The Home Health Planning Improvement Act of 2015 (S.878) was recently introduced in the Senate. The bill seeks to allow healthcare professionals (other than physicians) sign home health plans of care. S.578 will allow physician assistants (PA), nurse practitioners (NP), clinical nurse specialists, and certified nurse midwives to order home health services for Medicare beneficiaries. NPs, PAs, and clinical nurse specialists are currently unable to order less costly and less intrusive home healthcare services, although they are able to perform many other services for Medicare beneficiaries. In order to see these medical professionals as primary care providers, seniors and disabled citizens often require an extra office visit with an unknown physician. The extra visit leads to an extra administrative and paperwork burden and creates an unnecessary step that fails to recognize current training and scope-of-practice guidelines, according to NAHC. As a result of this requirement, patients in need of home healthcare are either place in more expensive care settings or experience delay in receiving the care they need. NAHC strongly supports S.878 and encourages its members to contact their lawmakers to urge them to support the legislation.
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We have received information from NAHC regarding the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014), which was passed on September 18, 2014. The IMPACT Act states that the Secretary shall require the submission of standardized clinical assessment data (with domains as specified) using assessment submitted to CMS by Long-Term Care Hospitals (LTCH), Skilled Nursing Facilities (SNF), Home Health Agencies (HHA) and Inpatient Rehabilitation Facilities (IRF). It further requires the submission of standardized data using such assessments for use the quality measures for which the Act specifies five domains. It also requires that standardized data be submitted on measures related to resource use, and other categories.
In order for CMS to meet the statutory timeline for standardized quality and resource measure reporting across PAC providers by 2017, they are on a fast tract and will be using the following criteria in selecting measures:
- Address a current area for improvement
- Consider measures in place in post-acute care quality reporting programs, and are:
- already endorsed and in place,
- finalized for use
- already previewed by the National Quality Forum(NQF), Measure Applications
- Partnership (MAP)
- Minimize burden
Following are the first four measures that have been selected and submitted to NQF, MAP:
- Functional status, cognitive function, and changes in function and cognitive function
- Percent of patients/residents with an admission and discharge functional assessment and a care plan that addresses function
- Skin integrity and changes in skin integrity
- Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened
- Incidence of major falls
- Percent of Residents Experiencing One or More Falls with Major Injury (NQF
- Measures to reflect all-condition risk-adjusted potentially preventable hospital readmission rates that are currently collected by each PAC provider
These four cross-cutting measures are going to be discussed and voted on TODAY, February 27th, from Noon to 2 pm ET on a meeting of the MAP Coordinating Committee that will be held via conference call. The call (and the information to be discussed on the call) is open to the public. See call information below.
Measure Applications Partnership,Coordinating Committee Conference Call
February 27, 2015 12:00 PM – 2:00 PM ET
- Public Participants: Dial (855) 499-0963; no conference ID required.
**Click here to access meeting materials
*Information above provided by NAHC.
The Medicare Payment Advisory (MedPAC) has recently been examining concerns related to hospitals’ increased use of “observation status” in response to Recovery Audit Contractors (RAC) reviews of appropriateness of use of short-term inpatient stays. MedPAC plans to develop new recommendations to ease tensions between hospitals and RACs relative to short-stay hospital admission policies. MedPAC is also looking at policies that would yield savings to offset the cost of the recommendations. One option is to include hospice in the post-acute hospital transfer policy. MedPAC estimates that hospitals currently have an 88 percent financial margin on patients that are discharged “early” to hospice. If a post-hospital transfer policy were to be applied to early discharges to hospice, MedPAC estimates that hospital financial margins on short-stay patients discharged to hospital would be about 31 percent. NAHC has expressed concerns regarding the inclusion of hospice in the post-acute hospital transfer policy and believe it could have a negative impact on hospice patients and the Medicare program.
NAHC is seeking input from its hospice member organizations on this issue. If you have comments about the potential impact that inclusion of hospice in Medicare’s post-acute transfer policy could have on hospices, their patients, or the Medicare program generally, please email to NAHC by COB March 3, 2015.
Click here for more information from NAHC, including contact information.
According to a new report from The Commonwealth Fund, increased insurance coverage under the Affordable Care Act is unlikely to overwhelm healthcare services despite earlier research indicating the contrary. The report found that outpatient and inpatient hospital visits will increase by about 2.5 and 3 percent nationwide and that prescription medication use and refills will rise 2.5 percent in nearly every state. Despite these increases, the healthcare system is “likely to be able to absorb these increases.” Additionally, widespread adoption of technological advances is likely to further blunt the impact of increased use of services.
Click here to see the report.
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Several states are now leaning toward or have outright abandoned all plans to allow expansion of their Medicaid programs. Most recently, Wyoming rejected plans to expand its Medicaid program via provisions offered under the Affordable Care Act. Representatives for Kansas have also told reporters that the state is not planning on scheduling hearings on three different bills allowing for Medicaid expansion. So far, 29 states have formally adopted Medicaid expansion, while the rest have either rejected adoption or are still considering it. Medicaid program enrollment has been growing exponentially under the new health law. The Obama administration announced that more than 10 million Americans have joined the Medicaid program since 2013.
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NAHC has added an ICD-10 Resource Page to its website to help home care and hospice agencies transition to the new coding system, and to provide up-to-date information on the ICD-10 update. NAHC and the home health and hospice vendor community have a shared goal in assuring that agencies are adequately preparing for the transition from ICD-9 to ICD-10 diagnosis coding. The page includes education and guidance materials along with tools to assist NAHC’s members in attaining that goal.
Click here to see it.