Nursing Home Staffing Rule In Dustbin
The controversial rule seeking to impose nursing home staffing requirements has been officially repealed by the federal government after a judge struck down the Biden administration provision. The rule would have meant huge costs for the industry and actually either forced the shutter of smaller firms or led them to sell out to massive consolidators in the industry. The rule was a political sop to the unions as well.
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-cms-nursing-home-staffing-mandate-repealed/
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#nursinghomes #staffing #medicaid #medicare
New ACCESS Model Tests Chronic Care In Medicare
The Centers for Medicare and Medicaid Servies (CMS) announced a new payment model on December 1. The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model tests an outcome-aligned payment approach in Medicare. The model is aimed at expanding access to new technology-supported care options that help people improve their health and prevent and manage chronic disease. The model will cover conditions affecting more than two-thirds of people with Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression. It will run for 10 years beginning July 1, 2026.
#medicare #caremanagement
https://www.cms.gov/priorities/innovation/innovation-models/access
Hospital-At-Home To Be Extended
The House of Representatives unanimously voted to extend the Medicare hospital-at-home program for five years. Though Congress has repeatedly extended hospital-at-home flexibilities, it often only does so for a handful of months at a time. The extension would bring great stability to a very innovative program.
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-house-acute-hospital-at-home-extension/
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#hospitalathome #medicare
Smaller PBMs Gain Traction
In 2026, smaller, transparent-model pharmacy benefits managers (PBMs) will have about 10% of the market and this has led analysts to say that their previous projection of these upstarts gaining 20% of the market must be changed. The Big Three PBMs – CVS Caremark, Cigna’s Express Scripts, and United’s OptumRx – are fighting back by introducing transparent reforms as well.
(Article may require a subscription.)
#drugpricing #pbms
https://www.modernhealthcare.com/insurance/mh-express-scripts-optumrx-cvs-upstart-pbms
— Marc S. Ryan
