Archive for the ‘Member Services & Publications’ Category

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:


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


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.


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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FCN Employer Survey

August 7, 2013

The Florida Center for Nursing (FCN) is presently conducting their Nurse Employer Survey, which measures demand for nurses in long-term care, home health, hospitals, public health departments, and hospices in the state of Florida. As of today, they only have a response rate of 8% for home health. They will be sending out another survey on August 21 to those who have not yet responded. Please ensure home care is well represented in these statistics that are used to help employers and other stakeholders make informed decisions and plan for the future. If you have not received the survey, please contact Michelle Yore at the FCN ( The FCN appreciates your participation!

2013 HCAF Annual Salary & Benefits Survey

Speaking of surveys, have you completed your 2013 HCAF Salary & Benefits Survey yet? The questionnaire was just distributed last week.  It’s FREE to participate, the report is FREE to participants ($250 savings) and the deadline is August 31. The more data we collect, the stronger the survey becomes. This survey is an extremely valuable tool and can help benchmark your agency against your closest competitors. No other survey focuses on the home care market wages and benefits for Florida like this one.  Please participate today.

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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…)

Affinity Program Spotlight: Building Home Health Referrals Using Patient Satisfaction

July 8, 2013

sale2HCAF’s Affinity Programs help our members save money and support HCAF, too! Deyta is an approved HHCAHPS vendor that also provides business development solutions. Click here to learn more about this partnership and start saving today! Visit Deyta at this year’s Annual Conference & Trade Show at Booth #51.

The days of passively expecting a reliable flow of new patients from referring physicians and discharge planners is long over. Home health agencies need to proactively incorporate quantified results that promote their unique position in the care continuum. Successful agency leaders align their agency to continuously deliver care that will be perceived in a positive manner by patients, driving word of mouth recommendations. Increasing both the quantity and quality of patient referrals using high patient satisfaction scores is an effective strategy for growth. Using the results from the Home Health CAHPS® survey, particularly the overall recommendation measure, will identify opportunities for care improvement helping agency leaders focus resources more effectively. (more…)

Summer Sale on the 2013 Private Duty Benchmarking Study

July 8, 2013

The summer temperature may be rising, but the price on the 2013 Benchmarking Study is at a season low!

We are so excited about the impact that the 2013 Private Duty Benchmarking Study is having on the home care industry that we wanted to offer a special summer promotion to your members so everyone can experience the impact the study will have on your home care business. Order your copy at the lowest price of the season of $229 – that’s a savings of $70 (23%), compared to the original price of $299. And, when you purchase your study today you will receive our “Taking Action” 4-part webinar series with Home Care Pulse founder/CEO Aaron Marcum for free….a $299 value! In this 4-part series, Aaron walks through some of the key findings of this year’s study and how to apply the information to your home care business.

Click here to order your copy today! (more…)

Deyta Invigorates Partnership with HCAF to Expand Member Benefits

June 21, 2013

Deyta’s expanded solutions address critical challenges today’s home care leaders face with having quick access to critical performance indicators to drive smarter decision making.

Deyta, LLC has renewed its partnership with the Home Care Association of Florida, expanding member benefits beyond a quality improvement focus to address a broader scope of business optimization tools that are critical to helping today’s home care agencies thrive. The Home Care Association of Florida now endorses Deyta’s new ActionBoard System as a solution that members can leverage to improve operational efficiency, strengthen financial performance, ensure compliance and gain a competitive advantage in their market.

“Deyta has been a leading provider of HHCAHPS to Florida home health agencies,” said Bobby Lolley, Executive Director of the Home Care Association of Florida. “We are excited to bring their new ActionBoard System to our members to help them leverage innovative technology solutions to keep up with today’s reimbursement cuts and increased compliance protocols.” (more…)

Available Now: HCAF’s Summer Edition of The Florida Home Care Connection

June 20, 2013

Summer-2013-Florida-Home-Care-ConnectionThe Summer 2013 issue of The Florida Home Care Connection, HCAF’s official magazine, is now available online! This issue focuses on renewing yourself for the new age of home care, and features articles from leading industry professionals.

Check out what’s inside: (more…)

Elizabeth Hogue on HIPAA Allowing Disclosure of Information When Risk of Danger is Present (Part 6)

June 19, 2013

On January 15, 2013, the Office of Civil Rights, the enforcer of HIPAA, published a letter that clarifies that providers may disclose information when there is a risk of danger. Specifically, providers may disclose necessary information about patients to law enforcement, family members of patients, or other persons when providers believe that patients present serious danger to themselves or to other people.

The letter goes on to say that: (more…)

2013 Member Directory Digital Edition Now Available!

June 19, 2013

FLHR0013_CoverMockupRevisedHCAF’s digital edition of the 2013 Home Care Agency Directory & Referral Guide is now available on the HCAF website, and is in the process of being shipped to every hospital discharge planner in Florida!

In addition, HCAF members can look out for their very own copy of the member directory in the mail, too. Here is what you’ll find inside the 2013 edition: (more…)

Test Your Aides on Heart Failure With June’s In-Home Aides: Partners in Quality Care

June 13, 2013

As a benefit of membership, HCAF provides agencies with In-Home Aides: Partners in Quality Care, a monthly publication that addresses relevant topics for home health aides. Topics addressed in In-Home Aides: Partners in Quality Care have included quality, aging, safety, teamwork, falls prevention and more.

The June 2013 edition addresses heart failure, about which aides will learn: (more…)