Archive for the ‘Medicare’ Category

Save the Date for Fall 2013 District Meetings

October 4, 2013

HCAF will host our in-person Fall 2013 District Meetings next month, and home care professionals are encouraged to attend to learn about the PPS Final Rule, companionship exemption and connect with your local home care community. The dates and cities are confirmed and so are most of the locations. The remaining specific locations will be announced soon.  Check our calendar for the latest updates.

  • District I (Pensacola) – Nov 25, mid-day
  • District II (Tallahassee) – Nov 22, mid-day
  • District III (Ocala) – Nov 21, morning
  • District IV (Jacksonville) – Nov 12, afternoon
  • District V & VI (Tampa) – Nov 18, afternoon
  • District VII (Orlando) – Nov 20, morning
  • District VIII (Fort Myers) – Nov 19, morning
  • District IX (Stuart) – Nov 13, morning
  • District X (Fort Lauderdale) – Nov 14, morning
  • District XI (Miami) – Nov 15, morning



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Timing of Initial Surveys for Providers who Reject Assignment

October 4, 2013

The Centers for Medicare & Medicaid Services (CMS), Survey and Certification Group has issued a memo that reiterates its policy on the timing of initial surveys for providers/suppliers  who reject assignment when an acquisition of another provider/supplier organization occurs.

When an acquisition has occurred, CMS automatically assigns the existing Medicare provider agreement or supplier approval to the new owner. Automatic assignment means uninterrupted participation of the acquired provider or supplier in the Medicare program. There is also no required survey of the provider or supplier as a result of the acquisition.

However, new owners have the option to reject automatic assignment, resulting in termination of the prior Medicare agreement. Generally, rejecting assignment precludes the buyer from having successor liability for Medicare overpayments or underpayments. However, it also means that there has been a voluntary termination of the existing Medicare provider agreement. If the new owner rejects assignment, the provider/supplier must be treated as an initial applicant for participation in Medicare. Like all initial applicants the provider/supplier will experience a period with no Medicare payments.

Given the lead time normally required to schedule and prepare for a full survey, if an initial survey takes place shortly after the acquisition date, for  example 14 days after the effective date of the acquisition, it suggest that the survey may have been  unannounced. CMS   is requiring that when a State Survey Agency (SA) conducts an initial certification survey of an applicant that acquired a provider/supplier but rejected assignment, the Region Office must review the case carefully to determine whether the SA deviated from CMS workload priorities as well as the SA’s typical practice for initial applicants.

The memo also reiterates that the effective date for Medicare participation of the provider under its new owner is established in the same manner as for any initial applicant, that is, after a prospective provider/supplier demonstrates it meets all Federal requirements. The effective date is not the date of the acquisition of the provider or supplier. Rather, the effective date of the Medicare agreement is the date when the last applicable Federal requirement has been met.

To view the Survey and Certification Memo click here

Source: NAHC

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OIG Exclusions & Sanctions Listing Updated for August

August 9, 2013

HCAF has posted the latest exclusion and reinstatements that were released by CMS’ Office of the Investigator General (OIG) on August 8, 2013. The list includes physicians and other provider types in Florida.

Health care providers must be careful not to make payments to sanctioned entities or employ sanctioned individuals. No payment will be made by any federal health care program for any items or services furnished, ordered, or prescribed by an excluded individual or entity. Federal health care programs include Medicare, Medicaid, and all other plans and programs that provide health benefits funded directly or indirectly by the United States.

The basis for exclusion includes convictions for program-related fraud and patient abuse, licensing board actions and default on Health Education Assistance Loans.

Please compare your referring physicians, employees or vendors against the listing of excluded individuals.

Click here to access the updated OIG list.

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House Ways and Means Committee Releases Draft Legislation – Includes a 1.1 Percentage Point Cut in Inflation Updates

August 9, 2013

Late last week the House Ways and Means Committee released draft legislation that would significantly alter post-acute care under the Medicare program. Proposals included in the draft legislation range from creating post-acute care bundled payments to establishing a skilled nursing facility (SNF) readmissions program. Of greatest concern to NAHC and its members, however, is a proposal that would reduce market basket updates for all post acute care providers, including home health agencies. The market basket reductions included in the draft legislation were also included in the President’s FY14 budget. The proposal as it is currently written would impose a 1.1 percentage point market basket cut on home health agencies every year between 2014 and 2023.

HCAF & The National Association for Home Care & Hospice (NAHC) remain committed in its opposition to the home health community having to shoulder a disproportionate share of cuts to the Medicare program, and has already been burdened by $77 billion in cuts over ten years.

If more cuts are made to the Medicare home health program, then Medicare beneficiaries will likely seek care in much more costly care settings such as hospitals, nursing homes and emergency rooms.

In April, the Ways and Means Committee announced a series of hearings on reforms to the Medicare system based on recommendations from President Obama’s budget, as well as from the Simpson-Bowles and Domenici-Rivlin proposals. NAHC submitted testimony to several of these hearings outlining its strong opposition to additional cuts to home healthcare while emphasizing NAHC’s commitment to work with the Ways and Means Committee to find savings though thoughtful and targeted program reforms.

The public is invited to submit their comments to the Ways and Means Committee via email to: entitlementreform@mail.house.gov by August 30, 2013. NAHC encourages all of its members and their patients to write to the Ways and Means Committee reiterating their strong opposition to further cuts in home health payments and describing the dire consequences this would have on home health beneficiaries and their caregivers. Members may also wish to comment on the post acute care bundling proposal in the draft legislation. NAHC has taken the position that home health agencies should play the central role in managing any bundled post acute care payments.

For more information on the draft Medicare legislation, please click here.

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Rate Rebasing in the 2014 HHPPS Proposed Rule

August 9, 2013

The National Association for Home Care & Hospice (NAHC) recently published a white paper entitled, Rate Rebasing in Medicare Home Health Services: A Review of the 2014 HHPPS Proposed Rate Rule, which offers home health care providers an in-depth look at how CMS’ proposed rebasing rules will affect them. Below are some excerpts from the white paper:

Background

The Patient Protection and Affordable Care Act of 2010 (PPACA) requires that Medicare reset or rebase the home health services episode payment rate beginning
in 2014 and phased-in proportionately over a four (4) year period. The legislative mandate provides some direction to Medicare on the factors required to be considered in the calculation of the rebased payment rate.

MedPAC recommended that home health services payment rates be rebased because of significant changes in the nature of the services provided during the
 60 episode of care along with what it perceived to be “overpayments” for services evidenced by continuing double-digit Medicare margins in comparison to costs. The average episode of care in the base year used for rate setting involved 37 visits primarily made up of nursing and home health aide services while the current care utilization in an episode is less than 20 visits with few aide services and significantly more therapy visits. From 2001 through 2011, MedPAC’s calculation of margins shows freestanding HHAs with an average ranging from 16-18%

On June 27, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that sets out the proposed rates for home health services in 2014 along with the methodology used by CMS in calculating such.

While the proposed rule states that the impact on home health services spending would be a reduction of $290 million in
CY 2014, in actuality it is far greater as the proposal, if finalized, would trigger four consecutive years of 3.5% reductions in the primary payment rates, totaling a 14% reduction by 2017. That level of rate cuts is estimated to reduce Medicare home health spending by well in excess of $25 billion over the next ten years.

The proposed rule is open for the submission of written public comments through August 26, 2014. This White Paper offers a report on the makeup of the proposed rule, an impact analysis, and a critical review of its shortcomings.

The Proposed Rule

General

The CMS proposed rule combines a rebasing of the base-level rates for normal episodes, per visit payments for Low Utilization Payment Adjustment (LUPA) episodes, and the add-on payments for Non- Routine Supplies (NRS) along with a recalibration of the case-mix weights assigned to each of the categories within the case-mix adjuster.

This presents a complication in an initial review as it makes the 2014 proposed rates seem much greater than the 2013 rates. However, the recalibration is proposed in a budget neutral manner by reducing each of the case-mix categories by 26.02%. (Alternatively, by dividing the case mix weights by 1.3517 which CMS states is the average weight in early 2012).

The Proposed Rates

The proposed rated for 2014 reflect a 2.4 Market Basket Index adjustment to reflect estimate costs increases in 2014. In addition, these rates reflect a rebasing adjustment of -3.5% for episodes, +3.5% for per visit LUPA rates, and -2.58% for Non-Routine Supplies.

Impact of Proposed 2014 HHPPS Rates

CMS estimates that the overall impact of the proposed rate rebasing and other rate changes is a reduction in Medicare spending of $290 million in 2014. That represents a decrease of approximately 1.5% in comparison to estimated 2013 payments.

The impact analysis performed by NAHC demonstrates that the continued delivery of home health services throughout the country is at high risk if the proposed rule is finalized. NAHC estimates that by 2017, 72.29% of all HHAs will be paid less than the cost of care and that the average Medicare margin will be -9.77%.

This estimate come by way of reviewing over 8,200 FYE 2011 cost reports from all types of HHAs from all over the country. In Alaska (91.7%), Hawaii (100%), New York (89.9%) and Oregon (87.2%) in can be expected that the entire home health infrastructure is at risk of crumbling to nothing. That is certain to lead to an access to care crisis and increased Medicare spending as patients seek care in the only viable option remaining: high cost care settings.

Conclusion

Rate rebasing is not a simple task for CMS. It has serious consequences to Medicare, providers of care and the patients served. As such, it must be performed carefully and correctly.

The CMS proposal fails on numerous counts, but most notably in the absence of any consideration as to its impact on access to care. The proposal should be abandoned and replaced with one that puts care access first, considers all methods of calculating rates, recognizes all of the current costs of care, and includes an appropriate margin to secure operating capital and a fair return on investment to allow for continued modernization of home health care for today’s health care delivery innovations.

The full text of the white paper is available here.

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Fazzi Associates: New National Average Case Mix Weight

August 1, 2013

Question: We saw the Minute in the Morning email with a preliminary case mix weight of 1.3517, up from 1.27.  Can you tell me more about it and what that means for my agency? (more…)

HCAF Statement on CMS Announcement of Temporary and Targeted Moratorium on the Approval of New Home Health Agencies

July 30, 2013

BLThe Centers for Medicare and Medicaid Services (CMS) recently announced a temporary and targeted moratorium on the approval of new home health agencies in Miami-Dade and Monroe counties. The moratorium takes effect on July 30, 2013.

According to CMS, the goal of the temporary moratoria is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care.  Authority to impose such moratoria was included in the Affordable Care Act, and CMS is exercising this authority for the first time. (more…)

AHCA: CMS Announces Temporary Provider Enrollment Moratorium

July 30, 2013

The Centers for Medicare & Medicaid Services have announced a temporary moratorium on the enrollment of new home health provider enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in fraud “hot spot” areas of the country. The goal of the temporary moratorium is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose such moratoria was included in the Affordable Care Act, and CMS is exercising this authority for the first time. (more…)

CMS Imposes First Affordable Care Act Enrollment Moratoria to Combat Fraud

July 26, 2013

Building on strong anti-fraud efforts already underway, Centers for Medicare & Medicaid Services’ Administrator Marilyn Tavenner today announced temporary moratoria on the enrollment of new home health provider and ambulance supplier enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three fraud “hot spot” areas of the country, including two Florida counties. The goal of the temporary moratoria is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose such moratoria was included in the Affordable Care Act, and CMS is exercising this authority for the first time.

Under the moratoria, existing providers and suppliers can continue to deliver and bill for services, but no new provider and supplier applications will be approved in these areas for all three programs. The temporary enrollment moratoria apply to newly-enrolling home health agencies in the Miami and Chicago metropolitan areas; and newly-enrolling ground ambulance suppliers in the Houston metropolitan area (see list of affected counties below). CMS announced the temporary, six-month moratoria in a notice issued today in the Federal Register. (more…)

U.S. Intervenes in False Claims Act Lawsuit Against Fla. Home Health Care Company and Its Owner

July 22, 2013

The government has intervened in a whistleblower lawsuit against A Plus Home Health Care, Inc., a home health care company in Fort Lauderdale, Fla., and its owner, Tracy Nemerofsky, the Justice Department announced today. The government alleges that A Plus offered referring physicians’ spouses sham marketing positions with the company to induce the physicians to refer Medicare patients for home health care services. (more…)