Why this Newsletter
Using the context of maternal health care this newsletter demonstrates the legal and broad scope of Medicare’s and Medicaid’s authority outside of their reimbursement mandate. Medicare and Medicaid are the two largest health insurance plans in the US.
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The Centers for Medicare & Medicaid Services (CMS) finalized the new national health and safety standards, known as conditions of participation (CoPs), for hospitals and Critical Access Hospitals that offer obstetrical (OB) services as part of CMS’ multi-pronged approach to improve maternal health outcomes. These CoPs include new requirements for maternal quality assessment and performance improvement; baseline standards for the organization, staffing and delivery of OB care; and staff training on evidence-based maternal health practices. The standards are effective on January 1, 2025.
Also effective on January 1, 2025, the Center for Medicare and Medicaid Innovation (CMMI) announced the creation of a new model to support state Medicaid program efforts to improve maternal health care and pregnancy outcomes. The Transforming Maternal Health (TMaH) model began in 15 states: Alabama, Arkansas, California, District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia and Wisconsin.
TMaH has a 3-year Pre-implementation Period, during which states receive targeted technical assistance to advance each model element and achieve required pre-implementation milestones, followed by a 7-year Implementation Period to execute the model.
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About Rowinski Group
Founded in 2004, Rowinski Group LLC is a reimbursement and healthcare payer data analytics consultancy for medical device, digital health and diagnostics companies who are developing and selling their medical technology in the USA. Rowinski Group has offices in Silicon Valley – San Francisco Bay area and Chicago, Minneapolis, and Raleigh.
Rowinski Group has two core service offerings; securing codes and reimbursement on behalf of companies and using healthcare insurance payer data analytics to help companies solve business issues such as responding to questions from the FDA and Medicare, sales forecasting, Key Opinion Leader (KOL) identification etc.
Through these service offerings Rowinski Group help U.S. and international companies build their U.S. market share for the medical technology they are developing and selling. For more information visit https://reimbursement.consulting or contact Daniel Zimmerman d.zimmerman@reimbursement.consulting.
