In The News

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
 

U.S. Supreme Court Clarifies Employer’s Religious Accommodation Obligations

  • The U.S. Supreme Court has announced its decision in Groff v. DeJoy, a long-awaited decision explaining employers’ obligations under Title VII to reasonably accommodate employees’ religious beliefs, observances, and practices.
  • In the case, a former United States Postal Service (USPS) mail carrier, Gerald Groff claimed that he was unlawfully denied his requested religious accommodation to not work Sundays. The USPS tried to find other carriers to cover Groff’s Sunday shifts, but because of a shortage of rural carriers, it often failed. Groff requested that the USPS exempt him from Sunday work, but the USPS declined, stating that his requested accommodation would lead to undue hardship for the USPS.
  • Under Title VII of the Civil Rights Act, employers are required to reasonably accommodate employees whose sincerely held religious beliefs or observances conflict with work requirements, unless doing so would create an undue hardship for the employer. With no statutory definition of “undue hardship”, courts have relied on the Supreme Court’s decision in TWA v. Hardison, 432 U.S. 63 (1977), to determine the parameters of the term. In Hardison, the Court stated that requiring an employer “to bear more than a de minimis cost in order to give [an employee] Saturdays off is an undue hardship.” In Groff, the Court changed the test. According to the Court, it now “understands Hardison to mean that ‘undue hardship’ is shown when a burden is substantial in the overall context of an employer’s business.” The Court declined to incorporate the undue hardship test under the Americans with Disabilities Act which requires significant difficulty and expense.

If employers have any questions or concerns, we recommend they contact us to ensure compliance. For assistance, contact us at 423-764-4127 or by email at [email protected]
 

NHPCO REGULATORY ALERT

CMS-1780-P: Medicare Program – Calendar Year 2024 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Program Requirements; etc.

Summary at a Glance

The Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment proposed rule was posted for public inspection in the Federal Register on June 30, 2023. It will post in the Federal Register on July 10, 2023.

This rule contains a number of hospice provisions, which are detailed below:

1. Hospice Informal Dispute Resolution (IDR), which allows a hospice with a condition-level survey finding to resolve disputes related to the findings informally and allow for continued participation in Medicare.

2. Hospice Special Focus Program, which provides details on the proposed implementation of the Hospice Special Focus Program (SFP), including selection, requirements while in the program, possible additional enforcement remedies, posting SFP participation in Care Compare, and completion and graduation from the SFP or termination from the Medicare program.

3. Home health and hospice health equity discussion and possible future health activities and measures.

4. Provider enrollment proposals for hospices, including categorical risk screening, with a high-risk designation for some hospices, fingerprint requirements, proposed 36-month rule for changes in majority ownership, deactivation timeframe changes, expanded definition of managing employees and more.

Comments on this proposed rule will be due on August 30, 2023. Implementation date for the final rule will be January 1, 2024.

The full analysis of the rule can be accessed via the Regulatory Alerts page on NHPCO's website.
 

Experts Answer Questions on Properly Documenting the Physician Certification of Terminal Illness in New Training

CMS has requested that CGS issue the following revision of their Q&A from their Terminal Illness webinar last month. 

Questions and Answers

We recently received information from the Centers for Medicare & Medicaid Services that telehealth face-to-face visits are acceptable until 12/31/24 and are being evaluated for future use as well. Can you please confirm?

  • Correct. Telehealth face-to-face visits are allowed until the end of 2024 and must include both audio and visual components.

If the CTI is not completed by the hospice physician team on the third day after the start of the episode, does the agency perform an administrative discharge and readmit the patient or bill with condition/occurrence code 77 for non-billable days?

  • Please refer to the CGS website [r20.rs6.net] for information on untimely certifications and occurrence span code (OSC) 77.

There is no diagnosis code to document when you are using non-disease-specific guidelines, correct? If a provider says the patient is eligible under the non-disease-specific guidelines, finding an ICD-10 to use as primary can be a struggle.

  • It's important to be very careful in the interpretation of the Hospice Local Coverage Determination (LCD). The Hospice LCD [r20.rs6.net] provides guidelines for making determinations about whether the patient is terminal (i.e., what to look for and what the reasonable and necessary care is for a terminal patient), which is a benefit access condition. You must have a primary or terminal diagnosis, and non-disease-specific guidelines factor into this primary or terminal diagnosis.

Is continuous home care [r20.rs6.net] available for use if a caregiver is not available to provide care (e.g., the caregiver has surgery)?

When using the LCD non-disease-specific guidelines, do you always pick the primary diagnosis as the most likely, even if the patient doesn't exactly meet the disease-specific guidelines for that diagnosis? We see this a lot when patients have a multi-diagnoses reason for qualifying.

  • You cannot use the non-disease-specific guidelines alone. You must have a terminal disease listed in the LCD disease-specific guidelines. If the patient has multiple diagnoses, then lean to the one that is having the most effect on the patient.

When a patient elects a primary care provider who is an NP, is the hospice-employed medical director CTI enough or does the NP's overseeing physician need to sign CTI?

  • In this circumstance, the hospice-employed medical director's signature is the only one required.

Are co-morbidities required on the CTI?

  • Although documenting co-morbidities is not required, doing so is important because it helps to identify why the patient has a terminal prognosis. We recommend that you document comorbidities as they might make the difference between a claim being paid or denied.

Is a physician's order required to do a start of care (SOC) assessment by the registered nurse?

  • A verbal order is required within 2 days of an SOC.

Is a new CTI required if a patient transfers to our hospice in the middle of a benefit period, or is the one from the previous hospice sufficient?

  • No, a new CTI is not required when transferring agencies.

Can an NP remain as the attending for the patient when they are put on hospice?

  • Yes, an NP can be assigned as the attending.
 
More Articles...
<< first < Prev 81 82 83 84 85 86 87 88 89 90 Next > last >>

Page 81 of 350