Submit a Speaker Proposal for the Fall Virtual Conference!

We are in the middle of planning with our colleagues in Utah for our joint Fall Virtual Conference, which will be available for on-demand viewing by early October. It’s going to be another great one!

We have approximately half of the presentations already planned. However, we would like your help with finding speakers for other topics that were recommended by members and the committee.

Please view the list below and email [email protected] if you or someone you know might be interested in being considered as a presenter on any of the topics.

Presentations are due by mid-September and should be at least 53 minutes long. 

• Value Based Purchasing – Get it Right

• Dry Needling in Home Health Therapy

• How to Build an Effective Bereavement Program

• Hospice Pain Medications Update & Overview

• Bullet Proof Home Health Documentation

• Bullet Proof Hospice Documentation

• Guiding Others on How & When to Apply for Medicare and Medicaid

• Lessons Learned and Joys Shared as a Hospice Chaplain

• Grass Roots Advocacy – Preserve & Improve Home Care and Hospice

• Coding Session (Home Health and/or Hospice)

• Sepsis Prevention and Management

• Home Health iQies/QA

• Hospice iQies/QA

• Lymphedema Management

• How to Implement a Volunteer Program (e.g., identifying a need and implementing a volunteer program to meet that need)

• Present and Future Use of AI in Home Care and Hospice

• Preparing for the Continued World of Mergers and Acquisitions

• Chronic Pain Management

• Paneling and Negotiating with Med Advantage Companies

• Working with Difficult Caregivers and Enmeshed Families

• General Legislative Updates for Home Health, Hospice, and/or Home Care

• Working with Patients with Spinal Cord Injury (therapy focus)

CMS Proposes $375M Cut to Medicare Home Health Payments

RevCycleIntelligence | By Jacqueline LaPointe
 
CMS has released the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule, which includes a 2.2 percent, or $375 million, cut to Medicare home health payments.
 
The federal agency said in the HH PPS Rate Update proposed rule that the payment cut reflects a 2.7 percent increase — approximately $460 million —  less a 5.1 percent statutory decrease. The decrease reflects the impacts of a proposed prospective, permanent behavior assumption adjustment ($870 million decrease) and an estimated 0.2 percent increase that reflects the impacts of a proposed update to the fixed-dollar loss ratio (FDL) for outlier payments determinations ($35 million increase).
 
“This rule proposes a permanent, prospective adjustment to the CY 2024 home health payment rate to account for the impact of the implementation of the Patient-Driven Groupings Model (PDGM),” CMS wrote. “This adjustment accounts for differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures due to the implementation of the PDGM and 30-day unit of payment as required by the Bipartisan Budget Act of 2018, which amended section 1895(b) of the Social Security Act (the Act).”
 
The federal agency had previously finalized a permanent adjustment following PDGM implementation, but the adjustment was half of the estimated required permanent adjustment, according to the latest proposed rule.
 
The HH PPS has undergone reform since the Bipartisan Budget Act of 2018 required CMS to “better align payment with patient care needs and to better ensure that clinically complex and ill beneficiaries have adequate access to home health care.” The PDGM became effective in 2020 and uses 30-day periods as a basis for payment that are adjusted based on case-mix groups.
 
By law, CMS has had to make assumptions about behavior changes that could occur because of the implementation of the 30-day unit of payment. CMS finalized three behavior assumptions around clinical group coding, comorbidity coding, and low utilization payment adjustment (LUPA) threshold.
 
The CY 2024 HH PPS Rate Update proposed rule continues to implement a permanent adjustment to Medicare home health payments as a result of the assumed behavior changes and how home health agencies actually performed in CYs 2020 and 2021. But the rule said Medicare paid more under PDGM and the 30-day periods than it would have under the old system based on a CY 2022 claims analysis, resulting in a larger permanent adjustment.
 
The proposed permanent adjustment includes the remaining -3.925 percent to account for CYs 2020 and 2021, which were not applied to the CY 2023 payment rate, and accounts for actual behavior changes in CY 2022.
 
CMS also said in the rule that it plans to adopt a 2021-based home health market basket and will recalibrate the 432 payment groups under PDGM using CY 2022 data…

Read Full Article

NAHC Sues Medicare to Preserve the Home Health Service Benefit

NAHC

The National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additional cuts expected over the next several years.  CMS has proposed an additional 5.653% permanent rate cut to begin in 2024 based on the same challenged payment methodology.

The lawsuit argues that Medicare is required to institute the payment model changes in a budget neutral manner rather than to inflict rate cuts that have precipitated services limitations or access to care.  Until recently, nearly 3.5 million Medicare beneficiaries received home health services annually.  Since the new payment model began in 2020, over 500,000 fewer Medicare patients have accessed home health services.

“We have done everything possible to get Medicare to understand the disastrous consequences of its actions.  We have presented hard facts, deep legal analyses, and extensive data to Medicare that demonstrate the errors in its policies to no avail.  As a last resort, we have filed this lawsuit to protect Medicare beneficiaries and the home health agencies that care for them.” stated William A. Dombi, President of NAHC.

“Home Health agencies again must withstand billions of dollars in payment cuts as cost of care continues to rise and still be expected to deliver the care to which our patients are entitled to as a Medicare benefit.”  added Ken Albert, Chairman of NAHC, and CEO of Androscoggin Home HealthCare + Hospice. “Since these cuts took effect in January, providers have reduced service areas, turned away thousands of patients, and halted the use of innovative technologies in order to stay afloat and serve some patients,” he noted.

The lawsuit was filed in the U.S. District Court for the District of Columbia.  It alleges that CMS and HHS promulgated an illogical and invalid methodology in determining whether expenditures stemming from payment rates established in 2020 were “budget neutral” in comparison to the estimated expenditures that would otherwise have occurred under the previous payment model.  Budget neutrality is required under a 2018 law that mandates certain payment system reforms.

Data from the Congressional Budget Office (CBO) highlights the extent of Medicare’s error.  Following the 2018 enactment of the payment reform legislation, CBO projected 2023 Medicare expenditures at $23 Billion. In May 2023, CBO revised its 2023 projections downward to only $16 Billion.

The lawsuit seeks declaratory and injunctive relief including a reversal of the rate adjustments in the 2023 rule and requirement that Medicare implement the budget neutrality mandate consistent with the law.

FAQ About the 2024 Hospice Proposed Rule

On Friday, March 31, 2023, the U.S. Centers for Medicare & Medicaid Services (CMS), released the proposed payment rule for hospice providers for fiscal year (FY) 2024. It includes a proposed update to hospice payments by 2.8%, which would increase hospice payments by $720 million (compared to the FY 2023 payments). In addition, there are important proposed updates to the Hospice Quality Reporting Program (HQRP), the hospice certification process, the Hospice Outcomes and Patient Evaluation (HOPE) tool, and more.

WellSky hospice regulatory expert Katherine Morrison, RN, MSN, CHPN, presented an informational webinar that covered key elements of the proposed rule and explored the changes your team should understand as you prepare for 2024; that webinar is now available to watch on-demand. The 2024 hospice proposed rule is an important opportunity to look into the near future of hospice care and to consider the impact of the proposed changes. In this tip sheet, Katherine answers the most frequently asked questions about the hospice proposed rule.

See Attached