CMMI’s Proposed TEAM Model Offers Another Risk-Based Opportunity For Home Health Providers

Home Health Care News By Andrew Donlan
 
Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives. 
 
The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge. 
 
CMS said that the model would build on the already existing Bundled Payments for Care Improvement Advanced (BPCI-A) and Comprehensive Care for Joint Replacement models. The proposed model would launch on Jan. 1, 2026, and run for five years, ending at the end of 2030. 
 
“TEAM would be a mandatory episode-based alternative payment model in which selected acute care hospitals would coordinate care for people with Traditional Medicare who undergo one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital,” CMS wrote. “As part of taking responsibility for cost and quality during the episode, hospitals would connect patients to primary care services to help establish accountable care relationships and support optimal, long-term health outcomes.”
 
Given those all-important 30 days post discharge involved in the TEAM model, home health providers will naturally play a role in helping hospitals achieve high-quality outcomes. 

The National Association for Home Care & Hospice (NAHC) is still awaiting further details, but sees home health agencies as squarely involved in the Innovation Center’s proposal. 

“Much of the specifics are still to be decided,” NAHC President William A. Dombi told Home Health Care News. “Home health agencies can be expected to be significantly involved with the participating hospitals given the nature of the surgical patients that will be targeted, such as hip fractures and joint replacement patients.”…

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Stateline Operations Manual (SOM) Appendix B

NAHC

CMS has issued the online (final) version of the State Operations Manual (SOM) Appendix B – Home Health Agencies (Interpretive Guidelines). A few revisions had been made from the Advanced copy of the Appendix B that was issued on March 15, 2024.  

• Revised criteria for citations related to the Error Summary Report for late OASIS submissions.

• If an HHA shows a pattern of multiple assessments with error -3330 on this report, surveyors should investigate compliance with G372, Encoding and transmitting OASIS data (§484.45(a)).

• Corrected the statement in §484.45(a) to read: The OASIS reporting regulations are not applicable to patients receiving personal care only services, regardless of payor source.
• Removed reference to the OASIS guidance for §484.55(a)(1) and (d)(3)

NAHC will continue to review the revised Appendix B for any other changes and will update the NAHC 2024 Revised IG Chart.

Home Healthcare for Elderly Sees Largest Price Increase Ever

The Hill - Changing America / By Alejandra O’Connell-Domenech

Costs for home healthcare for the elderly and bed-ridden have gone up by 14.2 percent over the past year, according to new Consumer Price Index data released Wednesday.  
 
That represents the largest percent increase in home healthcare costs during a 12-month period since the Bureau of Labor Statistics began collecting data on such costs in 2005.  

The United States has an aging population, and the need for care among the nation’s roughly 73 million Baby Boomers is driving up the cost of nursing homes, assisted living facilities and home healthcare.  
 
About 70 percent of American adults aged 65 and older will need some form of long-term care in the future, according to the Administration for Community Living.
 
There are two main types of in-home care providers for the elderly or bed-bound: home health aides who help with personal care and homemaker aides who assist with household chores.  
 
The prices for these aides’ services vary by need and location, but in 2023 the median cost for a home health aide was $33 an hour and that for a homemaker aide was $30 an hour, according to insurance company Genworth.  
 
The reason behind the striking increase in in-home care costs stems from shortages in the country’s home health workforce coupled with rising wages for these workers, according to Marc Cohen, co-director for the Leading Age Long Term Services and Supports Center at the University of Massachusetts-Boston.  
 
In 2022, there were about 4.8 million direct care workers, a category that include home health aides, according to an analysis from KFF. These workers helped 9.8 million people at home, 1.2 million in residential care facilities and 1.2 million in nursing homes.
 
The direct care sector is expected to add over 1 million new jobs by 2031, according to that same analysis. But those additional jobs will not be enough to meet the country’s rising eldercare needs.  

How Home Health Providers Can Avoid Payment Denials

Home Health Care News / By Joyce Famakinwa

Payment denials can be costly and time consuming for home health providers, and they’re often self-inflicted. 
 
In order to avoid this all together, home health leaders should educate themselves on the common reasons behind denials, and also adopt documentation techniques that will help their organizations stay compliant with Medicare’s coverage criteria.
 
That was the main takeaway of a recent webinar hosted by WellSky, an Overland Park, Kansas-based company that utilizes software and analytics to help providers across the continuum achieve better outcomes at lower costs.
 
One of the most prevalent claims errors is not including the signature of a certifying physician. Documentation not meeting medical necessity is another top claims error that providers make. 
 
Other common claims errors include encounter notes that don’t support all elements of eligibility, and missing or incomplete certifications or recertification documents.
 
“If you get a SMRC, or a supplemental Medical Review contractor, request for additional information, and you don’t comply … they will notify your Medicare Administrative Contractor. That can initiate claim adjustments and/or overpayment recoupment actions through their standard recovery process,” Beth Noyce, of Noyce Consulting, said during the webinar presentation. 
 
Providers are able to appeal, but this can be a lengthy and cumbersome process.
Noyce noted that providers looking to find the home health coverage and documentation requirements, in order to stay on the right side of compliance rules, should be aware that all of the information is available to the public.
 
“All of the things are published, everything’s available to you without having to spend a dime of extra money, and it’s all in the public domain,” she said. 

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