Information from team lead that these departments will soon be seriously downsized.
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notice from dept of health/ cms re medicare UM: Pursuant to 42 C.F.R. §§ 422.752(c)(1), 422.760(b), 423.752(c)(1), and 423.760(b), the Centers for Medicare & Medicaid Services (CMS) is providing notice to Humana Inc. (Humana), that CMS has made a determination to impose a civil money penalty (CMP) in the amount of$257,262 for Medicare Advantage-Pr-scrip-ion D–g (MA-PD), Medicare-Medicaid Plan (MMP), and Pr-scrip-ion D–g Plan (PDP) Contract Numbers H0028, H0336, H0473, H1019, H1036, H1468, H1951, H2463, H2486, H2944, H3533, H4007, H4141, H4461, H4623, H5216, H5377, H5525, H5619, H5970, H6622, H7284, H8087, H8145, H9070, R0110, R0865, R0923, R1390, R3392, R3887, R4182, R5361, R5826, R7315, S2874, S5552, and S5884. An MA-PD, MMP, and PDP’s organization’s primary responsibility is to provide Medicare enrollees with medical services and/or pr-scrip-ion d–g benefits in accordance with Medicare requirements. CMS has determined that Humana failed to meet that responsibility.Summary of Noncompliance CMS conducted an audit of Humana’s Medicare operations from June 3, 2019 through June 21, 2019. In a program audit report issued on September 16, 2019, CMS auditors reported thatHumana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage determinations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M. Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees. The enrollees experienced, or likely experienced, delayed or denied access to covered benefits, increased out-of-pocket costs, and/or inadequate grievance or appeal rights.....lease note this action may factor into Humana’s past performance evaluation. Further failures by Humana to provide its enrollees with Medicare benefits in accordance with CMS requirements may result in CMS imposing additional remedies available under law, including contract termination, intermediate sanctions, penalties, or other enforcement actions as described in 42 C.F.R. Parts 422 and 423, Subparts K and O.
humana s- - - -
Many complaints received concerning inefficient and inept Medicare UM management - some coming from high level source. Department is slated for review and remediation. Big reorganization coming.
Humana has subbed BH in the past and more cost effective. The “in house” BHU has no ROI, they are limited in what they do.
They could be contracting the services out. Then when the demand decreases they can cancel the contract
That makes no sense for either dept...they told us in hccp that both are in need of people and my leader just sent us an open position for behavioral health saying they need to hire more persons due to uptick in cases
Does that include telephonic behavior health?