Healthcare Financial News

Medicaid beneficiaries who were previously limited to receiving care in an institutional setting may now be given the option to receive that care in their homes and communities, under a proposed rule announced April 1 by the Centers for Medicare and Medicaid Services (CMS).

Previously, to qualify for assistance with personal care, home health care, or other services in the home or community setting, beneficiaries were required to be at imminent risk of institutionalization. A Deficit Reduction Act provision eliminates this requirement and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level, or $15,600 per individual in 2008, and who satisfy the needs-based criteria.

The proposed rule will be published in the Federal Register tomorrow, and will have a public comment period through June 3, 2008. Download the proposed rule.

Consumer, employer, and labor organizations on April 1 announced a comprehensive national agreement with leading physician groups and health insurers on principles to guide how health plans measure physician performance and report the information to consumers.

The “Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs” creates a national set of principles to guide measuring and reporting to consumers about physician performance. The accord is a step toward patient-centered health reform that gives patients reliable information that will help them make informed choices.

The health plans that adopt the Patient Charter are agreeing to a standard set of principles for performance measurement and reporting and to have their consumer reports assessed by an independent review organization. The agreement was spearheaded by the Consumer-Purchaser Disclosure Project, a group of consumer, labor, and employer organizations that works to ensure that all Americans have access to publicly reported healthcare performance information. Read the press release.