Posts Tagged ‘National Association for Home Care & Hospice’

Judge Allows Face-to-Face Lawsuit to Move Forward

January 7, 2015

Another huge win for home care! This particular ruling could have major implications…..

  • CMS approaching our industry with a settlement offer on the thousands of denied claims that are being held in limbo at the ALJ level because of the F2F narrative, so start considering what you might accept on your denied claims.
  • It could help slow down or lessen the intensity of the next round of F2F audits from RACs and MACs. They are gearing up and this may take a little wind out of their sails.
  • It strengthens our industry and gains us respect and leverage on a host of other critical issues. This will help us!

We are very grateful to all home care providers who choose every year to support associations like NAHC and HCAF. It is your dues dollars that made this happen. Thank you.  

January 5, 2015

Federal Court Rules in Favor of Homecare

Clears the Way for NAHC’s Face-to-Face Lawsuit to Go Forward

Today, a federal district court issued a resounding victory for the National Association for Home Care & Hospice (NAHC) and the home health agencies, Medicare participating physicians, caregivers, and beneficiaries it represents. The U.S. District Court for the District of Columbia held that it has the power to hear a challenge to the validity of a Medicare rule that requires physicians to provide a “narrative” explaining why the patient meets Medicare coverage standards for home health services. The court issued an order denying Medicare’s effort to have the lawsuit dismissed by the court.

The Centers for Medicare and Medicaid Services (CMS) issued a face-to-face rule that physicians had to lay eyes on patients and certify under penalty of law that that they were eligible to participate in Medicare and, more specifically, were “homebound” and needed “skilled care.” In addition, the rule required physicians to write a detailed narrative explaining the reasons why they thought this was true. This new requirement caused widespread chaos, spurred a physician rebellion, and in the end deprived many seniors from receiving the care to which they were entitled under the Medicare home health benefit.

NAHC convinced groups representing seniors and the disability community to join together with physician organizations and thereby succeeded in convincing a majority of the Senate to send a letter intervening on NAHC’s side in this matter. NAHC also filed suit in federal district court to overturn the onerous rule. The result was that CMS withdrew the physician narrative requirement which would have been effective January 1, 2015.

NAHC asked CMS to give the decision retroactive effect and pay claims that were denied between 2011 and 2014, but CMS denied to do so. NAHC made other appeals to CMS to settle the suit which it could have done by paying some $250 million owed to home health agencies for care they gave to Medicare patients between 2011-2014. This gave NAHC no choice but to proceed with the litigation.

In today’s action, the court ruled against the government on its motion to dismiss this case. The government attorneys had interposed numerous reasons, both substantive and procedural, as to why the case should not go forward, all of which were turned aside.

The court held that it would be futile for home health agencies to pursue endless administrative appeals challenging the requirement as Medicare had made it clear that it would reject all such appeals. By denying Medicare’s Motion to Dismiss, the legal validity of the narrative requirement will be fully reviewed by the federal court.

Medicare had filed a Motion to Dismiss the lawsuit arguing that administrative appeals had to be fully completed before a court had the power to hear a Medicare dispute. Medicare also argued that the case should be dismissed because the narrative requirement, on its face, was a valid interpretation of the authorizing law in the Affordable Care Act. Federal District Judge Christopher R. Cooper rejected both of these defenses.

Judge Cooper found that it would be futile for home health agencies to pursue administrative appeals because Medicare had definitively stated that it considered the requirement to be valid. NAHC had argued that Medicare had issued a final decision on the validity of the rule numerous times including when Medicare officials met with NAHC as well as in its issuance of the recent rule change that eliminated the narrative requirement. Judge Cooper agreed. He described the challenged policy as “embedded” and that “nothing indicates that administrative appeals might result in the agency overturning its regulation.”

While rejecting Medicare’s attempt to escape judicial review of the face-to-face narrative requirement, the court did grant dismissal of two additional claims in the lawsuit. NAHC also challenged the ambiguity of the interpretive guidance issued by the Centers for Medicare and Medicaid Services along with its failure to waive the recoupment of alleged overpayments under the Medicare “without fault” provision. On those matters, the court found that the factual complexities warranted a review of individual claim determinations at the administrative levels prior to any judicial intervention.

NAHC and Medicare will now move forward with the lawsuit. The next steps would include the filing of cross-motions for Summary Judgment. Summary Judgment is the equivalent of a trial on the merits of the claims where there are no material issues of facts in dispute. Here, NAHC argues that the plain language of the law prohibits Medicare from adding the burdensome narrative as a documentation requirement. The law itself only permits Medicare to require that a physician document that a face-to-face encounter occurred and when. As such, it is claim based on the language of the law itself and does not involve any facts other than that Medicare requires more documentation.

NAHC continues to litigate the dispute in spite of Medicare’s rescission of the narrative requirement to address the past claim denials and those denials that may still come involving home health services provided prior to January 1, 2015. If the lawsuit is successful, Medicare would be required to reopen and pay any claim previously denied for an insufficient narrative and stop any further claim reviews related to the narrative requirement.

NAHC continues to advise home health agencies to consider appealing any narrative-related claim denials while the lawsuit is progressing. Such action will preserve the opportunity to have the claims reviewed by Administrative Law Judges and also allow for easy identification of claims that may be subject to reopening if the lawsuit is successful.

“This great victory in federal court means that Medicare patients, physicians, and the home health community will have their day in court,” said NAHC President Val J. Halamandaris. “It is a clear signal that a federal judge also does not see why a rule which CMS had invalidated effective January 2015 should be honored for the years 2011, 2012, 2013, and 2014. There is no reason why the home care community should not be paid for the services it rendered in good faith to Medicare home health beneficiaries.”

Bill Dombi, NAHC’s Vice President for Law, appealed to CMS to save Medicare the cost of the trial. “We urged them to do the right thing. The right thing is to pay these claims. NAHC intends to pursue this litigation until CMS agrees to do so.”

Congressional Letter Opposing Face-to-Face Documentation Requirements Sent to CMS’ Administrator

September 27, 2013

Last week, a bipartisan group of 75 Members of Congress sent a letter to Marilyn Tavenner, the Administrator for the Center for Medicare and Medicaid Services (CMS), on the overly complicated and burdensome face-to-face (F2F) physician encounter documentation requirements promulgated by CMS.  The letter asserts that these documentation requirements go well beyond what the Affordable Care Act (ACA) required.

The letter was circulated by Representatives Tom Reed (R-NY), Paul Tonko (D-NY), Chris Smith (R-NJ), and Robert Andrews (D-NJ), and was sent to every congressional office asking for additional Member support.

New York and New Jersey NAHC members initiated the sign on letter and NAHC members and advocates were integral in the effort to get the 75 lawmakers to add their name to the letter.

HCAF worked diligently to get Congressmen from Florida to add their names to the letter. We are very thankful to Rep. Kathy Castor (D-FL 14) and Rep. Alcee Hastings (D-FL 20) for including their names on the letter.

The final 75 lawmakers who signed the letter are Democrats and Republicans from every region of the country representing rural, urban and suburban populations. In the letter, the lawmakers express their primary concerns with the F2F encounter requirement:

”[U]nder the Affordable Care Act (ACA), Congress included a provision aimed at increasing collaboration between home health agencies and physicians. This provision, implemented by the Centers for Medicare and Medicaid Services (CMS), is known as the Face-to-Face (F2F) Encounter Requirement. While we support the need for direct encounters between patients and physicians to occur, the current regulations contain complicated, confusing, and overlapping documentation requirements that exceed the intent of the law passed by Congress. These requirements have imposed a significant burden on home health providers and physicians in our districts.

As implemented by CMS, physicians are now required to document, sign and date an additional form with a narrative of the patient’s condition in order to justify home care services. Home health agencies must obtain this signed form prior to billing for Medicare home health services… Prior to billing for Medicare home health services, home health agencies already must obtain a signed and dated form from the physician which outlines the full plan of care…We have heard from home health agencies that believe as a consequence, these new forms are counterproductive to the underlying F2F intent.”

HCAF and NAHC will be working with the sponsors of the letter on follow-up with CMS.  Please continue to send Mary Carr ( your examples of F2F claims denials that you do not believe were justified, as well as physician complaints about the F2F documentation requirements, to aid in our advocacy with CMS.

To read the full article that was sent to Ms. Tavenner, as well as to see the final list of signees, please click here.

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House Energy and Commerce Subcommittee on Health Holds Hearing on Medicare Benefit Redesign

June 28, 2013

The House Energy and Commerce Subcommittee on Health recently held a hearing that looked at ways to redesign the Medicare benefit. The hearing’s witnesses were: Katherine Baicker, Ph.D.Professor, Health Economics, Department of Health Policy and Management, Harvard School of Public Health; Thomas P. Miller, J.D., Resident Fellow, American Enterprise Institute, and; Patricia Neuman, ScD., M.S., Senior Vice President, Henry J. Kaiser Family Foundation.

The National Association of Home Care & Hospice submitted testimony for the hearing, emphasizing the organization’s commitment to preserving the Medicare benefit without placing more financial responsibility on the backs of the program’s beneficiaries – particularly through the misguided idea to reintroduce the Medicare home health copayment. (more…)

Home Care Workers Still Waiting For Labor Protections After Promise From Obama

June 26, 2013

By Dave Jamieson, The Huffington Post

WASHINGTON – In December of 2011, President Barack Obama stood at the White House alongside a group of home care workers and announced that his administration would extend minimum wage and overtime protections to them after decades of exclusion. The White House still has a video on its YouTube channel explaining the significance of the regulatory change, entitled “A Promise Kept.”

But in reality, the president hasn’t yet delivered on that promise. A year and a half after the fanfare, home care workers who tend to the elderly and disabled in their homes are still not covered under the Fair Labor Standards Act, the Depression-era statute that serves as a bedrock of U.S. labor law. The president’s proposal remains under review at the White House, where industry players have lobbied to have it softened, if not scrapped. (more…)

Update on HIPPS Codes on MA Plan Claims

June 24, 2013

In a conference call with CMS officials earlier this week, the National Association for Home Care & Hospcie learned that although the Medicare Advantage plans have been instructed to include a HIPPS codes on claims effective July 1, 2013, the edits for this requirement will not be turned on until sometime in September. CMS will get back to NAHC with a firm date as to when exactly. At least for the short term there will be no payment consequence for MA plans that do not submit a HIPPS code for home health services, and therefore home health claims should not be held up either.

CMS expects the HIPPS code to be entered on claims the same as with Fee for Service Medicare. We do urge the providers and their vendors to begin the necessary changes to their software systems to be ready for when the firm compliance date is announced. We also urge you to contact your health plans to determine what specifically they are, or are not, requiring related to including the HIPPS code on claims.

We are seeking feedback on whether agencies and vendors can alter their systems in time for September.

Home Health Line: Florida Association Seeks Congressional Relief From MA Pain

June 24, 2013

By Burt Schorr, Home Health Line

The visit authorization delays and denials home health agencies long have experienced in serving Medicare Advantage (MA) enrollees show no signs of going away. But a new letter from the Home Care Association of Florida (HCAF) to a key senator aims to provide relief for the ever-worsening situation.

Home health executives are finding themselves forced to invest more and more hours in getting the information and authorizations plans require. Indeed, plans’ coverage reductions and delayed authorizations effectively have restricted beneficiary access to quality home care, the HCAF noted in its recent letter to Sen. Bill Nelson, D-Fla., chairman of the Senate Aging Committee. (more…)

CMS is Requiring HIPPS Codes on Medicare Advantage Claims

June 19, 2013

Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage claims. The Centers for Medicare & Medicaid Services has instructed MA organizations to reject any home health claim that does not include a HIPPS code. According to a CMS communication with the health plans, CMS is requiring the HIPPS codes on home health claims in order to accurately price home health encounters. (more…)

AARP Encourages its Members to Speak Out Against Medicare Home Health Copays

June 11, 2013

The AARP recently encouraged its members to “speak up now about the future of Medicare” by writing their elected officials in opposition to the reintroduction of copayments for home health care to Medicare, as well as other initiatives that the 37 million-member strong organization sees as harmful to the future of Medicare.

“”It’s important for NAHC members to remember that even though we face many challenges, we are not in this fight alone,” said NAHC President Val J. Halamandaris. “The AARP is also encouraging their members to take action to preserve Medicare and oppose the reintroduction of home health copays.” (more…)

NAHC Working to Resolve Issues with Outlier Payments

May 15, 2013

The National Association for Home Care and Hospice made its first report to the Centers for Medicare & Medicaid Services (CMS) of errors in home health outlier calculations early in 2010. CMS acknowledged and began investigation of the problem, which was related to the newly imposed outlier cap calculation. CMS’ attempts to fix the problem in October 2011, and January, May and July 2012 were unsuccessful.

As a result, many home agencies did not receive full outlier payments for the years 2010, 2011 and 2012, with underpayments ranging from tens of thousands of dollars by small agencies to millions by large agencies. In its efforts to seek a solution to this problem, NAHC wrote to the CMS Acting Administrator on June 21 – and again after the failure of the July fix – requesting her assistance in an immediate resolution. In response, the Acting Administrator directed CMS staff to resolve the problem as quickly as possible and agencies across the country finally began to receive the money owed them beginning in August. (more…)

Senior Groups Send Letter Opposing President’s Home Health Copay Proposal

May 14, 2013

In response to the President’s proposed FY 2014 budget, the Leadership Council of Aging Organizations recently sent a letter to the President and Congressional leadership that included strong opposition to the President’s proposal to impose a home health copayment.

The LCAO is a 68-member coalition of national organizations, including the National Association for Home Care & Hospice that is concerned with the wellbeing of America’s older populations and is committed to representing their interests in the policy-making arena. The President’ proposed budget submitted to Congress included a provision that would impose a $100 copay on home health episodes not preceded by a hospital or nursing home stay, beginning in 2017 for new Medicare beneficiaries. (more…)