In Pivotal Case, Federal Court Rules in Favor of HCBS for People with Disabilities

McKnight’s Home Care | By Adam Healy
 
In what senior care stakeholders have described as a potentially “game-changing” decision, the US District Court for the District of Columbia ruled this week that state and local governments must do more to help people with disabilities access home- and community-based services.

The class-action case, Brown, et al v. District of Columbia, found that Washington, DC, failed to inform Medicaid nursing facility residents that they could leave their facilities and instead receive home health services in their communities. Washington, DC, also failed to connect these patients with housing options and community-based services to ease their transitions home. 

The court ruled Tuesday that this negligence violated the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. LC, which prohibits unjustified segregation of people with disabilities. Washington, DC, was ordered to develop and implement a system to help nursing facility residents transition to community-based long-term care, and ensure that community-based long-term care services are able to meet patient capacity.

The AARP Foundation, which was involved in filing the lawsuit, described the court’s decision as a “landmark” moment for people with disabilities and nursing facility residents.
“What this case represents is a very fundamental change in the responsibilities that states have to provide outreach, education and also transition assistance to really help people to rebuild their lives in the community,” Kelly Bagby, vice president of litigation at the AARP Foundation and a lead attorney on the case, told McKnight’s Home Care Daily 
Pulse Thursday in an interview. 

National implications 

Although the court’s decision is only binding for Washington, DC, the case still has national implications, Bagby said. States and municipalities will be held to a higher standard when it comes to facilitating nursing facility residents’ transition into home- and community-based care, she explained.

“The ultimate goal is that there will be more people able to rely on the provision of home care, and [the US will] … shift that service system to the community,” Bagby said. “This also benefits states and the government, because it is so much more expensive to keep people in nursing facilities than it is to let them live in the place where they want to live, which is in their own communities.”

Christopher Durham, a partner at Duane Morris LLP, told McKnight’s Home Care Daily Pulse Thursday that the court’s decision could have implications for states for promoting access to Medicaid HCBS.

Alliance Eyes Three Home Care Bills as New Congress Convenes

McKnight’s Home Care | By Adam Healy
 
As Congress begins its 2025 session, the National Alliance for Care at Home is focused on three newly introduced bills related to veterans care and health savings accounts. 
 
The legislation and its key components:

• HR 71 would direct the secretary of the Department of Veterans Affairs to direct a pilot program aimed at helping veterans access community-based medical care by promoting beneficiaries’ choice of medical providers. 
• HR 74 would make changes to the Internal Revenue Code to facilitate tax-advantaged health savings account distributions during periods of family and medical leave. 
• HR 109 would require the VA secretary to formally recognize caregivers of veterans and temporarily extend certain benefits to veterans who are ineligible for the VA’s Program of Comprehensive Assistance for Family Caregivers.

Rep. Andy Biggs (R-AZ) introduced the three bills Friday. 
 
“Our team is actively reviewing all relevant legislative activity to assess its potential impact on our industry and the clients we serve,” the Alliance said Wednesday in a statement. “As more information becomes available, we will analyze these proposals thoroughly to determine what, if any, impact they may have on home care providers if enacted.”
 
Meanwhile, home care stakeholders are also working to make telehealth flexibilities implemented during the COVID-19 pandemic a permanent fixture in Medicare. Last month, Congress passed a continuing resolution extending these flexibilities until March 2025. Steven Landers, MD, chief executive officer of the Alliance, recently told McKnight’s Home Care Daily Pulse that achieving a longer-term extension remains a key priority.
 
“Our fight continues to ensure telehealth remains an option for providers. Unless Congress extends or makes permanent these telehealth flexibilities, patients and providers risk losing access after March 31,” the Alliance said Wednesday in a statement.
 
Home care industry advocates feel confident in their ability to score policy wins given the outcome of November’s elections. Numerous home care allies in Congress won seats, and President-elect Donald Trump recently outlined a healthcare policy plan that involves tax credits and reduced regulation for home care providers.

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Home Health OASIS Submission Requirements for All Patients, HHQRP Resources

Alliance Daily | Jan. 9, 2025

Effective January 1, 2025, home health agencies could voluntarily begin submitting OASIS data for all patients regardless of payer. The collection and submission of the OASIS for all patients becomes mandatory July 1, 2025.

The Centers for Medicare & Medicaid Services (CMS) removed the temporary suspension of the OASIS data collection on non-Medicare/non-Medicaid home health agency patients through the CY2023 Home Health Prospective Payment System Rate Update final rule and updated the removal in the CY2025 Home Health Prospective Payment System Rate Update final rule. With these changes, patients who have received home care services of more than one visit in a quality episode provided by all Medicare-certified home health agencies and Medicaid home health providers in states where those agencies are required to meet the Medicare Home Health Conditions of Participation, are eligible for OASIS data collection and submission. 

There are no changes to patients excluded which are those under the age of 18, those receiving only maternity services, and those receiving only chore, housekeeping or personal care services. As stated above, there is a voluntary period prior to the mandatory implementation date of July 1, 2025.

There are many questions about the revised requirement which CMS has addressed in a Q&A document. CMS has also released a Fact Sheet and provided guidance on the provision of the OASIS privacy notice. Specifically, effective January 1, 2025 HHAs should only provide patients with the CMS Privacy Act Statement and Attachment A – Statement of Patient Privacy Rights.  Attachment C – Notice About Privacy for Patients Who Don’t Have Medicare or Medicaid should not be provided to patients. These forms are available on the Home Health Agency Center webpage in the OASIS section. Both documents are available in English and Spanish.

In addition to these OASIS resources, CMS has also posted updated introductory courses to the Home Health Quality Reporting Program (HHQRP). This series of courses is helpful for those new to the HHQRP as well as those interested in a refresher.

URGENT: Telehealth Flexibilities for Home Health Face-to-Face Encounter

Alliance Daily | Jan. 9, 2025

In the January 8, 2025 Centers for Medicare & Medicaid Services’ (CMS) Home Health, Hospice, & DME Open Door Forum (ODF), CMS erred in its response to a question about the use of telehealth for the home health face-to-face encounter.  Specifically, CMS asserted that telehealth could not be used for the home health face-to-face encounter and that it must be completed in person. This is not correct.

As previously reported, the waiver of the geographic and originating site restrictions allowing for the home health face-to-face encounter to be performed via telehealth in the patient’s home and in any geographic location was extended until March 31, 2025 as part of the American Relief Act 2025. While the fight continues to extend or make permanent this flexibility, and that for hospice, telehealth may be used for the face-to-face encounter at this time. The Alliance has requested CMS make a correction.