Next week, CMS will be hosting an Open Door Forum call on their proposed 5 Star ranking system for home health providers. HCAF reported on this program in last week’s edition of eHighlights regarding concerns HCAF and other association and providers have about the proposed program.
HCAF strongly recommends providers join this call and learn more about this proposed rating system. It is certain that CMS must make changes in order for consumers to be able to accurately determine the true quality of an agency using these ratings. See below for information on the FREE call and make sure to join on February 5th!
The Centers for Medicare & Medicaid Service will host a second Special Open Door Forum (SODF) call to allow consumers, home health agencies (HHAs), and other interested parties to give additional input and feedback on the planned addition of star ratings to Medicare.gov’s Home Health Compare (HHC) web site.
The call follows up on their previous call on this topic and will include:
· a summary of the comments received on the material presented at the earlier call and on other aspects of the methodology,
· a presentation of their revised methodology, and
· plans for next steps.
After the SODF presentation, the phones will be opened for comments and questions. A link to the materials for this SODF, including a slide deck, a summary of the revised proposed HHC star rating methodology, and an updated “Frequently Asked Questions” (FAQ) document will be available soon on the Home Health Quality Initiative Spotlight page here.
Comments about the star ratings system can be submitted by email after the call to the following address: HHC_Star_Ratings_Helpdesk@cms.hhs.gov
Special Open Door Forum Participation Instructions:
Participant Dial-In Number: 1-800-837-1935
Conference ID #: 73412220.
After the call, transcript and audio recording of this SODF will be posted to the Special Open Door Forum website here.
HCAF is offering training for home care billers and collectors next month in Tampa and Ft. Lauderdale. There have been many changes that were made in the 2015 HH PPS Final Rule that will affect how your agency gets paid for your services. Making sure your agency’s billers and collectors are educated on these changes, including the new Face-to-Face documentation requirements is paramount in making sure you do not become the victim of ADRs and RAC audits. Read below for more information and then click to register today!
The Home Health PPS Regulation for implementation January 2015 has brought about changes to the PPS System, but most importantly the threat of more cuts in reimbursement. Knowledgeable billers and collectors are extremely important to agencies thriving in the current system, so do not miss this needed education! Be the first to be current on all Medicare billing regulations implemented in 2015. This workshop will lay a concrete foundation for home health billing, as well as, financial staff by giving billers a more effective approach to the Medicare PPS regulation, conducting Medicare verifications and understanding adjustments. We will discuss Medicare verifications on patients with HIQH screen examples & review adjacent episode calculations – field by field on claim forms. We will review the process of auditing a pre-bill for final claim purposes, both Medicare and Non-Medicare Payers, and review the details of billing for Non-Routine Supplies using billing guidelines. More and more scrutiny of agency records has been taking place in the form of ADR and RAC reviews. This session will identify the current risks and outline steps to manage that risk. If you are part of the revenue cycle in your agency this session is a must.
After this workshop, participants will be able to:
1. Calculate and evaluate the HHRG, HIPPS Code and Episode Exceptions.
2. Verify Medicare Eligibility of patients and calculate Adjacent Episodes.
3. Complete a RAP and Final Claim form.
4. Describe the process for effectively auditing a Chart for purposes of identifying pre-bill issues and Medicare Secondary Payor Issues.
5. Establish processes to improve revenue cycle management.
Melinda Gaboury is co-founder and Chief Executive Officer of Healthcare Provider Solutions, Inc. (HPS) which provides financial, reimbursement, clinical and cost reporting services to the home health, hospice and rehabilitation therapy industries. Melinda’s priority remains bridging the gap between clinical and financial issues in home health agencies.
HCAF or other State Home Care Association Members: $149
Prospective Members: $249
Today, the U.S. District Court for the District of Columbia struck down the new Companionship Services/Overtime rule in a triumphant win for patients, staff, and providers of home health care. This ruling completely invalidates the rule, allowing for the current practices of payment for workers to remain in place indefinitely. This lawsuit which was strongly supported by HCAF and lead by the National Association of Home Care and Hospice was crucial to making sure patients would continue to be able to afford high-quality home care, as well as necessary for state budgets to be able to continue providing Medicaid home health. Your membership in associations like HCAF and NAHC is what allows us to advocate on your behalf on critical issues like this one, therefore we thank our members for their continued support and encourage all others to join today.
Please read the press release from NAHC below for details on the case. It is unclear if the Department of Labor will file an appeal on this ruling, but for now, we are celebrating this fantastic success!
NAHC, along with Home Care Patients and Caregivers, Wins Huge Victory: Federal Court Rules to Strike Down Controversial New Overtime Rule
The National Association for Home Care & Hospice (NAHC) and its members today celebrated the decision of the U.S. District Court for the District of Columbia invalidating a proposed new U. S. Department of Labor (DOL) overtime rule slated to take effect on January 1, 2015.
“This decision is a huge victory for patients and their families who will be able to continue receiving home care services without interruption. The decision is a huge victory for caregivers who will continue to be protected instead of being forced to work only part time. The decision is likewise a huge victory for the agencies that serve patients and employ caregivers, and who will see continuity in a rule that has been in effect for 40 plus years and had recently been sustained by the U.S. Supreme Court. Finally, the decision is a huge victory for the states and the federal Medicaid program.” said Denise Schrader, chairman of the NAHC Board.
This is the third victory in this lawsuit for home care interests within the last month. On December 22, the court ruled that patients are entitled to equal rights regardless of whether they or their families paid their home care bills or they were paid by the joint, federal-state health insurance program, known as Medicaid. On December 31, the court ruled for NAHC by agreeing to issue a Temporary Restraining Order (TRO) blocking the DOL from enforcing new rules related to “companionship” and “live-in” care. On January 9, the court, in considering a motion from NAHC attorneys for an injunction to block enforcement of residual parts of these rules through this date or a trial, stated that so much evidence was in the record there would be no need for a trial. The judge therefore agreed to give his decision on the case on or by January 14, when the TRO was set to expire. Today, the judge ruled for NAHC and home care interests, saying the proposed new DOL rules violated the law.
The DOL has not announced whether it will appeal this decision to U.S. Court of Appeals. NAHC President Val J. Halamandaris, stated “The home care community is prepared to defend this case before the higher court. We fought this case once before and took it all the way to the U.S. Supreme Court where we won by a unanimous vote of 8-0. We are prepared to do this again if we need to do so.”
“The victory in the case proves the power of unity,” said Halamandaris. “United, fighting on behalf of the aged, infirm, disabled, and dying, we cannot lose; divided we cannot win.” He also thanked Bill Dombi who helped lead the strategy in this case, the International Franchise Association and the Home Care Association of America which joined in the litigation and the law firm of Littler Mendelson which had been hired to bring the suit.
To read the decision, click here: https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2014cv0967-32
HCAF will continue to keep members up to speed on all the latest developments as they occur. We will be keeping a log of the events, marked with dates at the link below for members.
P.S. With all of these changes happening very quickly, we strongly suggest members attendHCAF’s 2015 Winter Mini-Conference in Ft. Lauderdale, January 21-22. There is so much change occurring at a rapid pace, that HCAF feels it is imperative that we offer an educational event to supplement our Annual Conference and offer increased learning opportunities, on important topics such as this, more often throughout the year. Registration is still open, but space is filling fast!
Another huge win for home care! This particular ruling could have major implications…..
We are very grateful to all home care providers who choose every year to support associations like NAHC and HCAF. It is your dues dollars that made this happen. Thank you.
January 5, 2015
Federal Court Rules in Favor of Homecare
Clears the Way for NAHC’s Face-to-Face Lawsuit to Go Forward
Today, a federal district court issued a resounding victory for the National Association for Home Care & Hospice (NAHC) and the home health agencies, Medicare participating physicians, caregivers, and beneficiaries it represents. The U.S. District Court for the District of Columbia held that it has the power to hear a challenge to the validity of a Medicare rule that requires physicians to provide a “narrative” explaining why the patient meets Medicare coverage standards for home health services. The court issued an order denying Medicare’s effort to have the lawsuit dismissed by the court.
The Centers for Medicare and Medicaid Services (CMS) issued a face-to-face rule that physicians had to lay eyes on patients and certify under penalty of law that that they were eligible to participate in Medicare and, more specifically, were “homebound” and needed “skilled care.” In addition, the rule required physicians to write a detailed narrative explaining the reasons why they thought this was true. This new requirement caused widespread chaos, spurred a physician rebellion, and in the end deprived many seniors from receiving the care to which they were entitled under the Medicare home health benefit.
NAHC convinced groups representing seniors and the disability community to join together with physician organizations and thereby succeeded in convincing a majority of the Senate to send a letter intervening on NAHC’s side in this matter. NAHC also filed suit in federal district court to overturn the onerous rule. The result was that CMS withdrew the physician narrative requirement which would have been effective January 1, 2015.
NAHC asked CMS to give the decision retroactive effect and pay claims that were denied between 2011 and 2014, but CMS denied to do so. NAHC made other appeals to CMS to settle the suit which it could have done by paying some $250 million owed to home health agencies for care they gave to Medicare patients between 2011-2014. This gave NAHC no choice but to proceed with the litigation.
In today’s action, the court ruled against the government on its motion to dismiss this case. The government attorneys had interposed numerous reasons, both substantive and procedural, as to why the case should not go forward, all of which were turned aside.
The court held that it would be futile for home health agencies to pursue endless administrative appeals challenging the requirement as Medicare had made it clear that it would reject all such appeals. By denying Medicare’s Motion to Dismiss, the legal validity of the narrative requirement will be fully reviewed by the federal court.
Medicare had filed a Motion to Dismiss the lawsuit arguing that administrative appeals had to be fully completed before a court had the power to hear a Medicare dispute. Medicare also argued that the case should be dismissed because the narrative requirement, on its face, was a valid interpretation of the authorizing law in the Affordable Care Act. Federal District Judge Christopher R. Cooper rejected both of these defenses.
Judge Cooper found that it would be futile for home health agencies to pursue administrative appeals because Medicare had definitively stated that it considered the requirement to be valid. NAHC had argued that Medicare had issued a final decision on the validity of the rule numerous times including when Medicare officials met with NAHC as well as in its issuance of the recent rule change that eliminated the narrative requirement. Judge Cooper agreed. He described the challenged policy as “embedded” and that “nothing indicates that administrative appeals might result in the agency overturning its regulation.”
While rejecting Medicare’s attempt to escape judicial review of the face-to-face narrative requirement, the court did grant dismissal of two additional claims in the lawsuit. NAHC also challenged the ambiguity of the interpretive guidance issued by the Centers for Medicare and Medicaid Services along with its failure to waive the recoupment of alleged overpayments under the Medicare “without fault” provision. On those matters, the court found that the factual complexities warranted a review of individual claim determinations at the administrative levels prior to any judicial intervention.
NAHC and Medicare will now move forward with the lawsuit. The next steps would include the filing of cross-motions for Summary Judgment. Summary Judgment is the equivalent of a trial on the merits of the claims where there are no material issues of facts in dispute. Here, NAHC argues that the plain language of the law prohibits Medicare from adding the burdensome narrative as a documentation requirement. The law itself only permits Medicare to require that a physician document that a face-to-face encounter occurred and when. As such, it is claim based on the language of the law itself and does not involve any facts other than that Medicare requires more documentation.
NAHC continues to litigate the dispute in spite of Medicare’s rescission of the narrative requirement to address the past claim denials and those denials that may still come involving home health services provided prior to January 1, 2015. If the lawsuit is successful, Medicare would be required to reopen and pay any claim previously denied for an insufficient narrative and stop any further claim reviews related to the narrative requirement.
NAHC continues to advise home health agencies to consider appealing any narrative-related claim denials while the lawsuit is progressing. Such action will preserve the opportunity to have the claims reviewed by Administrative Law Judges and also allow for easy identification of claims that may be subject to reopening if the lawsuit is successful.
“This great victory in federal court means that Medicare patients, physicians, and the home health community will have their day in court,” said NAHC President Val J. Halamandaris. “It is a clear signal that a federal judge also does not see why a rule which CMS had invalidated effective January 2015 should be honored for the years 2011, 2012, 2013, and 2014. There is no reason why the home care community should not be paid for the services it rendered in good faith to Medicare home health beneficiaries.”
Bill Dombi, NAHC’s Vice President for Law, appealed to CMS to save Medicare the cost of the trial. “We urged them to do the right thing. The right thing is to pay these claims. NAHC intends to pursue this litigation until CMS agrees to do so.”
Please note the really good news below. Help pass this on to other homecare providers who are members and most importantly pass it on to those providers who are not members of HCAF. This in an excellent example of what Trade Associations (National and State) can accomplish when they work together and are supported by a connected, engaged industry. With your continuing support we will gain even more ground and additional wins in 2015! Thank you all and I hope each of you have a wonderful and safe New Year’s celebration.
December 31, 2014
U.S. District Court Issues Order Blocking a New Department of Labor (DOL) Rule Which Would Redefine Companionship Services
Andrea Devoti, Chairman of the National Association for Homecare and Hospice (NAHC) today hailed the decision of the U.S. District Court for the District of Columbia which issued a Temporary Restraining Order (TRO) blocking DOL from enforcing a proposed new definition of “Companionship Services.”
“This means that our most vulnerable citizens get at least a temporary reprieve from what would otherwise have become a significant cost barrier to their paying for help at home for their chronic diseases. Without this relief many seniors would be pushed into institutional care,” said Ms. Devoti.
This decision follows on the heels of a December 22 ruling by this same Court which restored the rights of home care consumers to benefit from the “companionship services” and “live-in” exemptions regardless of whether their caregivers were employed by persons receiving the care or by a home care company.
The lawsuit challenges a rule that would have significantly changed a longstanding 40 year old Federal overtime rule known as the ‘companionship exemption’ under the Fair Labor Standards Act. The new rule would have defined ‘companionship services’ to be primarily “fellowship” and “protection”. Under the new DOL rule, the exemption would not have applied if home care workers serving patients gave more than incidental personal care services. The proposed rule would have required all current caregivers to be paid overtime compensation in almost all cases. This change would have led to higher costs which would have to be borne by infirm individuals or by the states and federal government through financially strapped programs such as Medicaid.
Following the court’s ruling on December 22, NAHC asked the court to stay the effective date of a new narrow definition of “companionship services”, which seemed to have the intent to eliminate two exemptions to overtime rules which benefit patients and home care employers.
In its motion for a temporary stay, NAHC argued that home care recipients, companies, employees, and payers of services would face a risk of irreparable harm if the DOL rule went into effect. NAHC also explained that it would be likely that its claims would succeed on the merits and that the public interest would be best served by maintaining the status quo on overtime exemptions while the lawsuit proceeds.
The effort for temporary relief was supported with detailed affidavits of likely harm submitted by two disability rights advocacy groups, The Centers for Independent Living and ADAPT along with the Kansas state Department on Aging which is concerned about the financial stability of its home care programs if overtime compensation is required.
The next phase of the case will occur quickly, as the court has scheduled a briefing and a hearing on whether a Preliminary Injunction should be issued. A TRO can be in force for no more than 14 days while a Preliminary Injunction can be in effect until a final ruling on the case.
The hearing is set for January 9. The judge indicated that he may rule on the preliminary injunction at the hearing, but he would rule no later than January 13.
During the time in which the TRO is in effect, home care companies can continue to pay home care aides and personal care attendants without added overtime compensation (as per usual in Florida). Home care companies are advised to consult competent counsel to determine if they qualify to use the exemption. If the requested injunction is granted on January 9, the exemption from overtime will continue until the court’s final ruling or the Court of Appeals reverses the injunction. The Department of Labor has previously indicated that it would appeal any adverse ruling of the court.
“Obviously some well intentioned people in the DOL put forth a rule which they said would be good for patients, helpful to homecare employees, and the companies that hire them, and equally good for State/Federal programs such as Medicaid. The fact is that the proposed regulation would have had exactly the opposite effect on every category. For this reason NAHC applauds the US District Court for its rulings and will continue to lead the effort in support of the companionship rules as they have been in effect for more than 40 years, and which have been sustained by a unanimous vote in the U.S. Supreme Court,” said Chairman Devoti.
HCAF is proud to recognize three of our members for being awarded HHCAHPS Honors by Deyta. Each year, Deyta recognizes agencies around the country who continuously provide quality care as measured from the patient’s point of view. These agencies achieve the highest levels of patient satisfaction. This leads to both patient and agency success.
Award recipients are identified by evaluating performance on a set of nineteen satisfaction indicator measures. Individual agency performance scores were aggregated for the evaluation period and were compared on a question-by-question basis to a national average score calculated from more than 1,800 partnering home health agencies contained in Deyta’s HHCAHPS database. HHCAHPS Honors recipients include those agencies scoring above the Deyta National Average on at least eighty-five percent, or seventeen, of the evaluated questions.
This year’s member honorees were:
Ortho Home Health Care – Jacksonville, FL
S.E.T. Home Health – Crystal River, FL
Suwannee Medical Personnel – Jacksonville, FL
In addition, S.E.T. Home Health was recognized as an Elite Honoree. Deyta holds a special recognition, HHCAHPS Honors Elite, to honor home health agencies scoring above the Deyta National Average on one hundred percent, or all nineteen, of the evaluated questions.
HCAF is very proud to have these agencies as our members and would like to congratulate them on being recognized for such high standards of patient satisfaction.
The Office of the Inspector General (OIG) recently released its annual work plan. The Work Plan for 2015 specifically addresses issues for home health and hospice.
Overall, the Office of Inspector General (OIG) has identified reducing waste in Medicare Parts A and B and ensuring quality, including in nursing home, hospice care, and home- and community-based care, as top management challenges facing the Department. OIG has focused its efforts on reducing improper payments, improving quality and access, and fostering economical payment policies.
Work planning for fiscal year (FY) 2015 and beyond will consider the following:
Protecting an expanding Medicaid program from fraud, waste, and abuse takes on a heightened urgency as the program continues to grow in spending and in the number of people that it serves. The OIG’s continuing and new reviews of Medicaid in fiscal year (FY) 2015 address: prescription drugs; billing, payment, reimbursement, quality, and safety of home health services, community-based care, and other services, equipment, and supplies; State management of Medicaid, information system controls and security, and Medicaid managed care.
There were two issues specific to home health providers and one for Medicaid home health agencies. These topics have been part of the OIG’s previous work plans. The OIG’s plan for FY2015 for each of these areas is copied below.
Home health prospective payment system requirements:
“We will review compliance with various aspects of the home health PPS, including the documentation required in support of the claims paid by Medicare. We will determine whether home health claims were paid in accordance with Federal laws and regulations. A prior OIG report found that one in four home health agencies (HHAs) had questionable billing. Further, CMS designated newly enrolling HHAs as high-risk providers, citing their record of fraud, waste, and abuse. Since 2010, nearly $1 billion in improper Medicare payments and fraud has been identified relating to the home health benefit. Home health services include part-time or intermittent skilled nursing care, as well as other skilled care services, such as physical, occupational, and speech therapy; medical social work; and home health aide services.” OAS; W-00-13-35501; W-00-14-35501; various reviews; expected issue date: FY 2015.
Employment of individuals with criminal convictions:
“We will determine the extent to which HHAs employed individuals with criminal convictions. We will also examine the criminal convictions of selected employees with potentially disqualifying convictions. Federal law requires that HHAs comply with all applicable State and local laws and regulations. (Social Security Act, §1891(a)(5), implemented at 42 CFR §484.12(a).) Nearly all States have laws prohibiting certain health-care-related entities from employing individuals with certain types of criminal convictions.” OEI; 07-14-00130; expected issue date: FY 2015.
Screenings of health care workers
“We will review health-screening records of Medicaid home health agency (HHA) health care workers to determine whether they were screened in accordance with Federal and State requirements. Health screenings for home health care workers include vaccinations, such as those for hepatitis and influenza. HHAs provide health care services to Medicaid beneficiaries while the home health care workers are visiting beneficiaries’ homes. HHAs must operate and provide services in compliance with all applicable Federal, State, and local laws and regulations and with accepted standards that apply to personnel providing services within such an agency. (Social Security Act, §1891(a)(5).) The Federal requirements for home health services are found at 42 CFR §§440.70, 441.15, and 441.16 and at 42 CFR Part 484. Other applicable requirements are found in State and local regulations.” OAS; W-00-11-31387; various reviews; expected issue date: FY2015.
In 2013, the National Association for Home Care & Hospice along with its affiliates, the National Council on Medicaid Home Care and the National Private Duty Home Care Association, conducted the first and only national survey on the impact of the ACA employer mandate on home care. The findings were eye-opening for the home care industry, government officials, and policymakers. Overall, the findings showed that home care companies – particularly those that primarily provided Medicaid-funded services or focused on private pay personal care services – were at high risk of significant ACA penalties.
The ACA employer mandate survey has been used extensively by HCAF and others in the advocacy efforts on the employer mandate. Those efforts led, in part, to the initial postponement of the mandate in late 2013 and the additional postponements and adjustments effective for 2014. This advocacy also triggered a series of congressional proposals to modify or delay the mandate, including H.R. 5098 and S. 1330 that would further delay the start date of the mandate. H.R. 5098 is completely focused on a delay for Medicaid and Medicare dependent health care businesses. Also, both houses of Congress have legislation pending, S. 1188 and H.R. 2988, which would redefine “full-time” at 40 hours per week.
NAHC has prepared a new survey to get a “real-time” understanding of the likely impact of the ACA employer mandate. Home care businesses have made a number of adjustments to prepare for the start of the mandate. This new survey will create the opportunity for further evidence-based advocacy.
HCAF encourages every company that provides any form of home care to complete the survey as soon as possible. NAHC is working with other state home care and hospice associations to get the word out on the survey. Other national stakeholder organizations are joining this effort as well.
The survey can be found here.
The employer mandate responsibilities In the Affordable Care Act are scheduled to take effect on January 1, 2015. Employers of 100 or more full-time equivalent employees (FTEs) will be required to either offer a qualified health plan to all their full-time employees or face a potential financial penalty. For purposes of this law, a “full-time employee” is an individual who works 30 hours or more per week. The Internal Revenue Service (IRS) has determined that the requirement will be applied on a monthly basis using 130 hours per month as the standard for full-time.
For employers of 50-99 FTEs, the mandate takes effect on January 1, 2016.
The employer mandate involves a fairly complex formula for determining whether and how it applies to businesses. Each business should be individually evaluated to determine if and how the requirements apply to it. The cost of a qualified health insurance can be quite high. Likewise, the penalty cost can be as well, with the penalties set at $2000 each for all full-time employee (after the first 30 are exempted) when the employer does not offer a qualified plan so long as one of the full-time employees qualifies for a receive a federal subsidy. The penalty is set at $3000 for each full-time employee that qualifies for a federal subsidy through the insurance exchange when the employer does offer a qualified health insurance.