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The state canceled Beverly Likens’ coverage — days before surgery — without considering other ways she qualified for Medicaid, which experts say violated federal regulations.
Software sifts through millions of medical records to match patients with similar diagnoses and characteristics and then predicts what kind of care an individual will need and for how long. New federal rules will ensure human experts are part of the process.
Ballad Health, the only hospital system across a large swath of Tennessee and Virginia, has fallen short of quality-of-care and charity care obligations — even as it’s sued thousands of patients for unpaid bills.
The proposal would require major hiring at the most sparsely staffed homes. But the proposal is already badly received by the nursing home industry, which claims it can’t boost wages enough to attract workers.
Research commissioned by the Centers for Medicare & Medicaid Services analyzed only staffing levels below what experts have previously called ideal. Patient advocates have been pushing for more staff to improve care.
The Centers for Medicare & Medicaid Services backed off from a plan that could have curtailed access to a type of reconstructive surgery known as DIEP flap. Breast cancer patient advocates are relieved.
Each year, Medicare punishes hospitals that have high rates of readmissions and high rates of infections and patient injuries. Check out which hospitals have been penalized.
The annual cost of lecanemab treatment quadruples if the expense of brain scans to monitor for bleeds and other associated care is factored in. The full financial toll likely puts it beyond reach for low-income seniors at risk of Alzheimer’s, experts say.
It’s been the summer of broken weather records around the world — for heat, rain, and wildfire smoke — advertising the risks of climate change in a big way. But, apparently, it’s not enough to break the logjam in Washington over how to address the growing climate crisis. Meanwhile, in Texas, women who were unable to get care for pregnancy complications took their stories to court, and Congress gears up to — maybe — do something about prescription drug prices. Alice Miranda Ollstein of Politico, Shefali Luthra of The 19th, and Rachel Cohrs of Stat join Julie Rovner, KFF Health News’ chief Washington correspondent, to discuss these issues and more. Also this week, Rovner interviews Meena Seshamani, the top administrator for the federal Medicare program.
The federal government’s arcane process for medical coding is influencing which reconstructive surgery options are available, creating anxiety for breast cancer patients.
Patients in rural northeastern Nevada soon will have fewer providers and resources, after a local hospital decided to close its medical residency program. Nationally, the number of rural residency slots has grown during the past few years but still makes up just 2% of programs and residents nationwide.
Despite record enrollment in health insurance plans under the Affordable Care Act, some consumers who bought coverage and agents who helped them do so have had a tough start to the new year: Many say it’s hard to find an in-network doctor or hospital.
Hospitals are facing mixed reviews regarding their efforts to comply with a federal requirement that they post information about prices related to nearly every health care service they provide.
A federal lawmaker has introduced a House bill that would close one of a laundry list of oversight gaps revealed in a recent KHN investigation of the system regulators use to ban fraudsters from billing government health programs, including Medicare and Medicaid.
The federal government wants to change the way health insurers use prior authorization — the requirement that patients get permission before undergoing treatment. Designed to prevent doctors from deploying expensive, ineffectual procedures, prior authorization has become a confusing maze that denies or delays care, burdens physicians with paperwork, and perpetuates racial disparities. New rules may not be enough to solve the problems.
Hospitals in New Mexico, Texas, and Oklahoma are among the first to apply for a new rural hospital payment model that shifts the focus of services away from overnight stays to outpatient and emergency care. Still, experts say the law needs to be amended to provide the right mix of care for rural communities.
The removals, detailed in emails between state and federal health officials, hinged on disagreements over how states could disenroll people during the public health emergency. Consumer advocates fear the alleged violation signals the mess to come on April 1, when the pandemic-era Medicaid coverage mandate ends.
CMS advanced two proposed changes that could affect Medicare Advantage plans. One would allow the government to recover past overpayments. As a result, it could reduce those insurers’ profits, leading them to increase enrollees' out-of-pocket costs or reduce benefits. But it's inaccurate to characterize the changes as "cuts."
States are trying to reach millions of Medicaid enrollees to make sure those still eligible remain covered and help others find new health insurance.
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