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Hhs Centers For Medicare Medicaid Services - One of the best experts on this subject based on the ideXlab platform.
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medicare program advancing care coordination through episode payment models epms cardiac rehabilitation incentive payment model and changes to the comprehensive care for joint replacement model cjr final rule
Federal Register, 2017Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur frActure treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.
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medicare program comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services final rule
Federal Register, 2015Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:: This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.
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medicaid and children s health insurance programs essential health benefits in alternative benefit plans eligibility notices fair hearing and appeal processes and premiums and cost sharing exchanges eligibility and enrollment final rule
Federal Register, 2013Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark-equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.
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medicare program inpatient rehabilitation facility prospective payment system for federal fiscal year 2012 changes in size and square footage of inpatient rehabilitation units and inpatient psychiatric units final rule
Federal Register, 2011Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule will implement section 3004 of the Affordable Care Act, which establishes a new quality reporting program that provides for a 2 percent reduction in the annual increase fActor beginning in 2014 for failure to report quality data to the Secretary of Health and Human Services. This final rule will also update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2012 (for discharges occurring on or after October 1, 2011 and on or before September 30, 2012) as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before the August 1 that precedes the start of each FY the classification and weighting fActors for the IRF prospective payment system (PPS) case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. We are also consolidating, clarifying, and revising existing policies regarding IRF hospitals and IRF units of hospitals to eliminate unnecessary confusion and enhance consistency. Furthermore, in accordance with the general principles of the President's January 18, 2011 Executive Order entitled "Improving Regulation and Regulatory Review," we are amending existing regulatory provisions regarding ''new'' facilities and changes in the bed size and square footage of IRFs and inpatient psychiatric facilities (IPFs) to improve clarity and remove obsolete material.
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medicaid program payment adjustment for provider preventable conditions including health care acquired conditions final rule
Federal Register, 2011Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule will implement section 2702 of the Patient Protection and Affordable Care Act which directs the Secretary of Health and Human Services to issue Medicaid regulations effective as of July 1, 2011 prohibiting Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care-acquired conditions specified in the regulation. It will also authorize States to identify other provider-preventable conditions for which Medicaid payment will be prohibited.
Jorge D Reyes - One of the best experts on this subject based on the ideXlab platform.
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Intestinal transplantation.
Seminars in pediatric surgery, 2006Co-Authors: Jorge D ReyesAbstract:The modern era of clinical solid organ transplantation has just passed the half-century mark, having closed the 20th century with the long sought clinical success in intestinal transplantation and combinations of abdominal organs (liver-intestine, intestine-pancreas, liver-stomach-pancreas-intestine). Developments in technique, organ preservation, peri-operative care, and immunosuppressive management over the last 15 years have made intestinal transplantation an effective treatment for children with intestinal failure. However, the feasibility of intestinal organ engraftment remained enigmatic, until the demonstration of the interAction of recipient and donor immunocytes (contained in the transplanted organ) and postulated as the two-way paradigm of transplant immunology. This prompted further developments in immunosuppression which has ameliorated the morbidity and mortality that has prevented widespread use of intestinal transplantation. The ripple effects of these advances have resulted in the March 2001 Medicare report which provided a national coverage decision of the Social Security Act for intestinal Transplantation. As of May 2003, there were 61 centers worldwide which had performed 989 intestinal transplants. In this article, we describe the basis for successful clinical intestinal transplantation, reviewing progress with surgical technique, posttransplant management, and the evolution of immunosuppressive drug therapy.
Amy J H Kind - One of the best experts on this subject based on the ideXlab platform.
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improving healthcare value covid 19 emergency regulatory relief and implications for post acute skilled nursing facility care
Journal of Hospital Medicine, 2020Co-Authors: Ann M Sheehy, Charles F S Locke, Farah Kaiksow, Ryan W Powell, Andrea Gilmore Bykovskyi, Amy J H KindAbstract:Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.
Robert Hawkins - One of the best experts on this subject based on the ideXlab platform.
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welfare liberty and Security for all u s sex education policy and the 1996 title v section 510 of the Social Security Act
Archives of Sexual Behavior, 2016Co-Authors: Justin E Lerner, Robert HawkinsAbstract:When adolescents delay (meaning they wait until after middle school) engaging in sexual intercourse, they use condoms at higher rates and have fewer sexual partners than those who have sex earlier, thus resulting in a lower risk for unintended pregnancies and sexually transmitted infections. The 1996 Section 510 of Title V of the Social Security Act (often referred to as A–H) is a policy that promotes abstinence-only-until-marriage education (AOE) within public schools. Using Stone’s (2012) policy analysis framework, this article explores how A–H limits welfare, liberty, and Security among adolescents due to the poor empirical outcomes of AOE policy. We recommend incorporating theory-informed comprehensive sex education in addition to theory-informed abstinence education that utilizes Fishbein and Ajzen’s (2010) reasoned Action model within schools in order to begin to address adolescent welfare, liberty, and Security.
Nora Wells - One of the best experts on this subject based on the ideXlab platform.
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a family centered community based system of services for children and youth with special health care needs
JAMA Pediatrics, 2007Co-Authors: James M Perrin, Diane Romm, Sheila R Bloom, Charles J Homer, Karen Kuhlthau, Carl Cooley, Paula Duncan, Richard Roberts, Phyllis Sloyer, Nora WellsAbstract:Objective To present a conceptual definition of a family-centered system of services for children and youth with special health care needs (CYSHCN). Previous work by the Maternal and Child Health Bureau to define CYSHCN has had widespread program effects. This article similarly seeks to provide a definition of a system of services. Design Comprehensive literature review of systems of services and consensus panel organized to review and refine the definition. Setting Policy research group and advisors at multiple sites. Participants Policy researchers, content experts on CYSHCN, family representatives, and state program directors. Outcome Definition of a system of services for CYSHCN. Results This article defines a system of services for CYSHCN as a family-centered network of community-based services designed to promote the healthy development and well-being of these children and their families. The definition can guide discussion among policy makers, prActitioners, state programs, researchers, and families for implementing the “community-based systems of services” contained in Title V of the Social Security Act. Critical charActeristics of a system include coordination of child and family services, effective communication among providers and the family, family partnership in care provision, and flexibility. Conclusions This definition provides a conceptual model that can help measurement development and assessment of how well systems work and achieve their goals. Currently available performance objectives for the provision of care for CYSHCN and national surveys of child health could be modified to assess systems of services in general.