Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

• Author Health® Launches In CMS’s New Innovative Dementia Care Model
• CMS To Test Prior Authorizations To Reduce Wasteful Or Inappropriate Services In Fee-For-Service Medicare
• Most Medicare Advantage Beneficiaries Live In Highly Concentrated Markets With Few Plan Choices
• CMS Proposes New Behavioral Health Integration Add-On Codes For Advanced Primary Care Management Services
• Estimated Average Spending On Health Care During Retirement Rose 4% Between 2024 & 2025
• Nevada Medicaid To Launch PACE For Medicare, Medicaid Beneficiaries
• Physician Exit Rates From Traditional Medicare Accelerated From 2010 To 2023
• DOL Proposes Rolling Back Minimum Wage, Overtime Rules For Hospice, Home Health Aides
• Medicare & Medicaid Beneficiaries With Opioid Use Disorder Less Likely to Receive Behavioral Health Treatment 
• CMS Proposes New Medicare Ambulatory Specialty Model To Improve Chronic Disease Management 
• Solving For Access
• ‘Choose Medicare Act’ Introduced To Create ‘Part E’ Opt-In Program For Individuals & Employers 
• Medicare Proposes Cuts In 2026 Aggregate Home Health Payments & Temporary Reductions To Recoup Patient-Driven Groupings Model Overpayments
• Maine Dual Eligible System: An OPEN MINDS State Profile
• Florida Dual Eligible System: An OPEN MINDS State Profile

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Telehealth Flexibilities Did Not Increase Outpatient Medicare FFS Visit Volume, But Did Result In Lower Post-Visit Costs

After Medicare eased telehealth restrictions during the COVID-19 public health emergency, telehealth visits among fee-for-service (FFS) beneficiaries rose during 2020, but then stabilized in 2021 and beyond. The increased volume of telehealth visits was not associated with an increase in the volume of outpatient evaluation and management (E&M) visits. Telehealth-initiated episodes of care were associated with lower use of lab tests and imaging compared to in-person visits. Telehealth visits were associated with lower 30-day Medicare… Read

• 55% Of Behavioral Health Professionals Accepted New Appointments For Medicare Or Medicaid Beneficiaries, With A 30-Day Wait For Many, A Survey States 
• The DSP Talent Challenge
• Choose Medicare Act
• Medicare Home Health Use Among Consumers With Dementia On The Increase
• Nearly Half Of Behavioral Health Professionals Declining New Appointments For Medicare & Medicaid Beneficiaries 

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