Programs
Regulatory Updates
Total of 185 Records Returned
State: All
CMS Releases Hospice HOPE Resources
Date Effective : 10/1/2025
Program: Hospice
CMS has recently updated the CMS HOPE website with resources to help Hospice agencies prepare for implementation of the new HOPE assessment instrument which will be effective October, 1 2025. These updated resources include the finalized HOPE manual, data that will be collected at the required time points, and an all-item set change table to help agencies educate staff on changes from the current HIS items set items to the new HOPE items. Read more on the CMS HOPE website about these important changes that will be coming.
Read MoreState: Louisiana
Louisiana Waiver or Modification of Requirements Under Section 1135 of the Social Security Act as a Result of Hurricane Francine
Date Effective : 09/12/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Home Health, Hospice, Renal Dialysis
Pursuant to Section 1135(b) of the Social Security Act (the Act) (42 U.S.C. § 1320b-5), I, Xavier Becerra, Secretary of Health and Human Services, hereby waive or modify the following requirements of titles XVIII, XIX, and XXI of the Act and regulations thereunder, and the following requirements of Title XI of the Act, and regulations thereunder, insofar as they relate to Titles XVIII, XIX, and XXI of the Act, but in each case, only to the extent necessary, as determined by the Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the consequences of Hurricane Francine, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse
Read MoreState: All
mln Booklet Updated: Items & Services Not Covered Under Medicare
Date Posted : 09/5/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis, Sleep
This booklet outlines items and services Medicare never or only sometimes covers. This isn’t an all-inclusive list. For Medicare Advantage (MA) plan patients, check with the MA plan for information on eligibility, coverage, and payment. Each plan can have different patient out-of-pocket costs and specific rules for getting and billing for services. Follow the plan’s terms and conditions for payment. Note: Any item or service provided directly or indirectly by an individual or entity excluded by the Office of Inspector General from all federal health care programs isn’t covered.
Read MoreState: Texas
Hospice Benefit: Expanding Prepayment Review in 4 States
Date Posted : 09/5/2024
Program: Hospice
To combat fraud, waste, and abuse under the hospice benefit, CMS will expand prepayment medical review this September in Arizona, California, Nevada, and Texas. To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results. If you’re noncompliant, we may implement extended review or take additional administrative actions.
Read MoreState: All
Osteogenesis Stimulators: Prior Authorization Requirements Suspended
Date Posted : 09/5/2024
Date Effective : 08/24/2024
Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Pharmacy
There may be confusion over whether some noninvasive osteogenesis stimulators comply with the DME 3-year expected life requirement. Effective August 28, 2024, CMS suspended prior authorization requirements for HCPCS codes E0747, E0748, and E0760. We’ll provide additional direction about this requirement in future notice and comment rulemaking.
Read MoreState: Florida
Florida – All Provider Types UPDATE: Hurricane Debby – Key Medicaid Information for Fee-for-Service and Managed Care Providers
Date Adopted : 08/1/2024
Date Expired : 09/3/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Care, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis, Sleep
The purpose of this alert is to provide an update to the previous provider alert issued on 08/04/2024 regarding Hurricane Debby. The following flexibilities/waivers offered to providers in the alert issued on 08/04/2024 will expire at 11:59 p.m. on Tuesday, September 3, 2024:
- Waiver of prior authorization requirements for critical Medicaid services
- The lifting of early prescription refill edits will remain in place in accordance with Governor Ron DeSantis’ emergency executive orders issued for Hurricane Debby
- Waiver of service limitations to ensure a recipient requiring critical Medicaid services during the storm receives such care
- Temporary postponement of the Preadmission Screening and Resident Review processes
Accreditation Commission for Health Care, Inc.