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TECH- Google rolls out search features for Medicaid, Medicare patients

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Google seeks to replace your local Medicaid eligibility state employee.

 
 

Clipped from: https://www.fiercehealthcare.com/health-tech/google-rolls-out-search-features-aim-make-it-easier-sign-medicaid-medicare

 
 

LAS VEGAS—When many people are looking to enroll in health benefits, they turn to Google as a source of key information on eligibility, the application process and in-network providers.

In this spirit, the Google Search team has quietly rolled out multiple features for its search engine that aim to make it easier for users to access key information about obtaining Medicaid and Medicare benefits, as well as which doctors locally accept those types of coverage.


(Google)

If someone submits a search query for Medicaid in their state, for example, the top of the results will populate with multiple buttons that direct them to key results on eligibility requirements, how to apply and where they can log in to their accounts. Searching for Medicare generates similar buttons, as well as an option to pull up news about the program.

Hema Budaraju, senior director of product for health and social impact at Google Search, told Fierce Healthcare that access to information is a social determinant of health, and addressing that challenge is a key part of how the tech giant is thinking about equity.

“It’s equity by design in the product,” Budaraju said in an interview at the HLTH conference, “and we’re very proud of being part of the journey.”

Helping people secure coverage is one piece, better enabling them to use it effectively is another. Another recent addition to Google’s search allows people to seek out local physicians and the results will include if those doctors accept Medicare and Medicaid.

When a user clicks into a specific physician, they can also further investigate their options using a “check insurance info” option that allows them to filter by specific Medicare and Medicaid carriers and plans.

Budaraju said the goal was to offer these details in “an easily consumable manner” that enables them to make “timely” decisions about their care and coverage. She added that these tools are not limited to Medicare and Medicaid, and that Google has rolled out similar functionality for the Children’s Health Insurance Program, Supplemental Nutrition Assistance Program and electronic benefit transfer (EBT) programs as well.

The journey in accessing data on these social programs is “nonlinear,” Budaraju said, and often requires people to sift through multiple webpages and sites to find the details they need. That’s why Google saw an opportunity to streamline the experience.

She said the Search team also sees an opportunity to use this framework as a baseline for other scenarios, such as economic security, crisis response or in extreme weather. The focus on equity and easing the user experience is replicable in other areas, she said.

“There is a beauty to understanding, ‘What is the journey?'” Budaraju said.

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Potential Data Disclosure May Have Affected Certain Wisconsin Medicaid Members | Wisconsin Department of Health Services

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Who knew you could fit 12,358 pieces of PHI in a PowerPoint deck?

 
 

The Wisconsin Department of Health Services (DHS) today announced that on August 8, 2022, as part of a cybersecurity incident investigation, DHS was notified that a presentation emailed to the DHS Children’s Long-Term Support Council in April 2021 contained protected health information. This presentation was forwarded to employees working for county government agencies in Rock and other Wisconsin counties and posted to the DHS website as part of the meeting minutes. Information that was potentially exposed includes the first and last name, date of birth, gender, county location, Wisconsin Medicaid member ID number, and social security number of affected members of Wisconsin Medicaid.

After discovering what happened on August 8, 2022, DHS immediately removed the meeting minutes from the website and replaced them with a PDF version, which removed access to the protected health information. Additionally, DHS took steps to confirm that individuals who received the minutes via email deleted the files. DHS will continue to investigate and work to prevent such incidents from occurring in the future.

On October 7, 2022, notifications were mailed to 12,358 Wisconsin Medicaid members whose information may have been accessed by unauthorized individuals. These members have been offered free credit monitoring for one year as well as given access to a dedicated call center to answer questions they might have.

Members who received a notification letter or have questions about this incident can call 833-875-0804 from 8 a.m. to 8 p.m. CT Monday through Friday.

 
 

Clipped from: https://www.dhs.wisconsin.gov/news/releases/100722.htm

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Tech- Cognosante Customer Experience Business Sector to Support CMS Enrollment Assistance Program for Medicaid Unwinding

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The tech vendor just won another CMS contract with the federal agency.

 
 

FALLS CHURCH, Va. (PRWEB) October 04, 2022

Cognosante’s customer experience (CX) business sector, CognoConnected, has been awarded the Enrollment Assistance Program (EAP) for Medicaid Unwinding contract by the Centers for Medicare & Medicaid Services (CMS). The 19-month contract has an approximate value of $21 million.

Cognosante will support the CMS Center for Consumer Information and Insurance Oversight (CCIIO) in ensuring continuity of coverage for individuals and families impacted by the Medicaid Unwinding at the end of the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE). Cognosante will provide outreach and impartial, free, in-person and virtual enrollment assistance to impacted consumers in multiple states, facilitating their seamless transition into a Qualified Health Plan (QHP) through the Federally Facilitated Marketplace (FFM).

Following the end of the PHE, states must conduct Medicaid and Children’s Health Insurance Program (CHIP) eligibility redeterminations for beneficiaries. Many beneficiaries have remained on Medicaid and CHIP throughout the COVID-19 pandemic due to the continuous enrollment condition authorized by the Families First Coronavirus Response Act (FFCRA). As a result, a large volume of beneficiaries across the country who are determined to no longer be eligible for Medicaid or CHIP, or fail to respond to the redetermination requests, could face a loss of health insurance coverage.

To help these impacted consumers smoothly transition from Medicaid or CHIP to enrollment into QHPs – also referred to as Medicaid Unwinding – Cognosante will provide trained local support teams in designated states to help consumers and their families navigate the Healthcare.gov application process and make informed health coverage decisions. Cognosante will collaborate with local community organizations to maximize outreach efforts and engage directly with the enrolling community where they live and work.

According to CMS, Medicaid Unwinding presents the single largest health coverage transition since the first open enrollment period of the Affordable Care Act (ACA).“The Cognosante team will bring to bear the full depth and breadth of our customer experience expertise to support CMS’ mission of ensuring continuity of coverage for eligible consumers,” said Anita Griner, General Manager of Cognosante’s customer experience business sector.

 
 

Cognosante supported CMS in a similar EAP during implementation of the Affordable Care Act. In addition, Cognosante was recently awarded the CMS No Surprises Help Desk contract, which intends to protect individuals from surprise medical bills for emergency services, air ambulance services furnished by nonparticipating providers, and non-emergency services furnished by nonparticipating providers at participating facilities in certain circumstances.

About Cognosante


Cognosante is a mission-driven technology company delivering innovative and transformative solutions that improve the health and safety of Americans. With more than a decade of experience working with Federal and state government agencies, we aim to expand access to care, improve care delivery, deliver solutions addressing social determinants of health, and ensure safety and security through multi-faceted technology and customer experience (CX) solutions. Our broad range of capabilities includes enterprise IT and cloud, data science, telehealth, interoperability, public health surveillance, clinical performance, eligibility and enrollment, and consumer engagement. For more information, visit http://www.cognosante.com

 

 
 

 
 

Clipped from: https://insurancenewsnet.com/oarticle/cognosantes-customer-experience-business-sector-to-support-cms-enrollment-assistance-program-for-medicaid-unwinding

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Google adds Medicaid, Medicare enrollment info to Search

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Did you know Google is trying to fix the Medicaid network access dumpster fire? Or that your Fitbit data is being researched by researchers focused on however they define “equity”? Or that Youtube and Kaiser Family Foundation are about to start making a ton of health-related content together?

 
 

Photo: Courtesy of Google

Google announced several health equity-focused updates to its products Monday, including an addition to Search that provides information about public insurance programs like Medicare and Medicaid.

In a blog post, the tech giant said users will see eligibility requirements and how to enroll when they search for Medicare or Medicaid health plans. People currently covered under Medicaid will also be able to filter nearby providers who accept these plans, alongside a previously added filter for Medicare plans.

Over the coming weeks, when people search for these programs, they’ll see additional information about eligibility requirements and the enrollment process for your state and the federal government,” Hema Budaraju, senior director of product, health and search social impact, at Google said during the company’s Health Equity Summit. “We believe that this can help people enroll more easily into these programs.”

Additionally, YouTube revealed THE-IQ, a partnership with the Kaiser Family Foundation to help organizations create high-quality informational video content on health topics like mental health, maternal care and access to care.

YouTube and KFF will offer seed funding and video production assistance to The Loveland Foundation, which will create videos on mental health access for Black women and girls; the National Birth Equity Collaborative, which will focus Black maternal healthcare and outcomes; and the Health Equity Leadership and Exchange Network at the Satcher Health Leadership Institute, which will work on the root causes and drivers of health inequities. 

“I think particularly in this age, where we’re seeing misinformation so prevalent [and] targeted disinformation efforts that are out there to undermine confidence in science and information. It’s really critical that we amplify credible voices and provide it in ways that people can relate to and connect with,” said Tina Hoff, senior vice president at KFF and executive director of the organization’s Social Impact Media Program.

Google also announced it would expand its health equity research program, first announced last spring as the Fitbit Health Equity Initiative. The expanded program, now called the Google Health Equity Research Initiative, will offer selected researchers at academic institutions and nonprofits in the U.S. access to direct funding, Google Cloud credits, Fitbit devices and analytics platform Fitabase’s services.

THE LARGER TREND

Google has added several updates to Search that aim to provide more information about healthcare services at a glance. In March, the tech giant said it was launching new functionality that gives users a list of available appointments when searching for a specific provider. It also added a tool late last year that helps users find in-network providers

In the wake of the Dobbs decision that overturned Roe v. Wade, Google made abortion-related changes to its tools as well. Following push from Congressional Democrats, Google said it would clearly label healthcare facilities that provide abortions in Search and Maps to differentiate them from crisis pregnancy centers, which try to dissuade people from seeking abortions and may not offer accurate medical information

The tech giant also said it will automatically delete location history when users visit sensitive places like abortion clinics. 

Health misinformation has become a major concern on social media platforms like YouTube. An analysis published earlier this spring in BMJ Global Health found about 11% of YouTube’s most viewed videos on COVID-19 vaccines, accounting for 18 million views, contradicted information from the World Health Organization or the CDC. 

YouTube rolled out new guidelines surrounding vaccine misinformation last year, and has been expanding features that identify the source and context behind health videos and provide content from medical sources at the top of results.

 
 

Clipped from: https://www.mobihealthnews.com/news/google-adds-medicaid-medicare-enrollment-info-search

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TennCare: Update may have disclosed personal information of Medicaid recipients

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: People in one family may have been able to see data about 1 other family. And some of them are related.

 
 

 
 

 
 

NASHVILLE, Tenn. (WTVF) — Personal information for about 1,700 Medicaid recipients in Tennessee may have been disclosed during an update to a computer system, officials said.

The update may have led to a limited number of people from one household to be able to view some information about individuals in another household that included some of the same people, a statement from TennCare said. The breach happened when a new application listed the name of a person who was already in another household, the statement said.

TennCare quickly determined the scope of the breach, addressed the issue and notified those impacted.

There’s no indication that any information was misused, but the agency is offering 12 months of free identity theft protection services to those affected as a precaution.

TennCare provides health care insurance to 1.7 million Tennesseans.

Clipped from: https://www.newschannel5.com/news/personal-information-for-about-1-700-medicaid-recipients-in-tennessee-may-have-been-disclosed

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MO – Former state vendor awarded $23M in lawsuit over Missouri Medicaid system implementation

MM Curator summary

[MM Curator Summary]: A jury has vindicated EngagePoint after years the of systems vendor claiming unfair treatment by IBM and the state.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The verdict comes as the Department of Social Services faces increased scrutiny for its handling of Medicaid application backlogs

 
 

EngagePoint first filed its lawsuit in August 2016, alleging the state owed the company millions for work it conducted but hadn’t been paid for (Getty Images).

A software integration company’s six-year legal saga against the state reached a resolution last week, when it was awarded a little over $23 million in its lawsuit alleging contract breaches over extra work to implement a Department of Social Services’ case management system.

On Wednesday, Cole County Circuit Judge Jon Beetem granted a directed verdict of a little over $4 million that the company argued it was owed, said Ken Barnes, an attorney representing EngagePoint. A day later, a jury sided with EngagePoint and awarded an additional $18.9 million out of the $31 million it had requested on additional claims, Barnes said.

Beetem also issued a directed verdict in the state’s favor and found EngagePoint did not meet its burden of proof on a claim regarding software maintenance.

EngagePoint first filed its lawsuit in August 2016, and Barnes said the verdict affirmed that EngagePoint’s conduct did not play a role in the case management system’s issues and that it delivered the software it promised.

He said he hopes the state sees “that it’s time to put this to rest.”

“It feels like vindication for my client after a really long and hard battle,” Barnes said, “that, I think candidly, the state had every opportunity to avoid.”

A signed judgment was not posted to the case’s docket as of Monday morning.

Asked if the Department of Social Services was considering appealing the verdict, Caitlin Whaley, a department spokeswoman, said, “the agency will consider all options open to the state moving forward.”

Chris Moreland, a spokesman for the Office of Administration, which handles state contracting, said the agency is evaluating the jury’s verdict and the trial.

“Because all stages of this litigation are not yet final,” Moreland said, “OA will not comment on pending litigation.”

Meanwhile, Chris Nuelle, a spokesman for the attorney general’s office, said the office plans to appeal the verdict, but refrained from commenting further.

EngagePoint, a Florida-based firm, was hired by the state in 2013 in response to a request for proposals for a vendor to implement the Missouri Human Services Eligibility, Enrollment and Case Management System, a comprehensive, fully-integrated system for Department of Social Services’ programs, like Medicaid.

EngagePoint was hired over competitors such as IBM, and alleged in its lawsuit that the state ignored the company’s advice and licensed a software known as Cúram directly from IBM and then later held EngagePoint accountable for flaws with the software, which was “unstable and not functionally ready.”

As a result, numerous change order requests were made which EngagePoint alleged the state denied without proper review and out of compliance with federal regulations. The company also alleged the state breached its contract by changing the methodology for determining completion of the project and refused to pay for additional work EngagePoint conducted in order to be compliant with federal mandates.

“Despite not getting paid, EngagePoint continued to service the needs of the citizens of the state and continued to endeavor (to) fix problems with the Curam system,” the 2016 lawsuit read.

In 2014, state employees threatened they “would put EngagePoint out of business,” the lawsuit alleges, and that the company was issued an ultimatum to turn the contract over to IBM or face termination. IBM, who had been passed over for the initial contract, was paid $2 million by the state as a consultant to assess EngagePoint’s performance — a conflict of interest, EngagePoint argues.

IBM was eventually hired to complete the contract after EngagePoint was terminated by the state in May 2015. At least $37 million was owed to the company, EngagePoint argued in its 2016 lawsuit, which the state had moved to dismiss.

The state argued EngagePoint sought “money for work not performed” and in January 2017 filed a counterclaim alleging that EngagePoint breached its contract and “repeatedly failed to deliver, and those failures cost the State tens of millions of dollars,” or a total of roughly $84 million.

As a result, the state was justified in terminating its contract and hiring IBM, it argued.

“From January of 2014 forward, EngagePoint’s failures brought the eligibility determination and enrollment operations of the State’s Medicaid program to the brink of dysfunction,” the state wrote in its 2017 counterclaim, arguing overtime work of temporary staff was one of the only reasons that operations remained in place for nearly 18 months through a manual by-pass system.

DSS and OA officials highlighted those issues and placed blame on EngagePoint in 2015 legislative hearings scrutinizing the backlog and delays in the Medicaid system, the Jefferson City News Tribune reported at the time.

Ultimately, the jury last week issued three verdicts in EngagePoint’s favor.

The verdict comes at a time when the Missouri Eligibility Determination and Enrollment System that EngagePoint was hired to implement has come under increased scrutiny as part of the Department of Social Services’ delays in enrolling newly eligible participants under expanded Medicaid. 

The delays — more than twice the limit allowed under federal regulations — have led to the Centers for Medicare and Medicaid Services stepping in and requiring a mitigation plan for improved processing of applications.

“The state of Missouri has had seven years since they terminated EngagePoint to get their act together,” Barnes said, “and they’re just not doing it.”

Updates to the state’s Medicaid system to make eligibility determinations were previously cited as the reason why applications wouldn’t be processed for 60 days after the state was court-ordered to implement expanded Medicaid last year.

DSS officials have since vowed to get delays below the 45-day maximum allowed under federal regulations by Sept. 30.

“At some point, you got to say, ‘Who’s the common denominator here?'” Barnes said. “It isn’t EngagePoint. It isn’t even IBM. It isn’t the other contractors. The common denominator here is the state and how they manage their business.”

 
 

Clipped from: https://missouriindependent.com/2022/08/16/former-state-vendor-awarded-23m-in-lawsuit-over-missouri-medicaid-system-implementation/

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GDIT Wins $65 Million Medicare and Medicaid Cloud and Data Integration Contract

MM Curator summary

[MM Curator Summary]: The award will be to implement a data warehouse that includes claims and member data for Medicare and Medicaid programs.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Government Technology and Services Coalition member and mentor partner General Dynamics Information Technology (GDIT), a business unit of General Dynamics, has been awarded a new $65 million contract by the Centers for Medicare & Medicaid Services (CMS) Enterprise Architecture Data Group to support its Integrated Data Repository (IDR). The five-year contract has a one-year base period, three one-year and one eight-month option periods, and one four-month transition period.

CMS maintains the largest volume of healthcare data files in the world. The IDR is a high-volume data warehouse integrating claims, beneficiary and provider data sources to support various Medicare and Medicaid programs. Access to this robust integrated data supports analytics across CMS, including insights into medical trends, healthcare costs, and fraud, waste and abuse.

Under this contract, GDIT will provide agile transformation and development, security and operations services in support of on-premise and cloud systems. GDIT will support the migration to the cloud and provide operations and maintenance services on both systems.

“CMS has made incredible progress as it moves its enterprise systems to the cloud,” said Kamal Narang, vice president and general manager for GDIT’s Federal Health sector. “This is another step in improving the agency’s data accessibility and analysis capabilities. As one of the largest providers of cloud services to CMS, we are proud to continue providing our cloud expertise to support their modernization journey.”

The contract continues GDIT’s 40-year partnership with CMS. In September 2020, CMS selected GDIT to evolve one of the largest public clouds in the federal government. Under that task order, GDIT is supporting the agency to help optimize its cloud technology investments and financial operations as it implements a mature multi-cloud environment designed to deliver critical healthcare services to tens of millions of Americans through hosted sites, Medicare.gov and Healthcare.gov.

Read more at GDIT

 
 

Clipped from: https://www.hstoday.us/industry/industry-news/gdit-wins-65-million-medicare-and-medicaid-cloud-and-data-integration-contract/

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Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes

MM Curator summary

[MM Curator Summary]: CMS is starting to firm up the moving forward approach to telehealth reimbursement for Medicare.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2023 Medicare Physician Fee Schedule (PFS) rule. The rule, if enacted as proposed, will:

  1. Create three new permanent telehealth codes for prolonged E/M services;
  2. Discontinue reimbursement of telephone (audio-only) E/M services;
  3. Discontinue the use of virtual direct supervision;
  4. Postpone the effective date of the telemental health six-month rule until 151 days after the PHE ends;
  5. Extend coverage of the temporary telehealth codes until 151 days after the PHE ends; and
  6. Add 54 codes to the Category 3 telehealth list.

Reading between the lines, the nature of CMS’ comments and the changes it proposed (and refused to propose) suggest that CMS rulemakers anticipate the Public Health Emergency (PHE), and associated PHE waivers, will expire no later than the first half of 2023.

Three New Telehealth Codes for Prolonged E/M Services

This year, CMS rejected all stakeholder requests to permanently add codes to the Medicare Telehealth Services List. Following its standard evaluation process for such requests, CMS considered whether they met appropriate categories. Category 1 services must be “similar to professional consultations, office visits, and/or office psychiatry services that are currently on the Medicare Telehealth Services List.” Category 2 services require “evidence of clinical benefit if provided as telehealth” and all necessary elements of the service must be able to be performed remotely. CMS rejected this year’s requests because none of the proposed services (e.g., therapy, electronic analysis of implanted neurostimulator pulse generator/transmitter, adaptive behavior treatment and behavior identification assessment codes) met the requirements of Category 1 or 2 services. Interested stakeholders can collect and submit better evidence to persuade CMS to add these codes on a Category 1 or 2 basis next year (submissions are due by February 10, 2023).

Although it rejected stakeholder-submitted codes, CMS itself proposed three new codes to be added to the Medicare Telehealth Services list on a permanent basis:

  • GXXX1 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services).

 
 

  • GXXX2 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services).

 
 

  • GXXX3 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services).

CMS added these codes because they are similar to current CPT codes 99356 and CPT 99357 and HCPCS code G2212, all listed on a permanent basis.   

Discontinue Reimbursement of Telephone (Audio-Only) E/M Services

Under PHE waivers, CMS allowed separate reimbursement of telephone (audio-only) E/M services (CPT codes 99441-99443), something that was embraced by a sizeable cohort of practitioners and patients, particularly in rural areas or patients without suitable broadband access for audio-video. 

CMS rejected requests to permanently add these services to the Medicare Telehealth Services List. With the exception of certain telemental health services, CMS stated two-way interactive audio-video telecommunications technology will continue to be the Medicare requirement for telehealth services following the PHE. This is because Section 1834(m)(2)(A) of the Social Security Act requires telehealth services be analogous to in-person care by being capable of serving as a substitute for the face-to-face encounter. In CMS’ own language, “We believe that the statute requires that telehealth services be so analogous to in-person care such that the telehealth service is essentially a substitute for a face-to-face encounter.” As audio-only telephone is inherently non-face-to-face, CMS determined, that modality fails to meet the statutory standard. 

Therefore, 151 days after the PHE expires, audio-only telephone E/M services will revert to their pre-PHE “bundled” status under Medicare (i.e., covered but not separately payable). Practitioners will no longer receive separate reimbursement for these services.

Discontinue the Use of Virtual Direct Supervision

Under Medicare Part B, certain types of services (e.g., many diagnostic tests, services incident to physicians’ or practitioners’ professional services) must be furnished under the direct supervision of a physician or practitioner. For Medicare purposes, direct supervision requires the supervising professional to be physically present in the same office suite as the supervisee, and immediately available to furnish assistance and direction throughout the performance of the procedure. The supervising professional need not be present in the same room during the service, but the “immediate availability” requirement means in-person, physical – not virtual – availability.

In connection with PHE waivers, CMS temporarily changed the direct supervision rules to allow the supervising professional to be remote and use real-time, interactive audio-video technology. That change did not require the professional’s real-time presence at, or live observation of, the service via interactive audio-video technology throughout the performance of the procedure.

This change was temporary because CMS was concerned widespread direct supervision through virtual presence may not be safe for some clinical situations. In its proposed PFS rule, CMS rejected requests to make virtual direct supervision a permanent feature in Medicare. CMS is considering whether or not it should make virtual direct supervision a permanent feature of Medicare at some point in the future. Interested stakeholders with data are invited to submit comments and information to CMS on this topic.

If the proposed rule is finalized, virtual direct supervision will expire at the end of the calendar year in which the PHE ends. If the PHE ends in October 2022, the supervision waiver will end December 31, 2022. If the PHE ends in January 2023, the supervision waiver will end December 31, 2023.

Postpone the Effective Date of the Telemental Health Six-Month Rule Until 151 Days After PHE Ends

In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person exam requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met:

  1. The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service;
  2. The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and
  3. The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service.

For a full understanding of the rule, read the frequently asked questions and what it means for practitioners at Medicare Telehealth Mental Health FAQs.

This rule was originally scheduled to take effect the day after the PHE expires. Following an amendment to the rule, it is now set to take effect 151 days after the PHE expires. 

Extend Coverage of the Temporary Telehealth Codes Until 151 Days After the PHE Ends

Temporary telehealth codes are those services added to the Medicare Telehealth Services List during the PHE on a temporary basis, but which were not placed into Category 1, 2, or 3. Coverage of those temporary telehealth codes had been scheduled to end when the PHE expires.

In its proposed PFS rule, CMS states it will extend coverage of those temporary telehealth codes until 151 days after the PHE ends. CMS is doing so for consistency with the Consolidated Appropriations Act, 2022 (CAA). CMS stated this extension may simplify the post-PHE transition by applying the same coverage end date to all the various waiver-related telehealth codes in a hope to reduce billing errors.

Note, the Category 3 codes are set to expire December 31, 2023, while the other temporary telehealth codes are set to expire 151 days after the PHE ends. This means, under the proposed rule, if the PHE ends after August 2023, the Category 3 codes would expire before the temporary telehealth codes. If finalized, health care providers would need to keep a careful eye on the calendar to ensure billing practices keep up with the various sunset dates.

Add 54 Codes to the Category 3 Telehealth List

CMS’ Category 3 list contains services that likely have a clinical benefit when furnished via telehealth, but lack sufficient evidence to justify permanent coverage. CMS proposed adding 54 codes to that Category 3 list. The services fall into nine categories: (1) therapy; (2) electronic analysis of implanted neurostimulator pulse generator/transmitter; (3) adaptive behavior treatment and behavior identification assessment; (4) behavioral health; (5) ophthalmologic; (6) cognition; (7) ventilator management; (8) speech therapy; and (9) audiologic. The complete list can be found at this link.

Keep in mind, these codes will expire December 31, 2023.Category 3 codes were originally slated to expire at the end of the year in which the PHE ends, but CMS extended coverage of those codes through December 31, 2023. In this year’s proposed PFS rule, CMS declined any further extension, so all Category 3 codes will expire at the end of 2023. In the event the PHE extends well into 2023, CMS said it will consider a further extension of the Category 3 codes at that time.

What to Do Next?

Providers, facilities, technology companies, and virtual care entrepreneurs interested in changes to the telehealth codes for 2023 should consider providing comments to the proposed rule. CMS is soliciting comments on the proposed rule until 5:00 p.m. ET on September 6, 2022. Anyone may submit comments – anonymously or otherwise – via electronic submission at this link. Alternatively, commenters may submit comments by mail to:

  • Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, P.O. Box 8016, Baltimore, MD 21244-8016.

 
 

  • Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850

If submitting via mail, please be sure to allow time for comments to be received before the closing date.

Want to Learn More?

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Foley’s Telemedicine & Digital Health Industry Team.

 
 

Clipped from: https://www.foley.com/en/insights/publications/2022/07/medicare-telehealth-services-2023-cms-changes

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FL- State awards seven-year, $140M Medicaid IT contract

MM Curator summary

[MM Curator Summary]: Congrats to Automated Health Systems for the win to implement the unified operations center.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Florida is going with Automated Health Systems (AHS) to handle a multiyear, $140 million IT contract involving the state’s massive Medicaid program.

The Agency for Health Care Administration (AHCA) initially awarded the contract to AHS earlier this month. The company’s competitors had until June 27 to submit written notice to the agency if they wanted to challenge the decision.

AHCA did not respond to Florida Politics’ requests for information regarding challenges. But the agency did receive informal notices of appeal from vendors. However, a formal challenge wasn’t filed by the June 27 deadline and the website shows the bid is closed.

Immediate attempts to contact AHS for a comment were unsuccessful.

The contract could be for up to a ten-year period. The underlying contract is for a seven-year stint, but the invitation to negotiate (ITN) allows the state to enter into a three-year renewal. If the contract is renewed, the ITN makes clear that it is the agency’s policy to reduce the overall payment amount by “at least” 5% “unless it would affect the level and quality of services.”

 
 

The $140 million ITN was one of three the state has advertised as it moves ahead with remodeling the Florida Medicaid Management Information System, known as FMMIS, from a singular system into a modular one instead. The new system is called Florida Health Care Connections, or FX.

The contract with AHS centers around what is known as the unified operations center (UOC), which is responsible for all interactions between the agency and stakeholders, a group that includes customers, providers, vendors, other state agencies and others. 

The UOC is responsible for management and tracking of outbound communications, and printing, fulfilling and mailing (including standard and electronic mail) information of any type as approved by the agency on a scheduled and an ad-hoc basis.

The UOC also provides historic and real-time analytic capabilities to understand issues, trends and opportunities to inform decision-making and improve the interaction with customers, health care providers and managed care plans.

Meanwhile, the agency again pushed back the timeline to award a seven-year, $33 million contract for a provider services module. That decision was supposed to be announced June 30, but it has been pushed back to later this fall.

 
 

According to state documents, the provider services module will electronically capture, validate and process provider enrollment applications (initial and renewal), including an automated screening and monitoring component to support state and federal requirements.

The third ITN the agency will award is for so-called core systems and is expected to be worth $154.5 million.

 
 

Clipped from: https://floridapolitics.com/archives/536480-state-awards-seven-year-140m-medicaid-it-contract/

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Gainwell Technologies Selected to Provide Full Suite of Cost Containment Solutions to State Medicaid Agencies through NASPO ValuePoint Cooperative Contract

MM Curator summary

[MM Curator Summary]: Gainwell (nee DXC, nee HP, little nee HMS) is now set up to do TPL nationwide through a group purchasing arrangement.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Gainwell Technologies LLC

Expands on Gainwell’s recent contract win with NASPO ValuePoint to provide Medicaid Management Information System Claims Processing and Management Services

TYSONS, Va., June 14, 2022 (GLOBE NEWSWIRE) — Gainwell announced today that HMS, a Gainwell Technologies company, has been selected to provide Medicaid Third Party Liability (TPL) services and solutions to state Medicaid agencies through the National Association of State Procurement Officials (NASPO) ValuePoint TPL Services contract.
 

A pioneer in protecting the integrity of Medicaid programs through comprehensive TPL solutions and services, HMS has been awarded contracts for all five categories: Commercial Recoupment, Recovery, Hospital-Physician, MCO Come-Behind Billing and TPL Systems Module.

“For decades, HMS has been a leader in providing cost containment solutions to state Medicaid agencies,” said Paul Saleh, President and CEO of Gainwell. “This contract win further validates the long-standing quality, effectiveness and innovation of our TPL solutions – and they are invaluable in continuing to keep our nation’s healthcare programs protected and strong.”

HMS was selected as a supplier for ValuePoint’s TPL service offerings, allowing states to gain more efficiency and savings by choosing one sole provider to manage all their data and TPL service needs. This single-vendor approach will result in lower total cost for TPL services and fully streamlines the process by filling in gaps that previously required multiple vendors and disparate point solutions.

Since 1985, HMS has been the leader in TPL solutions for state Medicaid agencies. In addition to HMS’ benchmark fees, our recoveries and savings for states and MCOs surpassed $1.5 billion in recoveries and an additional $2.5 billion in savings in 2021 – providing clients with best-in-class ROI.

About Gainwell Technologies LLC
Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. With more than 50 years of proven experience, Gainwell has a reputation for service excellence and unparalleled industry expertise. We offer clients scalable and flexible solutions for their most complex challenges. These capabilities make us a trusted partner for organizations seeking reliability, innovation and transformational outcomes. Learn more at gainwelltechnologies.com.

About NASPO and NASPO ValuePoint
The National Association of State Procurement Officials (NASPO) is a non-profit association dedicated to advancing public procurement through leadership, excellence and integrity. It is made up of the directors of the central purchasing offices in each of the 50 states, the District of Columbia and the territories of the United States. NASPO is an organization that helps its members as public procurement leaders by promoting best practices, education, professional development, research and innovative procurement strategies. Learn more at www.naspo.org.

NASPO ValuePoint is the cooperative purchasing division of the National Association of State Procurement Officials (NASPO), facilitating cooperative public procurement solicitations using a Lead State model. NASPO ValuePoint delivers high value, reliable and competitively sourced cooperative contracts –offering public entities outstanding prices, favorable terms and conditions and value-added services. Learn more at www.naspovaluepoint.org.

Media Contact
Lacey Hautzinger, Gainwell Technologies
469.284.7240
Lacey.hautzinger@gainwelltechnologies.com

Schae Kane, NASPO ValuePoint
skane@naspovaluepoint.org

 
 

Clipped from: https://finance.yahoo.com/news/gainwell-technologies-selected-full-suite-120000613.html