News & Press

NAHC to Host Webinar Thursday

Wed, 17 Jul 2019 14:55:19 GMT

Medicare Home Health Proposed Payment Rule 2020

Thursday, July 18, 2019
1-2pm Central

Program Description:

Last week, CMS issued the proposed rule for the 2020 payment model, PDGM, including rates of payment that would start January 1, 2020. Unfortunately, the proposed rule still includes a significant “behavioral adjustment,” which amounts to an 8.01% reduction in base payment rates calculated on the assumption that HHAs will modify service and documentation practices in ways that would increase Medicare spending.

The proposed rule also offers some minor tweaks in the payment model and sets out 2020 payment rates for the first time. In addition, the proposed rule includes unrelated adjustments in other rules affecting home health, including the 2021 home infusion therapy benefit, quality measures and the Home Health Value Based Purchasing Demonstration program.

NAHC is working in partnership with Congress to secure sensible payment reforms and to protect the 3.5 million Medicare beneficiaries who receive home health services throughout the country.

Attend this webinar to learn more about the new proposed rule and how it will directly affect your Medicare home health agency. In addition, Mr. Dombi will explain how NAHC is fighting the behavioral assumptions and what you can do to help.

Faculty:

· William A. Dombi, Esq., President, NAHC

· Mary Carr, Vice President, Regulatory Affairs, NAHC

Webinar Access Information:

Event URL:	https://nahc.webex.com/nahc/onstage/g.php?MTID=e035c030b897baf39259316c6f35cc799
Event number:	667 242 301
Event password:	856247
Audio conference:	(415) 655-0045
Access code:	667 242 301

MedPAC Calls for Home Health Rate Cut, NAHC Objects

Wed, 20 Mar 2019 18:37:48 GMT

Article courtesy of NAHC.

MedPAC, the Medicare Payment Advisory Commission, released its annual March report to Congress on March 15, 2019. MedPAC is required to produce this report; however, Congress is not required to act upon all the recommendations contained in the report and historically has not done so. Chapters 9 and 12 of the Report, Home Health Recommendations and Hospice Recommendations respectively, will be of most interest to NAHC members. A summary of the Home Health recommendations is provided below.

MedPAC is recommending a five percent cut in the Medicare home health base payment rate for 2020 and indicated that this cut would also need to be accompanied by a rebasing of the rate in order to align Medicare payments with providers’ actual costs. MedPAC indicated that the planned revisions to the home health PPS likely will alter the mix and level of services HHAs provide and future rebasing should reflect the new patterns of care. Those data will not be available until mid 2021.

MedPAC cited adequate payment, as evidenced by the following, as the basis for the payment cut recommendation.

Beneficiaries’ access to care
Quality of care
Providers’ access to capital
Medicare payments and provider’s costs

The Report indicates over 98 percent of beneficiaries lived in a ZIP code where an HHA operated in 2017, and 84 percent lived in a ZIP code with five or more HHAs. NAHC notes this is a decline from the past and no information about the 2% of the Medicare population (nearly 1 million people) who do not have any access to home health services is provided in the Report.

“The recommendations from MedPAC on home health services and hospice are no surprise as the commissioners voted on them at their January meeting,” said NAHC President William A. Dombi, in response to the report’s release on the afternoon of Friday, March 15. “We disagree with those recommendations in all respects. The March Report sets out the MedPAC analysis and basis for its recommendations. As in past years, the report falls short of a full disclosure and presentation of the facts relevant to Medicare payment rates. While there are some improvements in the way data is presented, the report continues to rely on simple averages that do not display the wide range in financials for providers, gives short shrift to hospital-based providers, and essentially ignores the overall financial status of home health agencies and hospices. Notably, the report presents trend analyses that do not focus on recent times in evaluating changes that are vital to whether care is accessible and in full use.

“We will be working with Congress to provide all the needed information to assure a full understanding of the current state of home health serices and hospice care,” said Dombi.

In 2017 freestanding HHAs’ marginal profit—that is, the rate at which Medicare payments exceed providers’ marginal cost—was 17.5 percent according to MedPAC calculations and suggests a significant financial incentive for HHAs to serve Medicare patients. The Medicare margins for freestanding agencies averaged 15.2 percent. The projected margin for 2019 is 16 percent. However, MedPAC also indicates that HHA volume dropped 3.1 percent in 2017, the total number of FFS users also fell slightly, and the average number of episodes per home health user declined by 1.4 percent.

NAHC and other industry stakeholders have had concerns about HHA profit calculations used by MedPAC. MedPAC specifies its marginal profit and Medicare margin calculations are for freestanding agencies only and also provides an average all-payer margin of 4.5 percent. This differs from the NAHC calculation which shows an average all-payer margin of 2 percent. NAHC has asked for an explanation of the MedPAC calculation.

Two factors were cited in the Report for payments exceeding costs:

Agencies have reduced episode costs by decreasing the number of visits provided, and
cost growth in recent years has been lower than the annual payment updates for home health care.

It is important to note, however, that home health agencies have incurred cost increases. Some cost increases were referenced by MedPAC as it relates to the PPACA (Patient Protection and Affordable Care Act) changes to home health payment, but MedPAC focused more on the “net payment reduction” impact of the PPACA. Congress has legislated an annual update formula for home health agencies that is intended to reflect cost increases, not simply to raise rates for no valid reason.

In the Report, MedPAC indicates that ensuring appropriate use of home health care is challenging. MedPAC acknowledges that skilled care and the homebound requirement are the primary determinants of home health eligibility; yet, MedPAC continues to focus on length of home health care and a shift in focus to episodes not preceded by a hospitalization. The home health benefit is a skilled care benefit without a durational limit provided the patient meets the skilled care and homebound eligibility criteria Congress constructed, maintained, and reinforced several times that the benefit is not limited in terms of a length of stay. Additionally, healthcare has changed significantly in the last decade and no longer are hospitalizations the starting point of care.

The quality of care is also addressed in the Report with MedPAC relying more on claims-based measures than provider-reported measures. MedPAC indicates that there has not been a significant change in patients who were hospitalized or received treatment in the emergency room during an episode in 2017, while measures of functional status, such as improvement in walking and transferring, increased.

Throughout the Report, MedPAC provides a comparison of financial and utilization data for home health agencies over time. Much of the comparison in trends is for a span of well more than 5-7 years, not the norm for what most parties would use for trend comparison. Overall, MedPAC estimates that home health margins will remain high for 2019 – 16 percent margin for freestanding agencies. It also acknowledges that home health care can be a high-value benefit when efficiently and appropriately delivered.

NAHC Report coverage of previous MedPAC Reports to Congress can be found by using the Search function at the top right of the NAHC Report page for “MedPAC Report to Congress”.

Department of Labor Regulatory Guidance Update

Tue, 22 May 2018 22:31:47 GMT

Do you have questions about labor and wage issues? The following from the US Department of Labor may answer some of your questions. Have specific questions regarding labor laws? Email Mandy Rubenstein.

Travel Time
For many employers, there is some uncertainty about when to pay employees for travel time. The principles which apply in determining whether or not time spent traveling is hours worked depend upon the kind of travel involved. The U.S. Department of Labor’s Elaws section is designed to help you make this determination! Please click here for more information.

Training Time
Many employers give employees opportunities to go to lectures and seminars and to attend training programs. Employers may also require employees to attend company meetings. Time spent by your employees attending lectures, meetings, training programs and similar activities may or may not be hours worked depending on the facts of the situation. The U.S. Department of Labor’s Elaws section is designed to help you make this determination! Please click here for more information!

Regular Rate
Nonexempt employees covered by the Fair Labor Standards Act (FLSA) must be paid overtime pay at no less than one and one-half times the employee’s regular rate of pay for hours worked in excess of 40 in a workweek. But what is the regular rate? Generally, the regular rate includes all payments made by the employer to or on behalf of the employee (except certain statutory exclusions). Let the DOL’s eLaws FLSA Overtime Calculator clear up questions you may have about the regular rate! Click here for more information!

Recordkeeping
Many wage and hour compliance issues begin with recordkeeping missteps. How long are employers required to maintain time and payroll records under federal law? What type of information must be kept? Educate yourself and avoid recordkeeping compliance issues. A great place to start is right here with the Department of Labor/Wage-Hour Division’s Recordkeeping Fact Sheet!

Department of Labor Regulatory Guidance Update

Tue, 22 May 2018 22:31:47 GMT

CMS Issues Provider Enrollment Updates and Rural Add-on Tables

Wed, 18 Apr 2018 11:31:35 GMT

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 10443 that updates Medicare Program Integrity Manual related to policies for Medicare provider deactivations. The changes align the reasons for deactivation more accurately with the regulations at §242.540 and include several small changes in chapter 15 of the manual under sections 15.27and15.29.

Specifically, the contractor may deactivate a providers billing privileges for any reason without CMS’ review and approval, expect in cases when deactivating a HHA’s billing privileges unless the deactivation is due to failure to comply with a revalidation request.

Additionally, the time frame for when the contractors must send providers their revalidation notice letter has been increased from 75-90 days prior to the revalidation date to 90-105 days.

The regulation at §242.540(b)(3)(i) require a HHA, whose Medicare billing privileges have been deactivated, to obtain an State or accreditation survey before its Medicare billing privileges can be reactivated. However, CMS has confirmed for the National Association for Home Care & Hospice that this does not apply to deactivation related to revalidation since the provider agreement and the Provider Transaction Access Number (PTAN) remain intact.

Home heath and hospice providers are reminded to review the CMS web based revalidation list to ensure revalidations are completed timely. The list contains all Medicare enrolled providers and records the date for revalidation up to 6 months prior to a provider’s revalidation due date.

Rural Add-on Tables

CMS is rescinding Transmittal 2047, dated March 20, 2018, and replaced it with Transmittal 2051, dated, April 4, 2018 to include page 2 of Attachment B Rural Add on Rate Tables. All other information remains the same. The transmittal provides instructions to the Medicare Administrative Contractors on reprocessing claims related to several provisions of the Bipartisan Budget Act of 2018, (see NAHC Report Article).

CMS Holds Open Door Forum

Wed, 7 Mar 2018 14:39:47 GMT

CMS held an Home Health, Hospice & DME Open Door Forum on February 28, 2018. A summary of the call follows.

Home Health Agenda Items

Claims Adjustments for 2018 Home Health Rural Add-on Payments

MAC software will begin adjusting for the rural add-on from the Bipartisan Budget Act of 2018 beginning with claims received on April 2, 2018. Shortly after that date, MACs will begin reprocessing previous claims from this year which are also eligible for the rural add-on. Providers do not need to take any action.

Posting of Materials from Abt Associates’ Home Health Technical Expert Panel Meeting held on February 1, 2018
- CMS previously made materials from the TEP available here.
- CMS was asked about the next steps of the TEP by a Partnership member. CMS provided that a summary of the TEP is being developed and will be released at a date to be determined.
- CMS is still considering next steps for the TEP.
- Any questions or comments about this Technical Report should be sent to: HomeHealth@abtassoc.com.

Clarification in calculation of the cross-setting measure Percent of Residents or Patients with Pressure Ulcers that are New or Worsened
- An updated quality measure specifications document for the cross-setting measure Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened is now available in the Downloads section of the Quality Measures webpage. The measure specification logic has not changed but language has been added to clarify how valid skips are accounted for in the measure denominator.

Changes to the on-demand CASPER reports
- Changes are being made to reflect the removal of measures that were removed per the PPS rule.

Changes to the calculation algorithm for “Timely Initiation of Care” to align with the new CoP
- The Medicare Conditions of Participation (CoPs) for home health agencies that became effective January 13, 2018 included a change regarding resumption of care (ROC) dates for patients returning to home health following an inpatient stay. Specifically, the revised guidance allows for a physician ROC date as an alternative to the fixed 48-hour timeframe for the post-hospital reassessment.
- To align with this CoP change, updated logic for the Timely Initiation of Care process measure has been posted in the “Downloads” section here. With this update, an episode will also be included in the numerator (achieve success in the measure) when the physician-ordered ROC date is later than two days after inpatient stay and the agency completes the ROC assessment on the physician-ordered ROC date. Use of this new calculation logic will be effective for quality episodes that begin on or after January 13, 2018.
- This change will be reflected in the Quality of Patient Care Star Rating and Home Health Compare Preview Reports available in September 2018 for the January 2019 Home Health Compare update. Also, in September CMS will retroactively apply these specifications to the confidential feedback and Review and Correct reports available through CASPER.

Update for HHCAHPS
- All Medicare-certified home health agencies (HHAs) seeking an exemption from participating in the HHCAHPS Survey for the CY2019 APU to submit a Participation Exemption Request (PER) form on the HHCAHPS website.
- The deadline for submitting the CY 2019 APU exemption request is 11:59 PM Eastern Time Monday, April 2, 2018. This deadline has been extended because March 31, 2018 falls on a Saturday.
- As announced in the Home Health Prospective Payment System (HH PPS) Rate Update Final Rule for Calendar Year 2018 that was published in the Federal Register on November 7, 2017, Medicare-certified HHAs that served 59 or fewer unduplicated patients between April 1, 2016 and March 31, 2017 who met survey eligibility criteria can request a PER for the CY 2019 APU.

Low Volume Appeals Opportunity Announcement

On February 5, 2018, CMS started accepting Expressions of Interest for the Low Volume Appeals (LVA) settlement process. The LVA settlement option is for providers, physicians, and suppliers (appellants) with:
- Fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals and the Medicare Appeals Council at the Departmental Appeals Board, combined, as of November 3, 2017
- A total billed amount of $9,000 or less per appeal
For more information on participating in LVA to address pending appeals:
- Visit the Low Volume Appeals Initiative webpage
- Register for the Medicare Learning Network call on March 13
  - http://go.cms.gov/LVA
  - medicaresettlementfaqs@cms.hhs.gov

Hospice Agenda Items

Update on electronic submission of hospice Notices of Election
- The previous error with submission of hospice Notices of Election via EDI was successfully resolved on February 5, 2018. Hospices may submit NOEs electronically or though DDE.
HIS Modifications After Preview Reports
- CMS has noticed an increase in HIS modification after preview reports. Providers are encouraged to review their reports early and often.

Open Q&A

Face-to-Face in Bipartisan Budget Act- CMS will provide additional information in the proposed rule

TEP- CMS was asked about the future of the TEP. CMS provided that a summary of the TEP is being developed and will be released at a date to be determined. CMS is still considering next steps for the TEP.

DMEPOS Competitive Bidding- CMS had no update but will provide updates through its regular channels.

CMS Okays Non-Skilled Home Care Benefit in Medicare Advantage

Mon, 19 Feb 2018 12:42:50 GMT

The Centers for Medicare & Medicaid Services (CMS) recently announced that non-skilled in-home care will be included in Medicare Advantage plans in 2019 as a supplemental benefit.

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” CMS Administrator Seema Verma said in a statement. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”

The CMS decision is an important change to supplemental benefit because it allows payers to cover services like non-skilled in-home support for daily maintenance and activities, which is a first. CMS will also include portable wheelchair ramps and other assistive devices and modifications, as necessary, in the supplemental benefit. These benefits are meant ameliorate the damage caused by physical injuries and ailments and prevent hospitalization or re-hospitalization.

The CMS announcement will allow supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

“Home care services continue to demonstrate high value in all care delivery models, including managed care,” said William A. Dombi, President of the National Association for Home Care & Hospice, in reaction to the news. “By allowing Medicare Advantage plans to use caregivers in the home as a supplemental benefit, it can be expected that the plans will reduce overall care costs while improving patient outcomes. These caregivers can be very helpful in making care transitions successful, avoiding initial and re-hospitalizations, and spotting potential exacerbations in the patient’s clinical condition. That happens because they are in home with the patient and capable of assisting with care plan adherence and observing changes in the patient’s condition. If done correctly by the plans, this will be a very positive move by CMS.”

According to CMS, the “proposed updates will result in a payment increase that promotes stability and insures that resources will be available to support beneficiaries enrolled in private Medicare plans.”
While the CMS decision does not mention hospice benefits as supplemental benefits in Medicare Advantage, though the idea has been discussed and further changes could be made to include hospice in the future.

In related news, the Medicare Advantage 2019 Advance Notice, Part 2, includes numerous proposals related to Part D plan oversight of opioid utilization, including a seven-day supply prescribing limit on opioids for acute pain and a seven-day supply, 90 morphine milligram equivalents daily dose limit for non-acute pain. While it would not be anticipated that a high proportion of hospice patients would secure prescription opioids by way of their Part D plans, CMS indicates as part of the notice that, “Sponsors should continue to apply specifications to account for known exceptions, such as hospice care; cancer diagnoses; reasonable overlapping dispensing dates for prescription refills or new prescription orders for continuing fills; and high-dose opioid usage previously determined to be medically necessary such as through coverage determinations, prior authorization, case management, or appeals processes.”

Bipartisan Budget Act

Mon, 19 Feb 2018 12:39:02 GMT

The Bipartisan Budget Act was recently signed into law. This legislation includes language from the U.S. House of Representatives Continuing Resolution, which directs funding for the government through March 23, in addition to raising the debt ceiling and spending parameters for governmental budget caps through October 2019.

Below are the key impacts from the signed law:

Rural add-on: This program which provides an additional 3% reimbursement for home health services provided in rural areas was extended for an additional 3 – 5 years, depending on certain conditions.

    - All eligible claims will receive 3% in 2018

    - Services provided in frontier areas (defined as 6 or fewer people per square mile) will see an additional 4% in 2019, 3% in 2020, 2% in 2021, and 1% in 2022

    - The top 25% of eligible counties by utilization will receive 1.5% in 2019, and 0.5% in 2020

    - Every other eligible claim not included in the two preceding groups will receive 3% in 2019, 2% in 2020, and 1% in 2021

Additionally, as a result of advocacy efforts, a study analyzing opportunities for strengthening and improving the add-on will be conducted. This will allow for future debates to keep the add-on in place beyond this phase-out approach.

Payment Reforms: Episode units will now be on 30 day periods rather than the current 60 day model. Additionally, the therapy domain will no longer be used as a payment determinant. Behavior adjustments made by CMS will be more transparent, and a notice and comment period will be required. The reform must also respond to behavior assumptions that are made, but are not realized in practice. All reforms are set to go into effect in 2020, and are required to be budget neutral.

Market Basket Update: In 2020, the inflation factor, the market basket update, will be set at 1.5%

Face-to-face/Physician Documentation Certification: The legislation included a provision similar to HR 2663, which directs CMS to consider the home health agency record in conjunction with the physician record in determining claim status. The language included in the spending package addressing the requirement does not necessarily direct CMS to consider the home health agency record as NAHC would have preferred. It will be up to CMS’s interpretation for how this provision is implemented.

HR 2663 also called for a settlement process for past denied claims resulting from the face-to-face requirement currently residing in an appeals backlog. That provision was not included in the spending package.

CHRONIC Care: This provision is a series of programs to help those suffering from chronic conditions. Included is extension of the Independence at Home program, and various telehealth measures designed to increase its provision.

Hospice: Two hospice provisions were included. 1.) Physician Assistants will now be allowed to serve as attending physicians, 2.) Patients discharged early from hospitals to hospice will now result in a reduced reimbursement to the hospital. This has the potential to limit the full effect of the hospice benefit for hospice patients.

Home Infusion: A temporary payment system will be devised and implemented by the Secretary of Health and Human Services to cover 2019 – 2021 while CMS is transitioning to a permanent structure for these services.

Predictions for Legislation and Regulation in 2018

Tue, 6 Feb 2018 20:12:19 GMT

The year 2018 projects to be an interesting one in the halls of the United States Congress. As the majority party in both chambers, Republicans will continue to work to carry our President Trumps agenda, including a broad infrastructure plan, immigration reform, and border security. Lawmakers will also work towards passing a budget resolution funding the federal government for the remainder of the fiscal year, as opposed to short-term continuing resolutions that maintain current spending levels, and lifting caps on allotments for the military.

The National Association for Home Care and Hospice (NAHC) is predicting notable changes for our industries. For home health, we predict that the rural add-on will be extended. However, the proposed phase-out is a serious threat staff continues to combat. While actual legislative language has not been introduced, we could see a vote on the Medicare extenders and thus the rural add-on as soon as the next federal budget bill. We are also predicting Medicare home health payment reform. During last year’s discussion on the home health groupings model (HHGM) proposed by the Centers for Medicare and Medicaid Services (CMS), NAHC emphatically stated that industry stakeholders should be involved in payment reform efforts to ensure a budget-neutral system that protects patient access to care, and strengthens program integrity. As such, following their removal of the HHGM provision, CMS has engaged NAHC in preliminary discussions. However, no details or specifics have emerged regarding the direction CMS is planning to pursue with reform.

As has been the case in the past, NAHC will continue to monitor all regulatory and legislative developments that relate to home care and hospice. Stay tuned to the Informer for communications on developments, and how to get involved to protect and strengthen our industries. As always, the NAHC Legislative Action Center is open for business and an easy way to get in touch with your Congressional representation.

CMS to Hold New Open Door Forum on Medicare Card Project

Wed, 17 Jan 2018 16:32:20 GMT

The Centers for Medicare & Medicaid Services (CMS) will host a special Open Door Forum (ODF) conference call to allow State Medicaid agencies, Medicaid providers, Managed Care Organizations (MCOs), Medicaid partners and other Medicaid stakeholders an opportunity to learn more about and ask questions regarding CMS’s approach towards changing the Social Security Number-based Health Insurance Claim Numbers (HICN) to the new Medicare Beneficiary Identifier (MBI).a

The ODF will be held on Tuesday, January 23, 2018, from 1:00 PM to 2:00 PM Central Standard Time.

Participant Dial-In Number: 1-800-837-1935
Conference ID #: 8259057

CMS asks that you please dial in at least 15 minutes prior to the start of the call.

CMS Launches New Low Volume Appeals Settlement Option

Wed, 17 Jan 2018 16:29:15 GMT

The Centers for Medicare & Medicaid Services (CMS) is launching a new Low Volume Appeals (LVA) Initiative to help address the significant backlog of Medicare appeals that are currently in line for resolution. Under the program eligible providers and suppliers may submit an Expression of Interest (EoI) to CMS to be considered for an administrative settlement process to address a portion of pending appeals in exchange for a 62% partial payment of the net Medicare approved amount. Given the length of time that it is taking for Medicare appeals to be resolved, the National Association for Home Care & Hospice (NAHC) encourages eligible providers to examine the LVA Initiative as a potential option for addressing outstanding claim disputes.

On January 9, CMS held a brief National Provider Call during which the rudiments of the program were reviewed and a number of questions submitted in advance of the call were answered.

CMS plans to post an audio recording of the call within two weeks HERE.

Presentation slides for the January 9 call are available HERE.

In cases where providers are not eligible for the LVA option, the Office of Medicare Hearings and Appeals (OHMA) has been expanding the Settlement Conference Facilitation Process. Information on the Settlement Conference Facilitation Process is available at the following location: https://www.hhs.gov/about/agencies/omha/about/special-initiatives/settlement-conference-facilitation/index.html.

MedPAC Floats Draft Recommendation for Zero FY2019 Hospice Update

Wed, 20 Dec 2017 15:38:39 GMT

The Medicare Payment Advisory Commission (MedPAC) meets each year in December and January to consider Medicare payment recommendations for inclusion in its annual March Report to Congress. Last week the Commission met to consider, among other topics, the adequacy of payments under Medicare to hospice providers. In response to the findings presented, it appears that MedPAC will finalize, at its January meeting, a staff recommendation that Congress eliminate the update for hospice payments for FY2019. Imposition of a zero update – or any update change — for hospice providers would require a statutory change. Under current law for FY2019 hospice payment updates would be increased by a factor equal to the annual market basket less a “productivity adjustment”, with a subsequent 2 percent reduction due to the automatic sequester.

In developing payment recommendations, MedPAC considers payment adequacy, which takes into account access to care (supply of providers, volume of services), quality of care, access to capital, and payments and costs.

The latest data analyses by MedPAC indicate the following for 2016:
• Over 1.4 million beneficiaries used hospice services (up 3 percent from 2015)
• Nearly ½ of Medicare beneficiaries who died in 2016 used hospice services (49.7 percent, up from 48.6 percent in 2015)
• Medicare certified hospices totaled approximately 4,400 (up 4 percent from the previous year)
• Growth in number of hospices fueled entirely by for-profit entities
• Total expenditures were about $16.8 billion
• Average length of stay increased slightly both at the median and at the 90th percentile
• Average length of stay varies by profit status, freestanding vs. facility –based, diagnosis, and patient location
o Average length of stay for non-profit providers was 66 days as compared with for-profit providers, which was 106 days
o Average length of stay for freestanding providers was 91 days as compared with 63 days for provider-based
• Live discharge rates edge upward (16.9 percent, as compared with 16.7 percent in 2015) (Note: the top 10 percent of hospices had live discharge rates of 53 percent or more)

Relative to quality, MedPAC acknowledged that limited measures are publicly available, but for those that are 75 percent of hospices scored at least 93 percent for six of the seven measures. Given the scoring these measures are expected to “top out” in relatively short order, but others will be coming online in the future. MedPAC also notes that access to capital should be available to for-profit providers given they are viewed favorably by the investment community, and facility-based hospices should have access to capital through their parent organization.

Data Analysis of Costs by Level of Care, Margins, and Impact of New Payment System.

Earlier this year CMS published preliminary analysis of data gathered from freestanding hospices under the new cost reporting forms that estimated costs by level of care; MedPAC has begun similar analyses that have yielded almost identical results, and has similarly raised the issue as to whether or not payment rates should be recalibrated among the different levels of care. Such a recalibration would transfer dollars from routine home care to general inpatient, continuous home care, and inpatient respite, and could have a significant impact on hospice providers.

Additional MedPAC analysis indicates that financial margins increased, on average, from 8.2 percent in 2014 to 10 percent in 2015. This figure excludes non-reimbursable costs for bereavement and volunteer services. If those costs were included, they would reduce margins by as much as 1.6 percentage points. As has historically been the case, MedPAC found that margins are variable by hospice type as well as based on average length of stay. Of note in MedPAC’s analysis is the first available data examining the impact of the payment changes that were instituted in January of 2016 – MedPAC found that on average payments increased about 3 percent for the quintile of hospices with the fewest long-stay patients while payment decreased approximately 3 percent for the quintile of hospices with the most long-stay patients.

MedPAC projects the 2018 hospice margin to be 8.7 percent. Based on the projected margin and other factors, the general consensus supported the staff recommendation of a zero update for FY2019. Given that consensus, the Commission will bring the recommendation back in January under an expedited approval process, which for the most part guarantees that it will be included in the March Report to Congress.

During discussion, Commission members raised a number of issues related to hospice, including:

• Ways that program integrity efforts might be targeted toward providers that game the system
• The variability of margins by provider type and the impact of the new payment system in moderating that variability
• The potential for recommending differential updates based on certain provider characteristics (which MedPAC has historically avoided)
• The potential for making additional recommendations to further moderate the variation in profitability

To explore the MedPAC discussion in greater depth, please see the Presentation Slides and the Transcript of the meeting (starting on page 339).

MedPAC Draft Recommendation: Reduce Medicare HHA Payments by Five Percent

Wed, 20 Dec 2017 15:35:26 GMT

The most recent meeting of the Medicare Payment Advisory Commission (MedPAC) considered a draft recommendation to reduce payments to home health agencies by five percent in 2019 and a two-year rebasing of the pay system beginning in 2020. In addition, the draft recommendation urges Congress to direct the Centers for Medicare and Medicaid Services (CMS) to revise the payment system to eliminate the use of therapy visits as a factor in payment determinations, in line with rebasing.

“The Congress should reduce Medicare payments to home health agencies by five percent in 2019 and implement a two-year rebasing of the payment system beginning in 2020,” read the recommendation. “The Congress should direct the Secretary to revise the PPS, to eliminate the use of therapy visits as a factor in payment determinations, concurrent with rebasing.”

MedPAC believes this will lower spending without affecting provider ability to serve beneficiaries, though no evidence of that was presented. MedPAC claims the two recommended changes, reducing payments and eliminating the use of therapy visits as a factor in payment determinations, will be budget neutral and redistributive.

The Medicare advisers outlined an interim post-acute care payment system for CMS to implement until a unified system is put in place in 2021, as is required by the IMPACT Act. The interim system would keep total payments to each post-acute care setting at set levels, while redistributing pay across conditions within each sector.

The blended system would feature redistribution based on patient mix and therapy practices, with payments increasing to nonprofits and hospital-based providers, while falling in the case of for-profit providers.

All of the draft recommendations are expected to come for a vote in January and many commissioners indicated they would support the recommendations.

You can read the entire transcript HERE. The home health portion begins on page 236.

MedPAC Continues its Evaluation of Telehealth

Tue, 14 Nov 2017 19:06:14 GMT

The Medicare Payment Advisory Commission (“MedPAC”) recently met in Washington, DC, to conduct its monthly assessment of the issues and challenges facing the Medicare program. Their November meeting marked the third consecutive monthly meeting at which MedPAC discussed telehealth as mandated by Congress in the 21st Century Cures Act of 2016. In previous meetings, the commissioners reviewed how Medicare and commercial health plans currently cover the technology.

This past summer, MedPAC surveyed health programs, Medicare beneficiaries, primary care physicians, and home health agencies with the goal of better understanding their use and attitudes toward telehealth. Results of this survey show that despite the success of certain telehealth programs for health plans (e.g., tele-stroke, tele-mental health) and the increased use of telehealth services among home health agencies, many of those surveyed believe that telehealth provides convenience and improves care only in limited circumstances.

For its November meeting, MedPAC staff presented ways in which telehealth services covered under private insurance plans might be incorporated into the Medicare fee-for-service program and their recommendations for ways to accomplish this incorporation. Their report included a definition of telehealth, a comparison of Medicare and commercial plan telehealth coverage, principle for evaluating coverage expansions and also illustrative examples of policy options. Examples included direct-to-consumer care through companies like Teladoc or American Well, drug management, nursing home care and remote patient monitoring for chronic diseases.

MedPAC is in the final stages of assembling their recommendations to Congress. MedPAC is planning to discuss the full telehealth report in January 2018 and is forecasting that its report will include a recommendation that Congress grant Medicare Advantage plans the flexibility to include telemedicine in their annual bids to CMS. MedPAC is also planning to recommend that risk bearing entities such as Accountable Care Organizations (ACO) and Medicare Advantage plans be granted greater flexibility to cover telemedicine services. For services where tele-medicine’s value is unclear, MedPAC could recommend that CMS consider testing services through its Innovation Center.

The MedPAC commissioners will finalize their recommendations in January for the formal report to Congress which will be delivered to Congress by March 15, 2018.

Home Health Groupings Model (HHGM) Not Included in Final Rule

Tue, 14 Nov 2017 19:03:17 GMT

The 2018 Home Health PPS final rule was issued November 1 at the Federal Register public inspection page. The good news is that CMS is NOT finalizing the home health grouping model (HHGM) in this rule, stating they are "not finalizing the Home Health Groupings Model and will take additional time to further engage with stakeholders to move towards a system that shifts the focus from volume of services to a more patient-centered model. CMS will take the comments submitted on the proposed rule into further consideration regarding patients' needs that strikes the right balance in putting patients first."

A huge thank you to everyone who took time to reach out to their elected officials ! This change is an outcome of the home care industry across the country uniting and elevating your voices. Collaboration was key to this amazing success!

Stay tuned for further details regarding the final rule and stand ready to engage in the future conversations around Medicare reform.

Is Your Home Health or Hospice Organization Ready for the Emergency Preparedness 11/16 Deadline?

Tue, 3 Oct 2017 17:30:51 GMT

Effective November 16, 2017 home health, hospice and other Medicare and Medicaid-participating providers must meet extensive new emergency preparedness requirements, including the ability to demonstrate that they have:
• Developed an emergency plan for a full range of emergencies specific to their agency’s location;
• Developed and implemented policies and procedures based on the plan and risk assessment;
• Developed and maintain a communication plan compliant with state and federal law so patient care is properly coordinated with other providers, health departments and emergency systems; and
• Developed training and testing programs and participated in drills and exercises to test the plan.

To help you ensure timely compliance, the National Association for Home Care & Hospice, participating members of the NAHC Forum of State Associations, and RBC Limited are offering the following emergency preparedness product package — including the newly-revised HOME HEALTH CARE & HOSPICE EMERGENCY DISASTER WORKBOOK and its just-released companion THE DISASTER PREPAREDNESS TOOLKIT — for a SINGLE LOW PRICE of $324 that includes shipping and handling.
Both documents will be supplied on a single CD-ROM and contain model policies and procedures that can be downloaded and tailored to your agency’s needs! RBC Limited, the developer of these materials, is internationally known for its expertise in home care and hospice disaster preparedness. For additional information about RBC, please go to http://www.rbclimited.com/.

Click here to take advantage of this offer and receive BOTH products for $324:
• Scroll down to item number 611 — Emergency Disaster Preparedness Manual/Disaster Preparedness Toolkit CD-ROM Combo
• Add the product to your cart
• Register in the RBC store
• When provided the opportunity to REVIEW YOUR CART, please insert the following code in the State Code box: NAHCEDP
• Complete your checkout with payment information

WHAT YOU’LL GET:

Home Health Care & Hospice Emergency Disaster Preparedness Manual
The manual includes:
• Key Elements of an Emergency Disaster Plan such as Task Force Development, Agency Self-Evaluation Checklist and a Hazard Vulnerability Analysis
• Sample Emergency Preparedness Plan covering Infection Control Surveillance, Communication Systems, Plan Activation, and Patient Care Planning
• Infection and Prevention, including a Sample Infection Control Plan
• Patient Education Materials/Tools

This manual is approximately 160 pages and arrives in a type-able PDF file. The agency does have the right to convert the file into a Word document to make it more customizable.

Disaster Preparedness Toolkit
This toolkit is a companion to the manual/workbook and was designed to assist agencies in complying with the CMS Federal Regulations for Disaster Preparedness. It includes:
• Sample policies for events such as evacuation, active shooters, ransomware, and transportation
• Checklists for PACE, home care and hospice for compliance- readiness
• Information related to HIPAA in a disaster, 1135 waivers, and cyber security
• Various documentation forms, including documentation for coalitions and partnerships, and staff location
This Toolkit is approximately 250 pages and arrives in a type-able PDF file. The agency does have the right to convert the file into a Word document to make it more customizable.

Two Wins in One Day! Senate Passes CHRONIC Care Act and RAISE Family Caregivers Act

Tue, 3 Oct 2017 17:03:30 GMT

Home care and hospice won a double victory yesterday, September 26, when the United States Senate passed the CHRONIC Care Act and the RAISE Family Caregivers Act. Both pieces of legislation are important to the home care and hospice community and the millions of Americans who depend on it. The National Association for Home Care and Hospice (NAHC) worked hard to ensure passage of the legislation in the Senate and we will be working hard to get the legislation moved forward in the House of Representatives.

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870), will reduce Medicare costs by improving chronic disease management services and care coordination at home.

The legislation will increase access to telehealth for Medicare patients with chronic illnesses and create incentives for patients to receive care via accountable care associations (ACOs). The bill would also extend the Independence at Home (IAH) demonstration to allow people to remain in their homes rather than in institutionalized settings. The Act would also permit reimbursement for more social services and non-health, and permanently extend the MA Special Needs plans that assist chronically ill patients.

Ranking member Ron Wyden (D-OR) noted during a hearing on the bill last May that seniors suffering from more than two chronic conditions simultaneously (such as heart disease and diabetes) account for more than 90 percent of Medicare spending. Reforming health care policy to better serve seniors with chronic illnesses is “premier challenge of American health policy.”

A major advantage of the CHRONIC Care Act, according to Wyden, is that it allows more care to be provided at home and with an emphasis on primary care and non-physician providers. Wyden also emphasized the need for people with chronic illnesses to have an advocate to help “guide them through what can be a teeth-gnashing experience of navigating American health care.”

“This is a formal recognition that this package of services - the focus on care at home, the focus on new technology, the expanded role for primary care and prevention, which inevitably leads to more non-physician providers - is the beginning of our push to update the Medicare guarantee,” Senator Wyden told Medpage Today. “That's why it's transformative."

The RAISE Family Caregivers Act (S. 1028) will:

• Implement the federal Commission on Long-Term Care’s bipartisan recommendation that Congress require the development of a national strategy to support family caregivers.
• Create an advisory body to bring together relevant federal agencies and others from the private and public sectors to advise and make recommendations.
• Identify specific actions that government, communities, providers, employers, and others can take to recognize and support family caregivers and be updated annually.

The legislation is based on a recommendation by the bipartisan Commission on Long-Term Care to develop a national plan to support family caregivers.

Similar legislation is pending in the House of Representatives and NAHC is asking members of the home care and hospice community to ask their Representative to support H.R. 3759. NAHC recently wrote a Dear Representative letter to all House member offices urging co-sponsorship of the RAISE Family Caregivers Act (H.R. 3759).

The role of family caregivers is crucial in caring for many seniors and disabled individuals in their homes. The most recent estimates show about 40 million family caregivers in the United States provided approximately 37 billion hours of care to adults in 2013, according to a report released by the AARP’s Public Policy Institute. The estimated economic value of the unpaid contributions of family caregivers was about $470 billion in 2013, up from approximately $450 billion in 2009.

However, the ratio of potential family caregivers to the growing number of older people is in a precipitous decline. In 2010, there were seven potential caregivers available for each person 80 or older; by 2030 there will be only four, and by 2050, when baby boomers are between 86 and 104, there will be fewer than three.

Caring for an elderly or disabled relative carries a financial toll, both in terms of lost income and additional expenses. Those who care for people with Alzheimer’s disease typically spend more than $50,000 a year on expenses related to their duties. Developing a national plan to help care for the elderly and disabled is critical to the nation’s long-term fiscal and healthcare future, as well as a powerful moral imperative. By supporting family caregivers we help people stay out of hospitals and nursing homes and remain in their homes, which is where they want to be. This will save money for both families and taxpayers.

MHCA and NAHC are pleased with Senate passage of these two important pieces of legislation. It is a further sign that MHCA, NAHC, and the entire home care and hospice community is having a major policy impact on this Congress. We intend to continue succeeding for the more than 12 million Americans who rely on home care and hospice.

Join MHCA in Washington, D.C. – Discounted Hotel Through 8/19!

Wed, 16 Aug 2017 15:45:21 GMT

The Council of States, a consortium of state home care associations, is pleased to announce the 2nd Annual Public Policy Summit & Advocacy Day at the Four Seasons Hotel in Washington, D.C. September 10-12, 2017. “This year’s Summit will feature CMS officials who will discuss the new home health CoPs, hospice data reporting, Medicaid reform, as well as a panel discussion featuring the MACs from across the country along with other key speakers."

MHCA members interested in attending are asked to contact Kathy Messerli.

Hotel reservations can be made by calling the Four Seasons, at 202-888-2060 or online at www.fourseasons.com and provide this code to receive the discount: CI0917CSH. To receive the discounted rate of $289 per night, make sure you make your reservation by August 19 and mention that you are with the Council of State Home Care Associations.

Federal Factsheets

Wed, 2 Aug 2017 19:38:28 GMT

In anticipation of Congressional visits, MHCA has prepared factsheets on:

Medicare Face-to-Face

Rural Health Add-On

We encourage you and your staff to reach out to your US Representative and US Senators and ask them to support these efforts.

Not sure what to say? Click here for a brief video demonstration, or click here for a simple email option.

CMS Issues Final Rule for CoPs

Wed, 19 Jul 2017 18:41:29 GMT

MHCA issued a breaking news alert on July 7th, announcing the CMS issuance of the final rule for the Home Health Conditions of Participation (CoPs). Items that previously had a July 13, 2017 implementation date have been delayed until January 13, 2018. The phase-in date for performance improvement projects has been revised to July 13, 2018 with all other QAPI requirements effective January 13, 2018.

The CoPs remained consistent with the proposed rule, with the following exceptions:
• Implementation date has been revised to January 13, 2018.
• Current Administrators will be "grandfathered" in to the personnel requirement. These Administrators will not have to meet the new education and training requirements. The new personnel requirements will have to be met by all Administrators starting employment on or after January 13, 2018.

Interpretive Guidelines
CMS intends to publish a final version of the Interpretive Guidelines in December 2017. Because of this delay in releasing the interpretive guidelines, CMS explained that they expect flexibility by surveyors reviewing compliance.

NGSConnex Eligibility Search Enhancement

Wed, 19 Jul 2017 18:38:06 GMT

Do you utilize NGSConnex to verify Medicare eligibility for your patients? If so, have you noticed the changes recently made to the search functionality in the Eligibility mega tab, based on your feedback?

Your feedback indicated that it would be quicker to not have to click the search/browse icon before entering eligibility search criteria, and this enhancement removes that step. Other feedback indicated viewing information in the Eligibility mega tab required too much scrolling. In efforts to improve satisfaction, NGS removed unnecessary white space in the various eligibility panels to reduce the amount of scrolling.
Watch this two-minute video to learn about these enhancements.

Join MHCA in Washington, D.C.!

Wed, 19 Jul 2017 18:29:51 GMT

The Council of States, a consortium of state home care associations, is pleased to announce the second annual Public Policy Summit & Advocacy Day at the Four Seasons Hotel in Washington, D.C. Setpember 10-12. “This year’s Summit will feature CMS officials who will discuss the new home health CoPs, hospice data reporting, Medicaid reform, as well as a panel discussion featuring the MACs from across the country along with other key speakers!"

MHCA members interested in attending are asked to contact Kathy Messerli.

Hotel reservations can by made by calling the Four Seasons, at 202-888-2060 or online at www.fourseasons.com and provide this code to receive the discount: CI0917CSH. To receive the discounted rate of $289 per night, make sure you make your reservation by August 19 and mention that you are with the Council of State Home Care Associations.

Trump Budget - $616B Proposed Medicaid Cut Jeopardizes Home Health

Tue, 6 Jun 2017 20:18:35 GMT

President Donald Trump unveiled his budget proposal for 2018, which included significant cuts to Medicaid and the Children’s Health Insurance Program (CHIP). (READ MORE) The proposed cuts would total $616 billion from Medicaid and the Children’s Health Insurance Program over the next decade, and there are other provisions in the budget that could impact the home health industry.

“What is offered is a combination of good news and bad news,” Bill Dombi, vice president for law at the National Association for Home Care and Hospice (NAHC), told Home Health Care News.

The Bad:
• Drastic Medicaid cuts, on top of the roughly $800B in cuts outlined in the American Health Care Act (AHCA)
• Gives states the choice between a block grant or per capita caps for receiving federal dollars in the program
• Lacks details on spending cuts
• Community First Choice benefit could be eliminated

“Our largest concern as providers in the Medicaid services space is that this is $610 billion in cuts on top of any AHCA cuts,” Joy Cameron, vice president of policy and innovation at ElevatingHome, “Significant seems like such a little word to described the magnitude of these cuts. …This puts the ability of patients to get high quality service in their homes in serious risk.”

“We are very concerned that the decades-long battle to provide Medicaid beneficiaries with improved access to home care rather than institutional care will risk a serious setback through these changes,” Dombi said. “States can still fund home and community based care, but it will be harder.”

The Partnership for Medicaid Home-Based Care (PMHC) responded to the budget by urging Congress to push for home-based care services and incentivize this option over nursing homes.

“By strengthening Medicaid recipients’ access to high-quality, low-cost, consumer-preferred home- and community-based services, we are confident that decision makers can achieve improved outcomes, increased quality of life and satisfaction and significantly reduce program costs,” PMHC Chairman David J. Totaro said in a statement.

The Good:
• Does not include direct cuts to Medicare in 2018
• Includes a proposal to repeal the Independent Payment Advisory Board, which is responsible for recommending Medicare spending within legislated limits to Congress.
• Adds $127 million annually to help reduce the Medicare appeals backlog

Ultimately, the President’s budget proposal is just that—merely a proposal. Congress is charged with the authority to create and affirm federal spending, and it is not unusual for a final budget to bear little resemblance to the White House’s initial proposal.

Home Health Care Planning Improvement Act

Tue, 2 May 2017 15:00:24 GMT

We continue to make progress on the Home Health Care Planning Improvement Act (S. 445/H.R. 1825), which would allow non-physician providers to sign home health orders.

If you haven’t reached out to your members of Congress yet, please do so! Senator Amy Klobuchar, Representative Keith Ellison, and Representative Collin Peterson have signed on as supporters, but we hope to gain more support from the Minnesota delegation! Be sure to follow-up with your contacts in their offices as well. Staffers tend to be very busy and can forget to present the information to their boss. As always, the NAHC Legislative Action Center can be very helpful with advocacy efforts.

Short on time but still want to advocate? Tweet them!

United States Senators:

Amy Klobuchar @amyklobuchar *Current supporter - thank her!
Al Franken @alfranken

United States Representatives:

District 1 - Tim Walz @RepTimWalz
District 2 - Jason Lewis @Jason2CD
District 3 - Erik Paulsen @RepErikPaulsen
District 4 - Betty McCollum @BettyMcCollumn04
District 5 - Keith Ellison @keithellison *Current supporter - thank him!
District 6 - Tom Emmer @RepTomEmmer
District 7 - Collin Peterson @collinpeterson *Current supporter - thank him!
District 8 - Rick Nolan @USRepRickNolan

Emergency Preparedness Rule Effective This November

Mon, 17 Apr 2017 22:03:21 GMT

As a reminder, the Centers for Medicare and Medicaid Services (CMS) finalized the Emergency Preparedness Rule last November with an effective date of November 16, 2017. While most of the language and requirements of this rule were mirrored in the new Conditions of Participation, the rule has not been delayed for home health care providers.

According to CMS, there are four core elements to the comprehensive emergency preparedness plan:
• Risk assessment and planning
• Policies and procedures
• Communication plan
• Training and testing
CMS estimates that it will take a home health agency 26 hours at $1,424 to develop its comprehensive risk assessment and emergency preparedness plan, and approximately 80 hours total to complete everything listed in the regulation. There is no additional funding forthcoming from CMS.

VNAA has produced a webinar and slides on the emergency preparedness rule for both home health and hospice. Further guidance is anticipated from CMS in late May and VNAA will share that information with providers at that time.

MHCA is also offering a one-hour session on Emergency Management at the MHCA Annual Meeting. Join us on the afternoon of May 10 to hear Shawn Stoen, Regional Healthcare Preparedness Coordinator of CentraCare discuss best practices regarding emergency preparedness in a Home Care setting.