Literature Review

Payment cuts are having a compounding, dire effect on the home health industry Home Health Care News; by Andrew Donlan; 4/25/24 Home health providers’ fight against cuts to fee-for-service Medicare payment has become a year-by-year battle. But the yearly cuts are compounding, which is exactly what industry advocates are trying to illustrate to Congress prior to the next payment rule proposal. ... Many of the cuts CMS has implemented are permanent, and multiple cuts on top of each other moving forward – plus unsatisfactory adjustments for inflation – are putting significant pressure on providers.

Hospice groups, AOs speak out on proposed Accreditor Oversight Rule Hospice News; by Jim Parker; 4/22/24Some accreditation organizations (AOs) have balked at the U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed rule designed to strengthen oversight of those institutions. ... Three such organizations currently have deeming authority for hospices, The Joint Commission, the Accreditation Commission for Health Care (ACHC) and Community Health Accreditation Partner (CHAP). These accreditors have joined a host of other stakeholders in making public comments on the proposed rule, with some requesting clarifications and others outright denying that CMS has the authority to establish such requirements.

Analysis finds 4 in 5 nursing facilities don’t meet staffing requirements McKnights Long-Term Care News, by Josh Henreckson; 4/24/24 More than 80% of nursing homes do not meet the updated requirements in the final staffing mandate from the Centers for Medicare & Medicaid Services, according to new analysis from media outlet KFF. Those findings further amplify the chorus of concerns raised by providers following the news that CMS was raising its proposed requirement of 3.0 hours of care per resident per day to 3.48 in Monday’s final rule. CMS leaders, including Administrator Chiquita Brooks-LaSure, attempted to address sector questions and concerns at a press event Tuesday afternoon. ...

Medicare Advantage complaints that the plans don’t want – and the review of systems that wasn’t done RACmonitor, by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 4/24/24 ... In the past, I have talked about complaining to your regional Centers for Medicare & Medicaid Services (CMS) office about violations of CMS-4201-F, but Dr. [Eddie] Hu described how to do it to actually get action. [Click on the title's link for details] ... Now, why should you take the time to file these complaints? ... Why should you take the time to file these complaints? Because CMS tracks formal complaints, and a lot of complaints can significantly affect their quality bonus – and we know how when their money is at risk, the MA plans suddenly pay attention. ...

CMS increases hours to 3.48 in final staffing rule McKnights Long-Term Care News, by Kimberly Marselas; 4/22/24 Nursing homes will be required to deliver 3.48 hours of daily direct care per patient under a final staffing mandate issued this morning. A White House statement on the rule [4/22] said that 3.0 hours must be split between registered nurses at 0.55 hours and 2.45 hours for certified nurse aides. The remaining time was not immediately defined by the White House release, and the full rule text was not available.

What the ‘fundamentally contradicting’ Medicaid Access Rule includes Home Health Care News, by Andrew Donlan; 4/22/24 The White House teased the finalized Medicaid Access Rule early Monday, and the Centers for Medicare & Medicaid Services (CMS) later revealed more intricate details attached to the rule. [The] timeline of the rule is now clear. Specifically: ... [Click on the title's link for more]

Support mounts for increased hospice accreditor oversightHospice News; by Holly Vossel; 4/16/24Calls are growing louder in support of increased accreditation organization oversight that could help curb fraudulent activity in the hospice space. In a proposed rule released in February the U.S. Centers for Medicare & Medicaid Services (CMS) introduced a number of provisions aimed at addressing conflicts of interest and establishing more consistent standards, processes and definitions among accreditation entities. The proposed increased oversight would be an important step forward in addressing instances of fraud, waste and abuse in hospice, according to members of the California Hospice and Palliative Care Association (CHAPCA). Regulatory changes such as these would be particularly significant in detecting maleficence in regions like California, which have a rise in program integrity challenges, the organization stated in a recent letter to Congress shared with Hospice News.Notable mentions: Sheila Clark, California Hospice and Palliative Care Association.

Md. health dept. processed 1.5 million Medicaid enrollees in 12 months; one month left in ‘unwinding’Maryland Matters, by Danielle J. Brown; 4/19/24... Prior to the pandemic people with Medicaid insurance had to reapply annually. Medicaid terminations were paused over the COVID pandemic in order to ensure people were covered during a global health crisis. But starting in 2023, Medicaid re-enrollments were no longer automatic, and people had to reenroll in the program to continue coverage in a period often referred to as the ‘Medicaid unwind.’ ... At the start of the unwinding period, the data show that there were about 1,787,000 people enrolled in Medicaid in March 2023. A year later, there are 1,690,000 people covered by the program. ... But most of the terminations are due to what are called “procedural terminations,” which means that someone either did not start or did not complete their Medicaid reapplication. ... People with procedural terminations have short window after losing coverage when they can reapply to Medicaid and get covered again if they are still eligible.  

What home health providers can learn from CMS’ other proposed rules for 2025Home Health Care News, by Joyce Famakinwa; 4/19/24... CMS released the 2025 proposed payment rules for hospice and skilled nursing facilities (SNFs) in March. On the hospice side, the proposed rule included a 2.6% increase in the per diem base rate. Aside from the pay raise for hospices, the proposal also included a market basket index update, and notable changes to some of the geographic areas subject to particular indices. “There are rural areas that became urban and urban areas that became rural in the new CBSs — core based statistical areas,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.

Medicaid Access Rule review completed by White House McKnights Senior Living, by Lois A. Bowers; 4/16/24A proposed federal rule establishing mandatory quality measures for home- and community-based services and requiring providers to allocate 80% of HCBS payments to direct care worker pay is one step closer to being finalized. The White House Office of Management and Budget’s Office of Information and Regulatory Affairs has completed its review of the Centers for Medicare & Medicaid Services’s so-called Medicaid Access Rule, according to the agency’s website.

 Health Care Fraud and Abuse 2023 Year in ReviewJD Supra; by Kevin Coffey, Meredith Eng, Haley Essner, Rebecca Hsu, Christopher Kim, Tessa Lancaster, Dayna LaPlante, Logan Moore, Angela Powers; 4/12/24 Polsinelli proudly introduces the Health Care Fraud and Abuse 2023 Year in Review, a comprehensive examination of the evolving landscape surrounding the False Claims Act (“FCA”) and fraud & abuse enforcement efforts in the United States. Since its significant amendments in 1986, the FCA has stood as a formidable tool in combating health care fraud, with the Department of Justice reclaiming over $75 billion in allegedly fraudulent proceeds. 

Central Oregon hospice sues feds over challenged Medicare claims The Lund Report, by Nick Budnick; 4/11/24 One of a declining number of nonprofit hospice providers, Partners In Care leaders have successfully defended the vast majority of disputed claims, but have sued to erase the rest while challenging government methods. The case could have 'huge ramifications' and will be closely watched.

How MA Plan design affects utilization, health equity MedCity News, by Marissa Pescia; 4/8/24 A new study found that enrollees with zero-premium MA plans are three times as likely to be non-White compared to other MA enrollees and traditional Medicare enrollees. ... The study was published by Harvard Medical School and Inovalon, a provider of cloud-based software solutions. It used Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry dataset, which “tracks demographic characteristics and outcomes for about 30% of all MA members at any given point in time,” according to the report.