Literature Review

HHS issues new rule to strengthen nondiscrimination protections and advance Civil Rights in health careHHS Press Office; 4/26/24Today, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. By taking bold action to strengthen protections against discrimination on the basis of race, color, national origin, sex, age, and disability, this rule reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.

Federal Court halts lawsuit over Medicare home health payments Bloomberg Law; by Tony Pugh; 4/28/24 A federal court in Washington DC tossed a lawsuit against HHS over a disputed payment system that has slashed reimbursements for thousands of home health agencies since it was implemented in 2020. The US District Court for the District of Columbia ruled in a memorandum opinion on April 26 that plaintiffs in the suit by the National Association for Home Care & Hospice (NAHC) failed to exhaust their administrative rememdies because they "skipped the agency's process for seeking expedited judicial review." Because of that, the court "will grant the federal government's motion for summary judgment." [Additional content may require subscription.]

Congresswoman Kat Cammack introduces legislation to block 80-20 Rule Home Health Care News; by Joyce Famakinwa; 4/26/24 ... On Thursday, Congresswoman Kat Cammack (R-Fla.) introduced a bill to block the U.S. Department of Health and Human Services (HHS) from finalizing the 80-20 provision. Additionally, the legislation would also block HHS from implementing any similar rules that place a minimum requirement for how much of Medicaid spending on HCBS goes towards direct workers’ wages. Cammack’s reason for introducing this legislation is her belief that the 80-20 provision will severely limit access to care at a time when providers are already struggling to serve patients.

Relief provisions not enough to mitigate damage of 80/20 policy, providers say McKnights Home Care; by Adam Healy; 4/24/24 Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate. “Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,”  the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published. 

Getting your claims denied? Here are reasons why and what you can do about itMedial Economics; by Gretchen Heinen, RN, PHN, BSN and Wael Khouli, MD, MBA; 4/25/24A recent voluntary, national survey by Premier shed new light on denied claims. The survey, conducted from October to December 2023, revealed that nearly 15% of all claims across Medicare Advantage, Medicaid, Commercial, and Managed Medicaid are denied. Of those denied claims, 45% to 60% were overturned, albeit with a costly appeal process sometimes involving multiple appeals. ... With a skillfully crafted appeal letter, a denial can be overturned 50% to 70% of the time. In this article, we will cover denial basics, reasons for claim denials, and actions to take. It is crucial to address all potential reasons for claim denial, including: ...

NAHC expresses disappointment regarding Medicaid Access Rule HomeCare; 4/23/24 The National Association for Home Care & Hospice (NAHC) released a statement noting that it was, 'extremely disappointed that the Centers for Medicare and Medicaid Services (CMS) elected to finalize the “payment adequacy” provision in the Medicaid Access Final Rule (CMS 2442-F).' "This is a misguided policy that will result in agency closures, force providers to exit the Medicaid program, and will ultimately make access issues worse around the country," a statement from the organization read. "As NAHC and our partners across the homecare industry have demonstrated, such a provision is not only unworkable due to the varied nature of Medicaid programs across the country, CMS also lacks statutory authority to impose this mandate."

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.

Increasing Hospice CAHPS scores through enhanced caregiver training Hospice News, by Jim Parker; 4/19/24 Improving education and training for family caregivers may give hospices’ quality scores a boost. Maryland-based Hospice of the Chesapeake has introduced a standardized caregiver training program designed to enhance the work they had previously done in this area. After a review of scientific literature, it became clear that nationally, caregiver training was spotty, and this affected families’ perceptions of the care their loved one received, Monica Ferebee, clinical manager of hospice at Hospice of the Chesapeake ... More than 70% of hospice patients are primarily cared for by untrained family caregivers with no medical background, Ferebee found. She led Chesapeake’s change project to address these concerns, and thereby improve performance on Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. 

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.

Examining how improper payments cost taxpayers billions and weaken Medicare and Medicaid HHS-OIG; by Christi A. Grimm, Inspector General, Office of Inspector General, U.S. Department of Health and Human Services; 4/16/24 HHS Inspector General Christi A. Grimm Testifies Before the U.S. House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations on April 16, 2024. IG Grimm briefs members on HHS-OIG's work to address improper payments in Medicare and Medicaid managed care programs. Click here to watch the testimony.

Mississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’Mississippi Today - Legislature; by Bobby Harrison and Geoff Pender; 4/17/24Hundreds of people rallied at the Mississippi Capitol for a second day Wednesday, urging lawmakers to expand Medicaid to provide health coverage for an estimated 200,000 Mississippians. ... Speakers recounted their struggles with access to affordable health care in Mississippi and chanted for the Legislature to, “Close the coverage gap now,” and for “Full Medicaid expansion now.” ... [Dr. Randy] Easterling recounted a story of two of his friends diagnosed with similar cancers. One was uninsured and self-employed, and did not get early diagnosis or treatment. He’s now in hospice and on death’s door. The other friend, with insurance, received an early diagnosis and treatment and is now cancer free.

In two states, transforming the model for palliative care [CA & HI]Undark, by Meredith Lidard Kleeman; 4/16/24 "Being ill is like a full-time job,” said Andrew E. Kaufman, a 60-year-old author. Kaufman lives with myasthenia gravis, a neuromuscular disease, as well as other chronic conditions, and his self-care requires a lot of time — and communication. The cascade of his own needs “is frustrating and causes anxiety and a whole host of issues.” Lucky for Kaufman, he lives in California, where he has help from a palliative care team. California is one of the first states in the country to require insurance companies that administer Medicaid benefits to fully cover palliative care services for eligible residents. Editor's Note: Click on the title's link to read more, as this use redefines "palliative care."