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Revised Home Health Interpretive Guidelines- Chart
On March 15, 2024, the Centers for Medicare & Medicaid Services (CMS) released revisions to the Medicare State Operations Manual, Appendix B, Also referred to as the Interpretive Guidelines for the home health Conditions of Participation(CoPs).
CMS has made conforming changes to the regulatory tags and interpretive guidelines based on several final rules that have amended the home health agency (HHA) CoPs.
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Health Plans Continue To Reduce Prior Authorization Burden For Home Health Providers
Home Health Care News | By Andrew Donlan
Yet another payer organization is removing certain prior authorization requirements for home health care services.
Point32Health – the parent company of Harvard Pilgrim Health Care and Tufts Health Plan – announced Wednesday that it is removing prior authorization requirements for the first 30 days of home health care beginning on April 12.
The changes will affect members in Point32Health’s commercial plans.
“We continuously evaluate all our programs to ensure our members are receiving the highest quality of care and work closely with our provider partners to decrease their administrative burden wherever possible,” Dr. Hemant Hora, senior medical director at Point32Health, told Home Health Care News in an email. “We strive to offer a broad network of high-quality providers to our members. We welcome all home care providers interested in working with us to reach out.”
A nonprofit organization, Point32Health serves over 2 million members through a variety of health plans.
Formerly, home health services required prior authorization after initial evaluations from Harvard Pilgrim and Tufts Health Plan plans. That will no longer be the case, though prior authorization will still be required after the initial 30 days for a continuation of services.
Prior authorization requirements have long been one of the pain points for home health providers working with health plans outside of traditional Medicare.
“Care delayed is care denied,” Intrepid USA CEO John Kunysz told Home Health Care News recently, regarding prior authorization woes in home health care.
But there has been progress of late…
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Take Action: Tell Congress to Support Terminally-Ill Veterans!
Hospice Action Network | By Stephanie Marburger
Of the over 600,000 Veterans who die each year, 4 out of 5 will pass away outside of a VA facility. But for Veterans who choose to die at home under VA provided hospice care instead of a VA facility, they will be denied financial assistance in their greatest time of need. Veteran deaths that currently occur outside of a VA facility are ineligible for burial and funeral benefits. Tell Congress to support "Gerald's Law Act" (H.R.234 / S.1330) to end this injustice.
If passed, Gerald's Law would expand access to burial and funeral benefits for Veterans who die in non-VA settings while receiving VA hospice care. Veterans who choose to spend their last days at home surrounded by their loved ones deserve these benefits, earned through service and sacrifice to our country. Their end-of-life decisions should be based on comfort, not on cost.
We are proud to join the following supporters of Gerald's Law:
Department of Veterans Affairs (VA); Disabled American Veterans (DAV); Gold Star Wives of America; Tragedy Assistance Program for Survivors (TAPS); Veterans of Foreign Wars of the United States (VFW)
Share this action with your networks with the hashtag #HospiceAction!
Call on others to Sign Up to be a hospice advocate and join our cause today!
Thank you for being an advocate for hospice care. By supporting our efforts, you are helping policymakers and communities protect the future of hospice. |
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NAHC/HHFMA Medicare Advantage Survey – 2024
The National Association for Home Care & Hospice (NAHC), in conjunction with the Home Care & Hospice Financial Managers Association (HHFMA), has developed a survey to assess the current state of home health within Medicare Advantage (MA) plans.
We are asking home health providers that contract with MA plans to complete this survey, estimated at about 10-15 minutes. Thank you in advance for your participation.
Take the survey at https://www.surveymonkey.com/r/SHDB2TH |
CMS Finalizes Underwhelming Payment Adjustment For Medicare Advantage Plans
Home Health Care News | By Patrick Filbin
The Centers for Medicare & Medicaid Services (CMS) finalized a rule that will result in a 3.7% positive payment adjustment for Medicare Advantage (MA) plans in 2025.
According to an analysis done by the private investment banking company Stephens, rates are expected to remain virtually unchanged, with a slight decrease of 0.16%. This marks the second consecutive year of a cut to real “core” MA rates.
Although expected, the news worried some post-acute stakeholders who believe plans will pass cost concerns down onto providers.
“These inadequate rates paid by the MA plans destabilize the financial health of provider organizations more broadly,” LeadingAge President and CEO Katie Smith Sloan said in a statement shared with Home Health Care News. “Policymakers must act before we find few providers remaining to serve the more than 65 million Medicare beneficiaries, including the nearly 33 million who now receive their Medicare benefits via an MA plan.”
Under the new guidance, payments from the government to MA plans are expected to increase, on average, by 3.7% — or over $16 billion — from 2024 to 2025.
In previous years, CMS has bumped up the rate by 3.32% for 2024 and 8.5% in 2023.
“The finalized policies in the rate announcement will make improvements to keep Medicare Advantage payments up-to-date and accurate, lower prescription drug costs and ensure that people with Medicare have access to robust and affordable health care options,” CMS Administrator Chiquita Brooks-LaSure said in a statement.
The federal government is projected to pay between $500 and $600 billion to private health plans in 2025.
The final core 2025 rate update is well below expectations, Scott Fidel, an analyst with Stephens, wrote in the report.
As a result, Stephens projects the potential for slower enrollment growth for the MA industry in 2025 as MA plans look to adjust member premiums and benefits to preserve margins.
“Bottom line, we see the final core 2025 MA rate update of -0.16% as reflecting a ‘highly adverse’ outcome for the industry, inclusive of the additional industry headwind of higher utilization trends currently observed,” Stephens wrote in its report. “The final 2025 rates largely reflect a continuation of the negative CMS rate cycle — now denoted as ’Year 2’ — of a much more constrained annual MA reimbursement trend as compared to the significantly more favorable rate outcomes in 2022 and 2023.”
Generally, home health agencies have expressed dissatisfaction with payment rates and reimbursement policies set by managed care companies…
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