MA Prior Authorization Data Collection Initiative: Deadline to Submit August Data is September 13
Members are reminded that LeadingAge is asking SNF and home health members to submit data for one month on the prior authorization and re-authorization requests they make on behalf of the individuals they serve. This initiative kicked off for August data, which asked members to submit no later than September 13.
This data is not currently available through other sources as MA plans are not required to report this information to CMS. Policymakers have asked for data that shows the concerns on prior authorizations and re-authorization requests. This data will help demonstrate the magnitude of the number of requests that LeadingAge members must respond to monthly and speak to the administrative burden it places on providers. In addition, prior authorizations and continuation of care and service requests place stress on beneficiaries not knowing if they will get the care they need.
For members who did not collect data for August, LeadingAge will continue to accept/ data for September and future months. All monthly data submissions can be sent to Nicole Fallon. This data will provide critical evidence to support LeadingAge’s advocacy efforts including countering claims by the health plan association that the issues with prior authorizations are made up. Data submitted will be aggregated and reported only if LeadingAge receives sufficient submissions. Details on how to complete the data spreadsheet for this effort are explained in a recorded July 30 session or in one of the provider-specific guides listed below. Here is the recording and the data collection tools:
OSHA Releases Proposed Heat-Exposure Standard
On August 30, the Occupational Safety & Health Administration (OSHA) will formally publish a proposed rule concerning Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings. The rule would require employers to develop an injury and illness prevention plan to control heat hazards in workplaces affected by excessive heat. Among other things, the plan would require employers to evaluate heat risks and, when heat increases risks to workers, implement requirements for drinking water, rest breaks, and control of indoor heat. It would apply to employers in all industries, but certain work activities would not be covered, such as activities performed in indoor work areas where air conditioning consistently keeps the ambient temperature below 80°F.
OSHA announced several years ago that it planned to develop a nationwide heat standard, and it submitted a proposed rule to the White House Office of Management and Budget for review in June 2024. OMB signed off much more quickly than expected, and a review copy became public in July, but for reasons unknown OSHA did not move swiftly to publish the rule in the Federal Register. The August 30 publication marks the beginning of a 120-day public comment period. LeadingAge will provide additional information for members in the coming weeks.
LeadingAge Responds: The Guardian U.S. Recaps John Oliver Segment on Hospice Care
LeadingAge President and CEO Katie Smith Sloan sent a letter to the editor of the Guardian U.S. regarding the paper’s column on Last Week with John Oliver August 18 show. Oliver dedicated the majority of that episode to a discussion of bad actors and fraudulent behaviors at for-profit providers, which The Guardian U.S. recapped. Though the issues discussed by Oliver are not new, Sloan noted that Oliver “failed viewers by not referencing the hard work underway now and over the past two years by many policymakers and advocacy organizations – including the one I lead, which represents nonprofit providers – on a wide range of potential reforms, including Congressman Earl Blumenauer’s draft Hospice Care, Accountability, Reform and Enforcement (CARE) Act of 2024.” Read the full response here.
What We Know About Schizophrenia Audits
LeadingAge has recently heard increased concern from members and states about the Centers for Medicare & Medicaid Services’ (CMS) schizophrenia audits. LeadingAge has reached out to both CMS and the Center of Excellence for Behavioral Health in Nursing Facilities to learn more and has compiled information to assist members who may be facing these audits.
Vaccine Access for Uninsured/Underinsured Individuals
On September 3, LeadingAge learned from CDC that Section 317 funding has been awarded to local jurisdictions for the 2024/2025 respiratory virus season. This program provides access to vaccines and may be helpful in accessing vaccines for uninsured and underinsured healthcare workers and older adults in LeadingAge member communities. Reach out to your local public health jurisdiction to learn more.
Weekly Recaps: September 4, 2024
- Affordable Housing Weekly Update. Here is your weekly Affordable Housing Update.
- Nursing Home Weekly Update. Here is your weekly Nursing Home Update.
- Workforce Weekly Update. Here is your weekly Workforce Update.
- Medicaid, HCBS, and PACE Weekly Update. Here is your weekly Medicaid, HCBS, and PACE Update.
- Life Plan Community Weekly Update. Here is your weekly LPC Update.
- Home Health Weekly Update. Here is your weekly Home Health Update.
- Hospice Weekly Update. Here is your weekly Hospice Update.
