CMS Issues Change To Hospice Medicare Summary Notice

The Centers for Medicare & Medicaid Services (CMS) has issued a new Change Request (#7675) relative to the Hospice Medicare Summary Notice designed to correct problems related to reporting of visits and charges.  To view the change request, click here.

Click here to access MLN Matters for more information on the Revisions to the Hospice Medicare Summary Notice.  Contact HMS consultants with any questions or concerns you may have with regard to this change.

House Endorses Bill To Repeal CLASS Program

The House Ways and Means Committee last week endorsed legislation to repeal the Community Living Assistance Services and Supports (CLASS) program.

The repeal bill, the “Fiscal Responsibility and Retirement Security Act” (H.R. 1173), was supported by a united Republican caucus and one Democrat. This follows a vote by the Energy and Commerce Committee in November to support legislation to repeal the CLASS program. The legislation will now move to the House floor where it’s likely to pass, though its fate is uncertain in the Senate.  President Obama has also threatened a veto.  Advocates of the program are opposing the repeal, citing the need for an alternative in place so the needs of seniors and the disabled are not ignored.

The CLASS program was included in the Patient Protection and Affordable Care Act (PPACA) passed by Congress two years ago. It was designed to be a voluntary long term care insurance program for working Americans. Employees who become disabled after paying into the CLASS program for at least five years would quality for a daily cash benefit depending on their inability to perform activities of daily living.

Stay tuned to HMS for more information as details continue to unfold.

Final Rule May Be Near

Federal officials could release a final rule in the coming days implementing key provisions of the 2010 federal healthcare overall on Medicaid and insurance exchange eligibility.

Regulations implementing provisions of the Patient Protection and Affordable Care Act (PPACA), expected to expand Medicaid access by 16 million people and to determine eligibility for state exchanges that will insure another 16 million people, were submitted for approval late last week from the Office of Management and Budget (OMB). Approval by OMB is usually the final step before rules are publicly released.

Click here to read more.

Administration Argues Health Law Can Survive

HMS Healthcare Management SolutionsLast week, the Obama administration told the Supreme Court nearly all of President Barack Obama’s healthcare overhaul can survive if the court declares unconstitutional the law’s centerpiece provision requiring health coverage.

Administration attorneys argued in a written brief that all but two provisions can be separated from the requirement that Americans buy health insurance or pay a penalty by 2014, the law’s cornerstone known as the individual mandate.  Officials argue 26 states and the independent business group challenging the law have failed to show that Congress would have wanted the entire law to fall in the event the individual mandate was struck down.

Click here for more.

Aetna Launches Home Care Model

Hartford health insurer Aetna is launching a new national program in Connecticut and New Jersey that will incentivize doctors who more actively coordinate and manage their patients’ care across the health care system.  Primary care providers who participate in Aetna’s networks and are recognized as a patient-centered medical home practice will receive a quarterly payment for each commercial Aetna member in their care.

The patient-centered medical home is a model of care that requires doctors to improve access to care, increase preventive care services and employ care coordinators.  It is considered a key aspect of health care reform centered on the idea of using primary care physicians as central figures in coordinating patient care among specialists, hospitals and other health care providers.

Contact HMS today for further guidance on this and other healthcare issues.

HMS Participates On Home Care Panel Discussion

On Friday, January 27, HMS Healthcare Management Solutions Director of Home Care & Hospice Services Kim Skehan participated in a panel discussion The Direct Care Workforce: Meeting The Demand & Responding To The Needs of Connecticut Residents at the Legislative Office Building in Hartford. The discussion aimed to address Connecticut’s dramatically changing demographics, rapidly aging population and the state’s ongoing commitment to provide community-based services.

Skehan, who is also the facilitator of the Home Health Services Legislative Work Group, spoke about the confusion within the industry and the general public about the roles of caregivers in the community and the services they provide.

“People need to know they have choice,” said Skehan.  Skehan said offering clarity on those roles empowers people to make the right decision for themselves and their loved ones, but also stressed the importance of a sufficient and well-trained workforce. It’s estimated Connecticut will need 9,000 new direct care workers over the next five years.

Dawn Lambert, Project Director for the Money Follows The Person Program (MFP) at the Department of Social Services (DSS) said Connecticut is looking at state statutes to identify those acts not in line with state values.

“We want to give people more choice, more control” said Lambert.  “When we empower them, we reduce their dependency on government.”

Lambert said Connecticut’s rebalancing goals are currently at risk.  MFP is intended to rebalance the long-term care system so individuals have the maximum independence and freedom of choice regarding where they live and receive services.  The ultimate goal is to provide workforce initiatives to support consumer choice and quality while creating a channel for direct care workers.

“Quality choices are so important,” said Skehan. “There are challenges ahead, but working together, we can identify opportunities for change and develop a sufficient, well-trained workforce.”

The discussion lasted for approximately 90 minutes and was followed by a brief Q&A. Home Care: It’s Complicated, a press conference hosted by the Home Health Legislative Work Group (HHLWG) and Representatives Michelle Cook and Betsy Ritter immediately followed the event.  Click here for a recap.

In addition to Skehan and Lambert, other panelists included Julie Gelgauda, Director of Care Management for the Agency on Aging of South Central Connecticut; Deb Migneault, Community Liaison of the Connecticut Commission on Aging; Gail Coppage, State Director of Workforce Development for Connecticut State Colleges; Sherry Ostrout, Director of Government Initiatives for Connecticut Community Care; Alice Pritchard, Executive Director for the Connecticut’s Women’s Educational & Legal Fund and Susan Raimondo, Senior Director of Advocacy & Programs and the National MS Society.  Executive Director of the Connecticut Commission on Aging, Judy Evans Starr offered opening remarks and served as discussion intermediary.

For all the latest news and trends in healthcare, stay tuned to the HMS blog.

Home Care Press Conference Marks Senator Prague’s Return

On Friday, January 27, HMS attended a press conference Home Care: It’s Complicated held at the Legislative Office Building in Hartford.  The conference, hosted by Representative Betsy Ritter (D-Waterford/Montville) , Representative Michelle Cook (D-Torrington) and the Home Health Legislative Workgroup (HHLWG) focused on the importance of making informed decisions when selecting home care services.  HMS Healthcare Management Solutions Director of Home & Hospice Care, Kim Skehan, has served on the HHLWG since its inception in January, 2010.

The press conference served as an opportunity to outline home health care service delivery options for residents under state-funded programs. As Connecticut continues to implement its “right-sizing” plan for health services, providing information to allow consumers to make informed choices is of critical importance.

According to a recent poll, 89% of Connecticut residents desire to age at home, receiving services in the community beyond the walls of institutionalized care.  Currently, only half of those residents receiving Medicaid-funded long-term care live at home or in community settings.  But for those consumers who chose to stay at home, there is often uncertainty and confusion surrounding the selection of home care services.  Until now.

Caring For Yourself Or A Loved One: What Consumers Should Consider When Hiring A Personal Caregiver, unveiled at today’s press conference, provides a way for consumers to evaluate qualifications, credentials and options when selecting a home health or hospice caregiver.  The educational brochure offers guidance on the types of services available, the duties of those workers as well as training competency requirements and frequency of supervision.

Representative Cook referenced the tool as a way for consumers to find the information they need to make informed decisions. Cook recounted her own struggles finding appropriate services for her mother-in-law who recently fell ill.  Even with her connections at agencies across the state, navigating through the process proved confusing.

“We need to make this an easier process for consumers to manipulate,” said Cook.

Senator Edith Prague (D-Columbia), who made her return after suffering a stroke, talked about her first hand experience with the health care system and spoke about the need for easier access to home health care.

“People want to be at home in familiar surroundings and in charge of the care they receive,” said Prague.  “I’m living proof that home care works.”

HMS Healthcare Management Solutions Director of Home & Hospice Care, Kim Skehan, talked about the importance of explaining the differences between the different caregivers and the services they provide.

“There is confusion on behalf of the public and providers over the level of services in the community,” said Skehan.  “Clarifying the roles helps people make the choice that’s right for them.”

To view Caring For Yourself Or A Loved One: What Consumers Should Consider When Hiring A Personal Caregiver, click here.