Literature Review

New proposed federal legislation takes aim at concerns regarding perceived “looting” of health care systems by private equity investors JDSupra - Epstein Becker Green; by Melissa Jampol, Enrique Miranda, Kathleen Premo; 7/26/24On June 11, 2024, U.S. Senators Ed Markey and Elizabeth Warren from Massachusetts, introduced proposed legislation titled The Corporate Crimes Against Health Care Act (“CCAHCA”), aimed at addressing a perceived “looting” of health care systems by for profit private equity investors. According to Sen. Warren, the bill was introduced to “root out corporate greed and private equity abuse in the health care system,” “prevent exploitative private equity practices,” and to specifically ensure that actions such as “looting” do not happen again by addressing trigger events and targeting real estate investment trusts. ... Finally, the CCAHCA would require health care entities, including, but not limited to:  ... a hospice program, a home health agency, ... to publicly report to the Secretary of Health and Human Services on an annual basis: (i) transactions entered into ... [Click on the title's link to continue reading.]

Why home health providers should expect to see a ‘less draconian’ final payment rule Home Health Care News; by Joyce Famakinwa; 7/22/24 As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule. “We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.” Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.

Hospice CARES Act would update medical reviews, seek to reduce audits Hospice News; by Jim Parker; 7/12/24 The forthcoming Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act from U.S. Rep. Earl Blumenaur (D-Oregon), if enacted, would implement a number of changes to medical review processes. ... Though the bill language is still in development, it will likely contain proposed updates to payment mechanisms for high-acuity palliative services, changes to the per-diem payment process and actions to improve quality and combat fraud. The bill would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities among recently established providers concentrated primarily in California, Arizona, Texas and Nevada. ... Among the anticipated provisions of the bill would be an item requiring the U.S. Centers for Medicare & Medicaid Services (CMS) to use documentation in a patient’s medical record as supporting material. The documentation would include the reasons that an attending physician certified a patient for hospice and establish a six-month terminal prognosis.

Chevron deference derailed The Rowan Report; by Kristin Rowan; 7/12/24 ... Chevron Deference in Home Health: Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice [NAHC] has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it. Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022. The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. [Click on the title's link to continue reading the discourse between CMS and NAHC, specific to home health.]

Senior living providers embrace role in CMS dementia care pilot program McKnights Senior Living; by Kimberly Bonvissuto; 7/11/24 Senior living providers named participants in the federal government’s new dementia care pilot program said they are excited to be part of a new effort to support people living with dementia and their family caregivers. The Center for Medicare and Medicaid Innovation, CMMI, announced the Guiding an Improved Dementia Experience, or GUIDE, model last summer. The Centers for Medicare & Medicaid Services launched the eight-year GUIDE model on July 1 and published the program participant list on Monday [7/8]. Eligible model participants are Medicare Part B-enrolled providers eligible to bill for Medicare services and that provide, or will provide, ongoing care to people living with dementia. Eligible organizations include accountable care organizations, home health and hospice agencies, Programs of All-Inclusive Care for the Elderly, and physician practices. Additional long-term care providers and other healthcare providers, however, can participate as partner organizations by contract with another Medicare provider/supplier to meet the program care delivery requirements. Assisted living residents who are Medicare beneficiaries may be part of the model. Editor's Note: Adding to our previously published posts about the new CMS GUIDE Program (7/10/24 and 7/11/24) and its use by hospice organizations, this article describes its use by senior living care providers. 

3 pillars of effective hospice sales Hospice News; by Jim Parker; 7/8/24Hospices seeking to grow should consider building a culture of compliance driven by data, effective system design and accountability, including for its sales force. Compliance and sales should walk hand-in-hand, according to a recent report from the Transcend Strategy Group. This can help prevent sales staff from running afoul of regulations inadvertently as well as support sustainable growth, according to Tony Kudner, chief strategy officer for Transcend. ... “[Without] understanding of what the rules of the road are, you’re going to run into trouble,” he said. “Though no one-size-fits-all approach exists, providers can adapt three overarching strategies to support this kind of culture.”

Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. Federal Register; Proposed Rule by the Centers for Medicare & Medicaid Services; 7/5/24

CMS: Advance health equity through accessibility CMS.gov; posted for July 2024 Throughout July, the Center for Medicare & Medicaid Services Office of Minority Health (CMS OMH) celebrates Disability Pride Month and the anniversary of the Americans with Disability Act (ADA). Twenty-seven percent of adults in the United States have some type of disability, with mobility (serious difficulty walking or climbing stairs) and cognitive (serious difficulty concentrating, remembering, or making decisions) disabilities being the most prominent types. Individuals living with disabilities often face worse overall health outcomes, including likelihood of obesity (41.6%), diabetes (15.9%), and heart disease (9.6%). ... Find these resources on our health observance page this month or our Improving Access to Care for People with Disabilities page all year long.

National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade Health Affairs - Research Article - Costs & Spending; by Jacqueline A. Fiore, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Sean P. Keehan, Kathryn E. Rennie, and Alyssa C. Gross; 6/12/24 Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. ... Amonth eh major payers, Medicare has the highest projected ten-year average spending growth rath, mainly because of enrollment into the program. [Click on the title's link to examine this article's content and tables.]

How the Supreme Court’s Chevron Decision could help stop home health cuts Home Health Care News; by Andrew Donlan; 6/28/24 On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward. The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year. Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. ... The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023. “In our own analysis, we believe that providers of home health have been underpaid as it relates to budget neutrality,” NAHC President William A. Dombi said when the lawsuit was filed. “At minimum, we would expect to see the rate cuts from 2023, that were permanent readjustments to the base rate, and the one proposed for 2024, along with the temporary adjustments … to go away. The end product of that is that we would have a stable system to deliver home health services to Medicare beneficiaries.”

[Updated] CMS proposes over 4% cut to Home Health Medicare payments in 2025 Home Health Care News; by Andrew Donlan; 6/26/24 The U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule Wednesday. With it, the agency signaled that more significant cuts could be on the way for providers. To rebalance the Patient-Driven Groupings Model (PDGM) and make it budget neutral, at least according to its internal methodology, CMS is proposing a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067%. For CY 2023 and CY 2024, CMS previously applied a 3.925% reduction and a 2.890% reduction, respectively.

The opportunity for palliative care in ACO Flex Palliative Care NEws; by Audrie Martin; 6/24/24 On Jan. 1, 2025, the Center for Medicare and Medicaid Services (CMS) Innovation Center will begin implementing a payment model for primary care known as the Accountable Care Organizations (ACOs) Primary Care Flex Model under the Medicare Shared Savings Program (MSSP). The ACO Flex Model is a voluntary initiative to improve funding and other resources to support primary care delivery within the MSSP. The model encourages the formation of new, physician-led ACOs, particularly those serving underserved communities and addressing health disparities. This program is not just a test but also seeks to empower participating ACOs and their primary care providers to employ more innovative, team-based, person-centered and proactive approaches to care. [Click on the title's link for more information.]

ASTHO and NAMD call on Congress to fully fund Medicaid and CHIP in U.S. territories ASTHO - Association of State and Territorial Health Officials; by Jane Esworthy and Stephanie Rhodes; 6/20/24 In a joint letter to Congress, the Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD) urged Congress to fully fund Medicaid and Children's Health Insurance Programs (CHIP) in the U.S. territories. ASTHO and NAMD request that Congress lift the annual Section 1108(g) allotment cap for all territories and authorize a permanent 83% Federal Medical Assistance Percentage (FMAP) for Puerto Rico. ... “ASTHO recognizes the importance of permanent, sustainable, and equitable Medicaid financing for all U.S. territories,” says Joseph Kanter, MD, MPH, ASTHO CEO. ... “Unlike the states, the U.S. territories face an annual cap on their Medicaid funding,” says Kate McEvoy, Executive Director of NAMD. “This has impaired the territories’ capacity to provide needed health care to Medicaid-eligible U.S. citizens and nationals. It has also held the territories back from making the structural investments in care delivery and value-based payment reform, workforce, IT systems, and program integrity that are crucial to high performing and innovative Medicaid programs.”