article thumbnail

CMS unveils managed care rule, refutes nursing home rule complaints

Fierce Healthcare

Medicaid managed care plans and the Children’s Health Insurance Program (CHIP) will be subject to new wait time standards and quality ratings requirements, the Centers for Medicare & Medicaid S | CMS defended implementing stronger rules over nursing home staffing as well as explained its thoughts behind Medicaid access and managed care rules.

article thumbnail

STAT+: UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients

STAT

Health insurance giant UnitedHealth Group used secret rules to restrict access to rehabilitation care requested by specific groups of seriously ill patients, including those who lived in nursing homes or suffered from cognitive impairment, according to internal documents obtained by STAT.

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Trending Sources

article thumbnail

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

STAT

days, it estimated, she would be ready to leave her nursing home. On the 17th day, her Medicare Advantage insurer, Security Health Plan, followed the algorithm and cut off payment for her care, concluding she was ready to return to the apartment where she lived alone.

article thumbnail

STAT+: As pharmaceutical companies bemoan Medicare’s drug negotiations, hospitals and doctors stay mum

STAT

The American Health Care Association, which lobbies on behalf of nursing homes, did not comment on the list of 10 drugs or Medicare’s negotiating power. The Federation of American Hospitals offered no statement.

article thumbnail

STAT+: Complications spiked 25% in hospitals bought by private equity

STAT

The findings add to an accumulating body of literature underscoring the harm that occurs when financial investors take over health care providers — not only hospitals, but nursing homes , hospice care , and physician practices.

Hospitals 145
article thumbnail

STAT+: UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans

STAT

District Court of Minnesota accuses UnitedHealth and its subsidiary, NaviHealth, of using the computer algorithm to “systematically deny claims” of Medicare beneficiaries struggling to recover from debilitating illnesses in nursing homes. Continue to STAT+ to read the full story…

article thumbnail

STAT+: Private equity’s Welsh Carson, casting itself as a noble force, relentlessly pursues profits in health care

STAT

Before the allegations of neglect, before the lawsuits, before the government investigations, the health care nonprofit InnovAge had a simple mission: Help the sickest and poorest seniors live comfortably in their communities, beyond the confines of nursing homes and hospitals. Continue to STAT+ to read the full story…