Attention Home Health Agencies: CMS Has Issued CR 9027

CMS has issued Change Request (CR) 9027 to notify providers of new edits in Original Medicare systems to ensure Low Utilization Payment Adjustment (LUPA) payments under the Home Health Prospective Payment System (HH PPS) are made appropriately. CR 9027 clarifies billing instructions for HH PPS claims. Please note, no new policy is created by CR 9027 – these new requirements improve the enforcement of existing Original Medicare payment policies. Make sure your billing staff is aware of these changes.

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NAHC Completes Its 2015 Legislative Blueprint

Every year, the policy staff at NAHC develops its Legislative Blueprint for the coming year. This year’s Legislative Blueprint has been completed. To help develop these blueprints, NAHC’s policy staff sought input from the organization’s Membership and affiliated organizations. As issues develop throughout the year, NAHC gathers additional ideas for these agendas from members, state association affiliates, advisory committees, and the NAHC Board of Directors. With big changes on the legislative and regulatory horizon this year for Capitol Hill, NAHC is planning ahead with strategies to protect the continued viability of home care and hospice.

Click here to view NAHC’s 2015 Legislative Blueprint for Action, as well as Blueprints from past years.

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CMS Develops Pilot Program To Better Estimate Home Health Agency Fraud

CMS is developing a pilot program to determine how many Medicare fraud cases are taking place in home health agencies. A contractor search is currently underway to help implement the new initiative. Many Medicare fraud experts are commending the endeavor, believing the move to be positive in an industry with long-standing allegations of fraud.

Between 2010 and 2014, there were nearly $1 billion in improper Medicare payments and fraud identified relating to the home health benefit, according to the OIG. Statistically valid estimates of the rate of fraud in Medicare does not currently exist for home health agencies. The new contractor will focus on developing a methodology to estimate the extent of probable fraud of home health agencies in the Medicare fee-for-service program. The initial pilot will focus on agencies in Florida, which accounted for $2.1 billion of total Medicare home health spending in 2013.

Contractors will begin by reviewing 130 home health claims in the Miami-Dade County area. As part of the review process, the contractor will interview beneficiaries and their medical providers and make unannounced visits to the offices of onsite home health agencies. Any formed methodology is expected to be replicated later for a larger, nationwide program. CMS hopes the new initiative will help it better allocate its resources.

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NAHC Opposes Proposed Home Health Copays & Inflation Update Cuts In 2016 Budget

NAHC released a press release today stating that it strongly opposes President Obama’s proposed home health copayments and payment cuts. NAHC believes that a deficit reduction should not come in the form of a sick tax on the country’s poorest, sickest and most vulnerable individuals. Previously enacted changes are expected to cut Medicare spending on home health services by more than $100 billion in ten years. These cuts will result in Medicare paying home health agencies less than their costs, leading to 56 percent of Medicare home health agencies being “under water” by 2017. NAHC says Congress should reject any additional cuts and any home health copays whether the reason is postponement or elimination of scheduled cuts in physician fees or deficit reduction.

President Obama’s budget estimates that a home health copay would reduce Medicare spending by $830 million through 2025. However, NAHC says a home health copay will do the opposite and take Medicare spending in the wrong direction by forcing patients out of high-quality, cost-effective care into much more costly settings. The budget also includes a reduction each year in the Market Basket Index (inflation) updates for all post-acute providers from 2016 to 2025, including a 1.1 percentage reduction for home health care. These cuts would reduce home health reimbursements by over $15 billion. If these cuts do take effect, payment reductions would be an addition to the rebasing on home health, home health productivity adjustments and sequestration that lower payment rates by over 14 percent starting in 2015. According to NAHC, these home health cuts will push thousands of providers to the point of bankruptcy and limit patients’ access to home care.

Click here to read the press release.

Federal Court Strikes Down New Overtime Rule

The U.S. District Court for the District of Columbia invalidated a proposed new U.S. Department of Labor (DOL) overtime rule slated to take effect on January 1, 2015. NAHC spokespeople have stated that this decision is a “huge victory for patients and their families who will be able to continue receiving home care services without interruption.” The decision is also a victory for caregivers “who will continue to be protected instead of being forced to work only part time” and agencies “that serve patients and employ caregivers.” As of yet, the DOL has not announced whether it will appeal this decision.

Click here to see our last post on the DOL rule.

Click here to read more from NAHC.

Clarification Of CMS’ Final Rule Language Addressing 30 Day Therapy Reassessment Change

CMS has clarified the final rule language that appeared in the Federal Register on November 6, 2014, entitled “Medicare and Medicaid Programs; CY 2015 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Survey and Enforcement Requirements for Home Health Agencies.” The 30 day reassessment applies to episodes that begin on or after January 1, 2015. There was an inconsistency error in the final rule where it stated “ending on..” in one place and “beginning on…” in another. CMS has clarified that it meant to state the therapy reassessment changes finalized in the regulations are effective for episodes beginning on or after January 1, 2015. Every 30 days, a qualified therapist must provide the needed therapy service and functional reassessment of the patient. If more than one discipline of therapy is provided, a qualified therapist from each of the disciplines must provide the needed therapy service and functionally reassess the patient at least every 30 days.

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U.S. District Court Issues Order Blocking A New DOL Rule

On December 31, 2014, the U.S. District Court for the District of Columbia issued a Temporary Restraining Order (TRO) preventing a U.S. Department of Labor (DOL) rule that defines the “companionship services” exemption from overtime compensation under the Fair Labor Standards Act from taking effect on January 1, 2015. The TRO follows an earlier ruling that restored the rights of homecare consumers to benefit from the “companionship services” and “live-in” exemptions regardless of whether the workers are employed by the person receiving the care or a homecare company. This new ruling is seen as a victory for homecare and hospice, giving our most vulnerable citizens a temporary reprieve from an increase in the cost of care.  While the TRO is in effect, homecare companies can continue to pay homecare aides and personal care attendants without added overtime compensation except where the state law requires it. The next hearing is set for January 9, 2015.

Click here to see our previous blog on the rule.

Click here to read more from NAHC.