CMS Seems Intent On Sticking With Home Health Care’s Review Choice Demonstration

Home Health Care News | By Andrew Donlan
 
The Review Choice Demonstration (RCD) has received a set of diverse reactions since it has been live. Some home health providers find it useful and others find it to be yet another administrative burden. 
 
Either way, the U.S. Centers for Medicare & Medicaid Services (CMS) seems intent on expanding it. 
 
Broadly, the goal of RCD is to reduce improper billing in home health care. Illinois, Ohio, Texas, Florida and North Carolina providers have all participated at this point. An expanded implementation drew major criticism in some states, particularly during COVID-19. 
 
Now, the worst of COVID-19 has passed, and CMS is continuing its expansion of the demonstration, this time in Oklahoma. That will start in less than a month, on Dec. 1, 2023. 
“The choice selection period for Oklahoma will begin on Oct. 16, 2023, and will remain open until November 15, 2023,” Emily Richmond, who works on RCD for the Center for Program Integrity, said on a recent home health stakeholder call hosted by CMS. “Home health providers in Oklahoma can select from pre-claim review, post payment review, or a minimal post payment review with a 25% payment reduction, which means 100% of those claims have a 25% payment reduction.”
 
Meanwhile, the demonstration is set to expire in other states on May 31, 2024. CMS is currently considering extending it, though. 
 
“At this time, we have the demonstration set to end in May of 2024, but CMS is currently working internally to determine if the demonstration will be extended past that May expiration date, and we will definitely provide ample notice,” Jessica Czulewicz, who also works on RCD, said during the call. “At this point, that’s about the best answer I can give.”
 
Multiple sources have told Home Health Care News that they believe CMS is bullish on RCD and plans to continue expanding it. 
 
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Hospice from a Naturopathic Lens with CDPHE

Thursday, Nov 30  (2:00 –3:00pm MT)

Many fields of Western medicine have begun incorporating integrative therapies alongside more conventional practices, including within the field of hospice. Naturopathic doctors who have a background in both Western and integrative medicine are well-positioned to assist hospice teams and practitioners with a unique understanding of this shift as it relates to end-of-life and palliative care. This presentation, Hospice from a Naturopathic Lens, will discuss who naturopathic physicians are, the intersections of hospice care and naturopathic medicine, possible roles naturopathic doctors could play within hospice, various integrative therapies for common conditions, and finally, a short summary of the hospice survey process.

Presenter Information: Emily Keranen, ND is a health compliance inspector. Prior to joining the Colorado Department of Public Health (CDPHE), she worked as a physician in Arizona, with a focus on integrative thyroid medicine. In her spare time, she enjoys trail running, hiking, and triathlons. 

Google Meet joining info

Video call link: https://meet.google.com/wrb-ohvh-zoq 

Or dial: +1 567-707-0098 (PIN: 676382782)

More phone numbers: https://tel.meet/wrb-ohvh-zoq?pin=9633482962310

 

CMS Final Rule Reins in 2024 Rate Reduction, But Brings Big Cuts Beyond

HomeCare News

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) issued its 2024 Home Health Prospective Payment System Rate Update final rule on Nov. 1, landing on more moderate cuts than initially proposed but still enacting rate reductions beginning in 2025 that would present “serious concerns for the home health community,” according to the National Association for Homecare and Hospice.

The final rule calls for a -2.890% permanent adjustment in payment rates to home health agencies in calendar year 2024, half of the full permanent adjustment of -5.779%. The proposed rule called for a slightly lower overall permanent adjustment of -5.653%. CMS said that because the new rule only calls for half of the full permanent adjustment to go into effect in 2024, Medicare payment to home health agencies will increase by .8%, rather than the original 2.2% decrease initially proposed.

“This halving of the permanent adjustment is in response to commenter concerns about the magnitude of a single-year significant payment reduction,” CMS wrote in its announcement of the rule. “CMS will have to account for the remaining permanent adjustment not applied in CY 2024, and other potential adjustments needed to the base payment rate, to account for behavior change based on analysis at the time of future rulemaking.”

But NAHC said the cuts would still come to 6.533% over 2023 and 2024—with more to come in future years.

“We continue to strenuously disagree with CMS’s rate-setting actions, including the budget neutrality methodology that CMS employed to arrive at the rate adjustments,” said NAHC President Bill Dombi. “We recognize that CMS has reduced the proposed 2024 rate cut. However, overall spending on Medicare home health is down, 500,000 fewer patients are receiving care annually since 2018, patient referrals are being rejected more than 50% of the time because providers cannot afford to provide the care needed within the payment rates, and providers have closed their doors or restricted service territory to reduce care costs. If the payment rate was truly excessive, we would not see these actions occurring.”

“The fatally flawed payment methodology that CMS continues to insist on applying is having a direct and permanent effect on access to care,” Dombi continued. “When you add in the impact of shortchanging home health agencies on an accurate cost inflation update of 5.2% over the last two years, the loss of care access is natural and foreseeable.”

NAHC is currently suing CMS, saying the basis for its payment assumptions is flawed, and also pushing Congress to pass the bill S 2137, which would block the final rule.

“We now implore Congress to correct what CMS has done and prevent the impending harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit,” Dombi said. “We urge the Congress to support this bill and enact it into law before the end of the year. The 2024 rate cuts must not take effect” Dombi added.

The new rule also finalizes CMS’s proposals to:

  • Rebase and revise the home health market basket
  • Revise the labor-related share
  • Recalibrate case-mix weights under the Patient-Driven Groupings Model (PDGM)
  • Update low utilization payment adjustment thresholds, functional impairment levels and comorbidity adjustment subgroups for 2024
  • Codify statutory requirements for disposable negative pressure wound therapy
  • Establish payment rules for lymphedema compression treatment and home intravenous immune globulin

The rule also updates requirements for how often and when providers of durable medical equipment prosthetics, orthotics and supplies (DMEPOS) must contact beneficiaries before dispensing resupply items…

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Find the final rule at: https://www.federalregister.gov/public-inspection/2023-24455/medicare-program-calendar-year-2024-home-health-prospective-payment-system-rate-update-quality

Read a fact sheet on the rule at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-final-rule-cms-1780-f

 

[Updated] CMS Finalizes 0.8% Home Health Payment Increase for 2024, Additional PDGM Cuts

Home Health Care News | By Andrew Donlan

The U.S. Centers for Medicare & Medicaid Services (CMS) released its CY 2024 home health final payment rule Wednesday.

It comes with an estimated aggregate increase to 2024 home health payments of 0.8%, or $140 million, compared to 2023 aggregate payments. But that doesn’t tell the entire story, with sharp rate cuts also finalized.

“The $140 million increase in estimated payments for CY 2024 reflects the effects of the CY 2024 home health payment update percentage of 3.0% ($525 million increase), an estimated 2.6% decrease that reflects the effects of the permanent behavioral assumption adjustment ($455 million) and an estimated 0.4% increase that reflects the effects of an updated FDL ($70 million increase),” the final rule reads. 

CMS is finalizing a permanent prospective adjustment of -2.890% to the CY 2024 home health payment rate, short of a -5.1% adjustment proposed in June.

A -3.925% permanent rate adjustment was already implemented in 2023.

The agency had proposed a 2.2% aggregate decrease in 2024 in June. The full fact sheet on the final rule can be viewed here.

The Nuts and Bolts

While a 0.8% increase in aggregate payments – compared to the 2.2% decrease proposed – is positive news in the near term, CMS is not backing off its desire for permanent, negative adjustments. The agency continues to maintain that it overpaid home health agencies during the first three years of the Patient-Driven Groupings Model (PDGM), too.

The permanent prospective adjustment of -2.890%, while smaller than the 5.1% proposed, is something that providers and advocates hoped CMS would do away with completely.

CMS is suggesting that home health agencies have been overpaid by about $3.5 billion from 2020-2022, which means clawbacks are still on the table. Specifically, CMS believes it overpaid by $873 million in 2020, $1.2 billion in 2021 and $1.4 billion in 2022. 

“A permanent prospective adjustment of -1.767% to the CY 2024 30-day payment rate (assuming the -7.85 percent adjustment was already taken) would be required to offset for such increases in estimated aggregate expenditures in future years,” CMS wrote in its rule. 

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Partnership for Quality Home Healthcare

FHP Strategies Final Rule Assessment

 

[UPDATED] CMS Finalizes Hospice Special Focus Program, 36-Month Rule

Hospice News

The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized its 2024 home health rule, including the implementation of a hospice Special Focus Program (SFP).

The rule also finalizes the proposed “36-month”rule for hospice providers. The requirement mirrors a regulation that has existed for several years for home health agencies. The final rule forbids any change in majority ownership during the 36 months after initial Medicare enrollment, including acquisitions, stock transactions or mergers.

Despite comments from stakeholders in the hospice community, CMS decided to proceed with its proposed algorithm for selecting providers for the SFP.

“We proposed to identify a subset of 10% of hospice programs based on the highest aggregate scores determined by the algorithm. The hospices selected for the SFP from the 10% would be determined by CMS,” the agency indicated in the final rule. “To identify ‘poor performance,’ we have identified several indicators, namely, survey reports with Condition-Level Deficiencies (CLDs) and complaints with substantiated allegations, and CMS Medicare data sources from the Hospice Quality Reporting Program (HQRP) (Medicare claims and Consumer Assessment of Healthcare Providers and Systems (CAHPS®).”

CMS will also examine hospices’ performance on certain Conditions of Participation (CoPs) that the agency says “directly contribute to the quality of care delivered to patients, their caregivers, and families,” according to the final rule.

Though each of the 23-hospice specific CoPs will continue to have equal weight when it comes to Medicare certification and enforcement decisions, CMS is giving “special attention” to 11 CoPs. The agency contends that a condition-level deficiency on any of these rules may indicate that a hospice is providing poor quality care.

While the hospice community has generally embraced the concept of the SFP, some raised questions about this methodology.

Each of the major national hospice industry organizations voiced concerns about the algorithm that CMS will use beginning in 2024, including LeadingAge, the National Partnership for Healthcare and Hospice Innovation (NHPI), the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO).

In August, these organizations sent a joint letter to CMS asking to delay the program to allow for the development of a new methodology…

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