thousands of women each year to choose a custom prosthesis after a mastectomy.

David Santana was charged and agreed to plead guilty in connection with a $44 million telemedicine fraud scheme involving medically unnecessary DME

BOSTON – The owner of Conclave Media (Conclave) and Nationwide Health Advocates (Nationwide) has been charged and has agreed to plead guilty in connection with a $44 million telemedicine fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces and genetic tests. 

Reps. Terry Sewell (D-AL) and Adrian Smith (R-NE) are leading an effort to help maintain strong access to home oxygen for individuals with respiratory challenges.

Reps. Terry Sewell (D-AL) and Adrian Smith (R-NE) are leading an effort to help maintain strong access to home oxygen for individuals with respiratory challenges.

The tool helps customers quickly and accurately identify the potential impact of proposed and final Medicare reimbursement changes on their unique agencies

DALLAS—Homecare Homebase (HCHB), a software for home-based care, has released an updated HCHB Analytics Home Health Impact Report Model, less than two weeks following the Centers for Medicare & Medicaid Services (CMS) publication of the 2024 Home Health Proposed Rule. The tool helps customers quickly and accurately identify the potential impact of proposed and final Medicare reimbursement changes on their unique agencies.

WASHINGTON—The Centers for Medicare & Medicaid’s (CMS) proposed rate reductions for home health could be devastating for agencies if they are codified, said Bill Dombi, president of the National Association for Home Care & Hospice (NAHC). Even worse, CMS has left a door open to demand some $3 billion in clawbacks for prior years of what it interprets as over-payments.  

Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following the Food and Drug Administration’s (FDA) move to grant traditional approval to the drug that treats individuals with Alzheimer’s disease. The Centers for Medicare & Medicaid Services had previously announced this would be the case and released more details on coverage.

MyoPro expected to be reimbursed by CMS in a lump-sum payment rather than as a rental should the proposal be finalized following a 60-day public comment period

BOSTON—Myomo, Inc. (NYSE American: MYO), a wearable medical robotics company that offers increased functionality for those suffering from neurological disorders and upper-limb paralysis, announced that its request to the Centers for Medicare and Medicaid Services (CMS) to classify the company’s MyoPro as a brace has been published for public comment.

Alexander Schleider pleaded guilty before U.S. District Judge Michael A. Shipp in Trenton federal court to an information charging him with one count of conspiracy to commit health care fraud

NEWARK, New Jersey—An Ocean County, New Jersey, man admitted his role in a durable medical equipment (DME) kickback scheme, U.S. Attorney Philip R. Sellinger announced.

Alexander Schleider, 57, of Lakewood, New Jersey, pleaded guilty before U.S. District Judge Michael A. Shipp in Trenton federal court to an information charging him with one count of conspiracy to commit health care fraud and one count of wire fraud.

CMS has proposed an additional 5.653% permanent rate cut to begin in 2024 based on the same challenged payment methodology.

Washington, D.C.—The National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additio

Tamara Yvonne Motley was found guilty by a federal jury of 20 counts of health care fraud

LOS ANGELES—A South Bay woman was found guilty on Tuesday, June 27 of nearly two dozen felonies for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment—mostly power wheelchairs (PWC)—and PWC repairs, many of which were never performed.

The bill is designed to address deep cuts made to home health by CMS during the implementation of the Medicare home health payment system

The National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (the Partnership) commended Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) for introducing the Preserving Access to Home Health Act of 2023 to safeguard access to essential home-based, clinically advanced health care services by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing dire cuts of negative -7.85% to the Medicare Home Health