If you came across my recent report on the significant concern of “maternity deserts” in the U.S., as you will recall, the widely accepted definition of the phenomenon is any county lacking maternity care units.
The Centers for Medicare & Medicaid Services (CMS) just released news that they will be working on a 10-year payment and care delivery model called the Transforming Maternal Health Model (TMaH). This model strives to support participating state Medicaid agencies in developing and implementing a whole-person approach to pregnancy, childbirth, and postpartum care for women with Medicaid and Children’s Health Insurance Program (CHIP) coverage.
There are not a lot of details yet on how this program is going to be fleshed out, other than generic reference to key terms such as data, research, and evidence-based practice. However, I anticipate that more information will be coming in the first quarter of this year.
What we know so far is the following:
CMS is planning to release a notice of funding in the spring of 2024, with application submission requirements later in the year. Only 15 states will be awarded acceptance, with kickoff in January 2025.
Although I am thankful for the financial opportunity, and I don’t want to appear ungrateful, I am concerned about how this will end up trickling down to create scalable impact. Completing some quick math, $17 million divided per year would be $1.7 million annually for an entire state.
Let’s assume the Medicaid plan takes 20 percent prior to this going to the provider level, leaving $1.36 million to split – and this is just a conservative estimate. I am also concerned about what the other 35 states are going to do without the additional funding, as well as what health systems should consider for this year since funding would not begin until 2025. To learn more, click here: Transforming Maternal Health (TMaH) Model | CMS
Well, one of our clients recently got me really excited. They received a denial of an inpatient admission from a well-known Medicare Advantage (MA) plan
The Self-Disclosure Protocol (SDP) can certainly be daunting. Most of my clients, after they discover abnormalities or aberrant billing, the questions become: The answer is
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