Florida’s 1115 MMA Managed Medical Assistance (MMA) Waiver Amendment

September 25, 2014

The Agency for Health Care Administration (the Agency) is seeking federal authority to amend Florida’s 1115 MMA Managed Medical Assistance (MMA) Waiver (Project Number 11-W-002064) to allow certain populations who were previously excluded from the MMA program to voluntarily enroll.

The proposed amendment will allow for Medicaid-eligible recipients residing in group home facilities licensed under Section 393.067, Florida Statutes, as well as Medicaid-eligible children receiving Prescribed Pediatric Extended Care (PPEC) services to become eligible to voluntarily enroll in Florida’s MMA program, a component of the Statewide Medicaid Managed Care (SMMC) program. This amendment is being submitted to implement Florida Law that allows recipients residing in a group home facility and children receiving PPEC services to voluntarily enroll in Florida’s MMA program upon federal approval.

The proposed amendment will:

  • Ensure continuity of care and allow these group home residents access to expanded benefits offered by the plans;
  • Allow for those children receiving PPEC services and currently enrolled in the Children’s Medical Services Network or another managed care plan to remain in that plan without disruption of services, ensuring their continuity of care and ensuring children will be able to take advantage of the higher plan standards required and the expanded benefits offered by the plans.

The Agency is conducting a 30-day public notice and public comment period that takes place between September 17, 2014 and October 17, 2014.  Please visit the MMA Federal Authorities page for more information on the public meetings, information for submitting comments, and to view a comprehensive description of the waiver amendment request.

The Agency is hosting a public meeting to solicit public input on the amendment of Florida’s 1115 Managed Medical Assistance (MMA) Waiver.   On September 17, 2014, the Agency published the following public meeting notice in the Florida Administrative Register.

The notice invites all interested parties to the public meetings and provides the meeting dates, times, and locations.  Individuals who will be unable to attend the meeting in person can participate via conference call by using the toll free number provided in the FAR notice. During the meetings, the Agency will provide an overview of the provisions in Part IV of Chapter 409, Florida Statutes, related to the MMA program; a description of the amendment request; and time for public comments.

The 1115 MMA Waiver Amendment Public Meeting will be held on

Monday, September 29, 2014; from 1:00 p.m. to 2:00 p.m.

Agency for Health Care Administration
6800 North Dale Mabry Highway
Main Training Room
Tampa, FL 33614

Conference Line: 1-888-670-3525

Participant Code: 4201652735 #

Mail comments and suggestions to: 

1115 MMA Waiver Amendment Request
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308

E-mail comments and suggestions to: FLMedicaidWaivers@ahca.myflorida.com  with “1115 MMA Waiver Amendment Request” referenced in the subject line.

Reference your 2014 Membership Directory online, any time!

September 12, 2014

Your digital edition of the  2014 Membership Directory is always available online, for whenever you need members’ contact information or quick info about home care agencies and facilities. This online version is the same as your print copy.

Click on the image to the right to go to the directory, or click any of the links below to go directly to that section.  2014 Directory Cover

Bookmark the digital directory in your browser or save it to the home screen of your mobile device for quick access any time you need this information.

 

Thank you to our advertisers. Their support helps make this publication possible.

View Past Issues

Florida Owner of Home Health Care Company Sentenced to Nearly Six Years in Prison for Role in $6 Million Medicare Fraud Scheme

August 29, 2014

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A co-owner of Professional Medical Home Health LLC was sentenced today to serve 70 months in prison and ordered to pay $6.2 million in restitution for her participation in a health care fraud scheme involving the now defunct home health care company .

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, and Acting Special Agent in Charge Reginald France of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office made the announcement. U.S. District Judge Federico A. Moreno of the Southern District of Florida imposed the sentence.

According to court documents, Annarella Garcia, 44, of Hialeah, Florida, was a co-owner of Professional Medical Home Health, a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. Between December 2008 and February 2014, Garcia and others engaged in a scheme to bill the Medicare Program for expensive physical therapy and home health care services that were not medically necessary or were not provided. During that time, Professional Medical Home Health was paid approximately $6.25 million by Medicare for the fraudulent claims.

Specifically, Garcia and her co-conspirators paid kickbacks and bribes to patient recruiters in return for their providing patients to Professional Medical Home Health for home health and therapy services that were not medically necessary or were not provided. In furtherance of the scheme, Garcia and her co-conspirators falsified patient documentation to make it appear that beneficiaries qualified for and received home health care services, when, in fact, many of the beneficiaries did not actually qualify for such services and did not receive such services.

Garcia pleaded guilty to conspiracy to commit health care fraud on June 25, 2014.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Trial Attorneys A. Brendan Stewart and Anne P. McNamara of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov .

Source: OIG

Participate in this year’s HCAF Salary & Benefits Survey!

August 20, 2014

salary_survey Blinder

 

For several years now, HCAF has been conducting a salary and fringe benefit survey of the home health industry in Florida. It is our goal to continue helping providers understand how agencies around the state are compensating their employees in order to remain competitive when it comes to recruiting and maintaining staff.  HCAF does this by collecting the data through a secure excel toolkit. Read the rest of this entry »

CMS Announces its Next Home Health, Hospice and DME Open Door Forum – August 20

August 15, 2014

CMS has announced that its next Home Health, Hospice and DME Open Door Forum will be held next Wednesday, August 20. NAHC members are encouraged to note that some key issues will be addressed, including the revised hospice cost report for freestanding agencies.

The link that accompanied the announcement appears to be the second version of the cost report that was issued on November 22, 2013.  It is unclear whether these will be the actual, final cost report forms and instructions for freestanding agencies that CMS has indicated will be required for cost reporting years beginning October 1, 2014, and afterward, or if CMS will release another version that incorporates some of the additional changes that were recommended by the industry during December 2013.

Below is the tentative agenda for CMS Home Health, Hospice and DME Open Door Forum:

I. Opening Remarks

Chair – Randy Throndset, Center for Medicare

Moderator – Jill Darling (OC)

II.  Announcements & Updates

  •   OASIS-C1 webinar, September 3, 2014 @2PM, Survey and Certification letter attached.

§Can be found at: http://www​.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html search for OASIS-C1_ICD9

  • FY 2015 Hospice Payment Rate Update Final Rule

§ http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/H​ospice/Hospice-Regulations-and-Notices-Items/CMS-1609-F.html

  • Hospice Cost Report

§  http: //www.reginfo.gov/public/do/PRAViewIC?ref_nbr=201312-0938-003&icID=8476

  • Hospice CAHPS Survey

§  http://www.hospicecahpss​urvey.org

  • HHCAHPS (Home Health CAHPS Survey)

§at URL https://homehealthcahps.org

III. Open Q&A

**Next Home Health, Hospice & DME ODF: October 1, 2014

Mailbox: HomeHealth_Hospice_DMEODF-L@cms.hhs.gov

———————————————————————

Open Door Participation Instructions:

This call will be Conference Call Only.

To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID: 44421630.

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-855-859-2056; Conference ID: 44421630.

Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID beginning 2 hours after the call has ended. The recording expires after 2 business days.

For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

 

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CMS Issues Several Change Requests Specific To Home Health Agencies

August 8, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued four Change Requests that provide guidance to the Medicare Administrative Contractors (MACs) on several home health policy and claims processing issues.

Change request 8699- Preventing Duplicate Payments When Overlapping Inpatient and Home Health Claims Are Received Out of Sequence

CMS has instructed the MACs to implement edits that will prevent home health claims from processing with dates of service that overlap an inpatient stay. In response to a 2012 Office of Inspector General report that exposed claim vulnerabilities, CMS has identified two conditions where a home health claim could process that overlap with an inpatient claim:

The edit that rejects home health claims when they have dates overlapping an inpatient stay – other than the admission date, discharge date, or a date during an occurrence span code 74 period indicating a leave of absence – does not consider inpatient stays in a swing bed (Type of Bill 018x), and

Medicare systems only identify overlaps with inpatient stays when the inpatient hospital or skilled nursing facility claim was received before the home health claim.

Effective January 1, 2015, If an HH Prospective Payment System (PPS) claim is received, and CWF finds dates of service on the home health claim that falls within the dates of an inpatient, SNF or swing bed claim – not including the dates of admission and discharge, and the dates of any leave of absence – Medicare systems will reject the home health claim. The HHA may submit a new claim removing any dates of service within the inpatient stay that were billed in error.

If the home health PPS claim is received first and the inpatient hospital, SNF or swing bed claim comes in later, but contains dates of service duplicating dates of service within the home health PPS episode period, Medicare systems will adjust the previously paid home health PPS claim to non-cover the duplicated dates of service.

For more on this change request, please click here.

Change Request 8710-PreventingPayment on Requests for Anticipated Payment (RAPs) When Home Health Beneficiaries are Enrolled in Medicare Advantage (MA) Plans

Current Medicare systems edit reject claims for home health episodes when a beneficiary is enrolled in a Medicare Advantage plan.  However, Requests for Anticipated Payment (RAPs) for such episodes are currently being paid.

Effective January 1, 2015, edits will be put n place to ensure that RAPs with “From” dates falling within Medicare Advantage enrollment periods are processed, but are paid at zero percent. If a final claim is received it will be rejected, as is currently the process.  Additionally, the requirements add remittance advice coding to zero-paid RAPs processed in Medicare Secondary Payer situations, so that the two situations can be distinguished. In the future, CMS will seek a new alert remittance advice remark code to specifically identify the Medicare Advantage cases also.

For more on this change request, please click here.

Change Request 8813- Diagnosis Reporting on Home Health Claims

Effective January 1, 2015, the MACs will implement edits to reject HH claims that list a manifestation code as a primary diagnosis.

An analysis of Outcome Assessment and Information Set (OASIS) records and claims for CY 2011 revealed that some agencies were not complying with the coding guidelines when reporting the primary diagnosis, in particular with regards to certain codes that require the underlying condition be sequenced first followed by the manifestation.

The principal diagnosis reported on the home health claim shall be the ICD-9-CM code that is most related to the current home health plan of care. HHAs shall not submit manifestation codes as the primary diagnosis.

For more on this change request, please click here.

Change Request 8818 -Clarification of the Confined to the Home Definition in Chapter 15, Covered Medical and Other Health Services, of the Medicare Benefit Policy Manual

In the calendar year 2012 Home Health PPS Final Rule published on November 4, 2011, CMS finalized its proposal to provide clarification to the Benefit Policy Manual language regarding the definition of a patient being “confined to the home.”

In October 2013, CMS issued change request 8444 to clarify the definition of “confined to the home” to more accurately reflect the definition articulated in Sections of 1814(a) and 1835(a) of the Social Security Act. At that time, chapter 2 of the Medicare Benefit Policy Manual was revised. Change request 8818 also updates chapter 15 of the Medicare Benefit Policy Manual to reflect the clarification of “confined to the home” definition.

For more on this change request, please click here.

Source: NAHC

 

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HCAF Celebrates 25 Years of Supporting the Home Health Industry at Its 2014 Annual Conference and Trade Show

July 25, 2014

This past week, HCAF was joined by over 700 members and guests for 6 days of fantastic educational workshops, a bustling trade-show with top-tier vendors and prize giveaways, increased motivation for advocacy efforts, and even a bit of fun at our 2014 Annual Conference and Trade Show.

Sandy Elsass of Ponce De Leon LTC RRG addresses the conference

Held in the Buena Vista Palace Hotel and Spa, attendees participated in over 65 educational sessions covering topics such as how to get more referrals, home health marketing, upcoming CMS changes, leadership skills, employment law, compliance, wound care, and much, much more. In addition, HCAF also offered ICD-9 and ICD-10 coding courses, as well as OASIS-C training and the COS-C Certification exam.

Attendees and vendors network at the Trade Show

In the Trade Show Hall, nearly 100 home health support companies displayed their services and showed attendees how they could help their agency’s succeed. Members and guests had the opportunity to have one-on-one meetings with these vendors who could be the partners that help their business reach their own silver anniversary and beyond. Our Trade Show had even more to offer than these wonderful networking opportunities: attendees walked away with incredible prize giveaways such as a 3 hour spa package, several iPads, a $300 gift certificate to Walt Disney World, and even $500 cash! Following the Trade Show, members and vendors headed up the scenic 20Seven lounge on the 27th floor of the hotel to take in panoramic views of Walt Disney World and the surrounding area, while they enjoyed beverages, heavy hors d’oeuvre, and chatted with other guests and vendors.

 

 

Rep. Castor Dentel speaks at the PAC Breakfast

Advocacy was also a large focus at this year’s conference, with many attendees being inspired by messages from HCAF Board President Anthony Clarizio and NAHC Vice President of Law Bill Dombi that we all need to do more to convince legislators of the importance of home health in the spectrum of patient care options. They stressed the value of the Home Care PAC, HCAF’s political arm that raises money to support the campaigns of legislators who have been home care heroes in the past. This year the PAC Raised over $7,000 to use in the 2014 election; more than tripling the amount of donations from the previous year. Some of these fundx were raised through the annual Home Care PAC Breakfast, where this year PAC members heard from Rep. Karen Castor Dentel (D-Maitland) about the importance of building relationships with legislators and how home health professionals could do so.

 

 

Hundreds of attendees pack the general session hall

In short, HCAF is thrilled to have had one of our most successful conferences ever and would like to thank everyone who joined us to celebrate our 25th anniversary. We would also like to thank our generous sponsors, Ponce De Leon LTC RRG, Hometown Homecare, Kinnser Software, and Axxess, as well as our other sponsors and our hardworking volunteers. We could not have pulled off such a great event without all of these great friends. We look forward to beginning to plan our 2015 Annual Conference and Trade Show and continuing to reach our golden anniversary and beyond!

 

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Owner and Administrator of Miami Home Health Companies Pleads Guilty for Role in $74 Million Health Care Fraud Scheme

July 25, 2014

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A Miami resident who owned a home health care company and was the administrator of another home health care company pleaded guilty today for her participation in a $74 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office made the announcement.

Elsa Ruiz, 45, pleaded guilty today before U.S. District Judge Marcia G. Cooke in the Southern District of Florida to one count of conspiracy to commit health care fraud. Her sentencing is scheduled for Oct. 8, 2014.

According to court documents, Ruiz was an owner of Professional Home Care Solutions Inc. (Professional Home Care) and an administrator of LTC Professional Consultants Inc. (LTC), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Ruiz and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Also according to court documents, Ruiz ran and oversaw the schemes operating out of LTC and Professional Home Care. Ruiz and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care , as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Ruiz and her co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services.

From approximately January 2006 to June 2012, LTC and Professional Home Care submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.

Source: OIG

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Submit Comments on CMS’s Proposed Rule on 2015 Home Health PPS!

July 18, 2014
With the recent release of the 2015 CMS Proposed Rule on the Home Health Prospective Payment System, it is incumbent on providers to submit comments to CMS about the rule during the 60 day commentary period. The 2015 proposed rule stands to make significant changes to the face-to-face process, therapy assessments, and much more. The home health industry has rarely submitted much more than 100-200 comments on each years proposed rule changes to the PPS. For an industry with over 12,000 nationwide Medicare providers, our voice must be louder!
John M. Reisinger of Innovative Financial Solutions for Home Health has provided HCAF with a bookmarked version of the 2015 proposed rule in the Federal Register in order to better understand it. If you would like additional explanation, HCAF will be hosting a webinar featuring John entitled, “The Proposed Rule for 2015″. Click here for more information.
Once you are more familiar with the rule, you can click here to submit a formal comment to CMS. Speaking up as an industry is the only way we can affect positive regulatory changes for the home health industry!
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Miami Patient Recruiter Pleads Guilty for Role in $6.5 Million Health Care Fraud Scheme

July 3, 2014

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A patient recruiter for a Miami home health care agency pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Nestor’s Health Services Inc. (Nestor HH). The owner and operator of Nestor HH pleaded guilty to charges related to the scheme earlier this month.

On June 27, 2014, Euridice Borroto, 45, of Miami, Florida, pleaded guilty before U.S. Magistrate Judge Jonathan Goodman in the Southern District of Florida to one count of conspiracy to solicit and receive health care kickbacks and to defraud the United States. Sentencing is scheduled for Aug. 25, 2014.

According to court documents, Borroto was paid bribes and kickbacks for recruiting patients on behalf of Nestor HH, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. The owner and operator of Nestor HH operated Nestor HH for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

According to court documents, Borroto solicited and received kickbacks and bribes from the owner and operator of Nestor HH in return for recruiting and providing patients to Nestor HH for home health care and therapy services that were medically unnecessary and, in many instances, were not provided. Nestor HH would then fraudulently bill the Medicare program for home health care services on behalf of the recruited patients, in violation of federal criminal laws. Borroto knew that in many instances the patients she recruited for Nestor HH did not qualify for the services billed to Medicare.

From approximately March 2009 through at least January 2014, Nestor HH submitted more than $6.5 million in claims for home health services. Medicare paid Nestor HH more than $6.1 million for these fraudulent claims before the fraud was exposed.

In documents filed with the court, Borroto also acknowledged her involvement in similar fraudulent schemes at other Miami health care agencies.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Trial Attorneys Anne P. McNamara and A. Brendan Stewart of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: http://www.stopmedicarefraud.gov.


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