In the News

As Denials Climb, MACPAC Approves Recommendations for Managed Care Oversight 

McKnight’s Home Care | By Adam Healy

The Medicaid and CHIP Payment Advisory Commission on Friday approved seven recommendations to enhance congressional oversight of Medicaid managed care organizations as recent reports reveal startlingly high rates of prior authorization denials.

MACPAC’s recommendations aim to improve the prior authorization and appeals process by requiring MCOs to report relevant data to the Centers for Medicare & Medicaid Services. CMS would be required to release public reports on the data, as well as update regulations and create additional guidelines for MCOs’ use of prior authorization.

recent investigation by the Office of the Inspector General found that 12.5% of prior authorization requests were denied by Medicaid MCOs, and about 2.7 million Medicaid beneficiaries were enrolled in MCOs with denial rates greater than 25%.

Thousands of prior authorization requests for elderly, chronically ill or disabled patients requiring home care were denied by MCOs, according to the report. 

“Few denials are appealed and little is known about the beneficiary experience,” Lesley Baseman, senior policy analyst at MACPAC, said during the Thursday meeting. “The appeals process is also challenging and burdensome for beneficiaries. Denial notices can be late in the mail and the content is often unclear, and beneficiaries encounter multiple barriers in accessing continuation of benefits.”

Part of the challenge, OIG’s investigation found, was that few guidelines for MCOs’ prior authorizations requests are currently in place.

States are not federally required to collect data on denials, continuation of benefits, or appeals outcomes, according to Baseman. Federal rules do not require states to assess clinical appropriateness of denials, she said, and they do not require that states publicly report information on denials and appeal outcomes.

OIG’s report also found that many MCOs employed staff who were not qualified to approve or deny requests, and most states lack safeguards to identify improper prior authorization denials.

 

Elon Musk Says the First Human has Received an Implant from Neuralink, but Other Details are Scant

MedicalXpress | By WYATTE GRANTHAM-PHILIPS and LAURA UNGAR

According to Elon Musk, the first human received an implant from his computer-brain interface company Neuralink over the weekend.

In a Monday post on X, the platform formerly known as Twitter, Musk said that the patient received the implant the day prior and was "recovering well." He added that "initial results show promising neuron spike detection."

The billionaire, who co-founded Neuralink, did not provide additional details about the patient. When Neuralink announced in September that it would begin recruiting people, the company said it was searching for individuals with quadriplegia due to cervical spinal cord injury or amyotrophic lateral sclerosis, commonly known as ALS or Lou Gehrig's Disease.

Neuralink is one of many groups working on linking the nervous system to computers, efforts aimed at helping treat brain disorders, overcoming brain injuries and other applications. There are more than 40 brain computer interface trials underway, according to clinicaltrials.gov.

Neuralink reposted Musk's Monday post on X, but did not publish any additional statements acknowledging the human implant. The company did not immediately respond to The Associated Press' requests for comment Tuesday.

Neuralink previously announced that the U.S. Food and Drug Administration had approved its "investigational device exemption," which generally allows a sponsor to begin a clinical study "in patients who fit the inclusion criteria," the FDA said Tuesday. The agency pointed out that it can't confirm or disclose information about a particular study.

Neuralink's device is about the size of a large coin and is designed to be implanted in the skull, with ultra-thin wires going directly into the brain. In its September announcement, Neuralink said the wires would be surgically placed in a region of the brain that controls movement intention. The initial goal of the so-called brain computer interface is to give people the ability to control a computer cursor or keyboard using their thoughts alone.

In a separate Monday post on X, Musk said that the first Neuralink product is called "Telepathy"—which, he said, will enable users to control their phones or computers "just by thinking." He added that intial users would be those who have lost use of their limbs…

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APTA Reports Reveal Workforce Trends

APTA | By Keith Loria

Three recent reports give APTA and its members data on the demographics, wages, and vacancies in the profession.

What with the tail of a global pandemic, shifting dynamics between employers and employees, economic uncertainty, and emerging artificial intelligence technologies, the U.S. workforce is in a state of disruption. Add in continuing examination of health care reform as the nation attempts to make services more accessible, more affordable, and with better outcomes, and health care in particular — physical therapy even more specifically — faces mounting challenges.

To that end, APTA has taken measures to understand and improve the physical therapy workforce, releasing several reports based on data from its latest periodic practice profile surveys and other sources. In 2023 alone, three such reports were released and are freely available to all APTA members. These include in-depth reports on the demographics, wages, and outpatient clinic vacancy rates in the profession.

But these reports are more than just numbers on a page. In getting a greater sense of the profession and its workers, APTA is using the data and results to inform advocacy efforts, increase diversity in the profession, and encourage salary transparency. So what does that mean for you?

It's clear from the reports that APTA membership largely reflects the physical therapy profession as a whole — something APTA has long assumed but until now didn't have evidence to back the claim — but it also points to some challenges and holes in the workforce.

Here's a look at the reports and how APTA staff and members are using them to benefit the profession and inform the association's work on members' behalf.

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APTA CSM 2024 will be held Feb. 15-17, 2024, in Boston, Massachusetts, at the Boston Convention and Exposition Center. Attendees can enjoy hundreds of educational sessions, posters, and a huge exhibit hall. Programming for the APTA Combined Sections Meeting is designed by APTA's 18 specialty sections and academies.

Click here to learn more about CSM.

APTA Home Health Specific Events:

 

House Bill Could ‘Fast Track’ Medicare, Medicaid Cuts, Senator Warns

McKnight’s Home Care | By Adm Healy
 
A bill advancing through the House would create a process to expedite major fiscal policy changes, including cuts to the Medicare, Medicaid and the Social Security program, according to Sen. Ron Wyden (D-OR), Senate Finance Committee chair.
 
The Fiscal Commission Act would create a commission of experts tasked with identifying strategies for the United States to “improve the fiscal situation in the medium term and to achieve a sustainable debt-to-GDP ratio of the long term,” according to the bill’s text. The group, made up of both legislators and “outside experts,” would recommend ways that federal programs such as Medicare or Medicaid could improve their solvency over the next 75 years.
 
“The term ‘fiscal commission’ is the ultimate Washington buzzword, and it translates to trading away Americans’ earned benefits in a secretive, closed-door process,” Wyden said in a Jan. 18 statement.
 
Rep. Bill Huizenga (R-MI) and 13 others, a mix of Republicans and Democrats, introduced the bill last Sept. 28, and the number of cosponsors has since grown to 24. The House Budget Committee approved the bill on Thursday, moving it further towards official passage by the House. 
 
Wyden argued that the creation of such a fiscal commission would allow program cuts to be rushed through the legislative process. 
 
“The proposals … would fast-track cuts to Social Security and Medicare,” he warned in a statement, “and allow a handful of legislators and unelected political insiders to trade away Americans’ earned benefits in a secretive, closed-door process.”
 
He also requested that certain federal benefits, including Medicare and Medicaid, be barred from consideration by any fiscal commission. However, the House Budget Committee approved the legislation without such a provision.
 
“No one should be trying to claw back Americans’ earned Social Security and Medicare benefits,” he said. “I urge Speaker [Mike] Johnson to take Social Security, Medicare and Medicaid off the table as part of any proposed fiscal commission.”

 
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