April 22, 2024

United Did Pay Ransom In Cyberattack

United HealthGroup confirmed that personal health information (PHI) and personally identifiable information (PII) was exposed in the attack and “could cover a substantial proportion of people in America.” It also confirmed a ransom was paid. It will take awhile to get to what was exposed and who was impacted. Experts have data which points to the payment of a $22 million ransom by United.  United confirms that while some systems are functioning near normal, others are not yet up and will be restored over time.

In additional news, the United CEO will appear before a House subcommittee on May 1: https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-ceo-testify-before-us-house-panel-cyberattack-tech-unit-2024-04-19/ .

Additional article: https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-unitedhealth-ransom

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#united #changehealthcare #cyberattacks


Sweeping Medicaid Manage Care Rule Finalized

The Centers for Medicare and Medicaid Services (CMS) finalized Medicaid managed care rules today that cover a number of critical areas, including requiring states and Medicaid plans to report on state-directed payments, disclosing rates compared with Medicare, mandatory surveys of members, and quality-rating transparency.

My blog today discusses major changes.

CMS press release and fact sheets: https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f and https://www.cms.gov/newsroom/fact-sheets/medicaid-and-childrens-health-insurance-program-managed-care-access-finance-and-quality-final-rule

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#medicaid #cms #healthplans #managedcare


Biden Administration Finalizes Nursing Home Rule

The Biden administration finalized numerous changes impacting nursing homes, including minimum staffing requirements and directing that 80% of all payments from Medicaid (ramped up over six years and with some flexibility) go to wages for aides and nurses.  The problem with the rule is that rates just are not sufficient enough to meet these requirements and proposals Biden has made. Proposals to increase dollars have not yet passed.  The fear is that the moves in each case could force many nursing home providers to fold. A new analysis from the Kaiser Family Foundation (KFF) finds that less than 20% of facilities meet the proposed minimum standards.

In additional news, some House GOP lawmakers are aiming to block aspects of the rule, although the Senate would likely not agree: https://insidehealthpolicy.com/daily-news/snf-workforce-staffing-rule-clears-omb-lawmakers-push-block-it

Center for Medicare and Medicaid Services (CMS) fact sheet: https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Kaiser Family Foundation (KFF) analysis: https://www.kff.org/medicaid/press-release/the-vast-majority-of-nursing-facilities-will-need-to-hire-more-staff-to-comply-with-the-final-federal-rule-when-fully-implemented-unless-they-qualify-for-an-exemption/ and https://www.kff.org/policy-watch/nursing-facilities-staffing-levels-standards-final-rule/

Additional article: https://www.modernhealthcare.com/providers/medicaid-home-care-rule-transparency-requirements

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#nursinghomes #medicaid


Hospitals May Bring New Fight To MA Plans In Form Of 340b

Medicare Advantage (MA) plans may now have to fight hospitals on evolving requirements to reimbursement hospitals more for 340b participation. Without added funding, any additional reimbursement would need to be taken out of other rates. Remember, too, that there is plenty of evidence that hospitals are not increasing access to the hard-to-serve through the 340b program.  Dollars are pushed to the bottom line.

(Article may require a subscription.)

#340b #medicareadvantage #hospitals


Expansion Of Remote Patient Monitoring Codes

The American Medical Association may expand CPT codes related to remote patient monitoring.

#coding #sdohs #providers #healthplans


— Marc S. Ryan

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