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The final rule related to recovery audit contractors (RACs) for Medicaid was released in mid-September (http://www.gpo.gov/fdsys/pkg/FR-2011-09-16/pdf/2011-23695.pdf), just over three months before it goes into effect. It provides a variety of guidance and opt-outs for states that have many compliance experts scratching their heads.
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Being accredited by The Joint Commission makes a difference in outcomes for patients with certain diagnoses, according to a study in the October issue of the Journal of Hospital Medicine.
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They come from 45 states, represent 14% of Joint Commission-accredited hospitals, and are the first class of hospitals to be recognized as top performers in the commission's annual report.
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The National Association for Healthcare Quality (NAHQ) honored several people in September for their efforts to improve quality and safety in healthcare.
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Would you expect a New York Medicaid client to be able to access mental health service equally well, regardless of where he or she lived within the state?
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As a general rule, courts have upheld limitations on Medicaid reimbursements for services, as long as the services are "sufficient in amount, duration, and scope to reasonably achieve their purpose," according to Laura Hermer, JD, LLM, an assistant professor of health policy and bioethics at the University of Texas Medical Branch in Galveston.
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A new Medicaid recovery audit contractor (RAC) program will help strengthen the integrity of the Medicaid program, according to Xiaoyi Huang, JD, assistant vice president for policy at the National Association of Public Hospitals and Health Systems in Washington, DC. "That being said, we need to be cognizant of program integrity efforts that places undue burden on providers," she cautions.
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A state plan amendment submitted by North Carolina Medicaid to the Centers for Medicare & Medicaid Services (CMS) to participate with the Medicaid recovery audit contractor (RAC) program has already been approved, and a request for proposal will be released shortly, reports Brad Deen, a spokesperson for North Carolina Division of Medical Assistance (NCDMA).
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The Affordable Care Act (ACA) requires that state Medicaid agencies reimburse primary care providers at 100% of the Medicare fee schedule for two years, notes Donald Ross, manager of the policy and planning section at the Oregon Health Authority's Division of Medical Assistance Programs.
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Under a proposed rule published in May 2011 from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies would have to review access to a subset of Medicaid-covered services every year, and review access to every Medicaid-covered service at least once every five years.
