Literature Review

Hospice Claims Edits for Certifying PhysiciansCenters for Medicare & Medicaid Services (CMS); Related CR Release Date 4/18/24; Effective Date: 5/1/24; Implementation Date: 10/7/24Related CR Title: Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare EnrollmentStarting May 1, 2024, we’ll deny hospice claims if the certifying physician, including hospice physician and hospice attending physician, isn’t on our PECOS hospice ordering and referring files. This addresses hospice program integrity and quality of care per Section 6405 of the Affordable Care Act.

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.]

How Avow Hospice used triage to boost quality, reduce turnoverHospice News; by Jim Parker; 4/26/24Avow Hospice has implemented a triage system that has resulted in improved quality scores and reduced turnover. The Florida-based provider uses an acuity system that draws data from its electronic medical record (EMR) system to help stratify patients based on their most likely immediate needs. To complement these efforts, Avow also revamped its approach to night time and weekend visits, Rebecca Gatian, COO of Avow Hospice, said at the National Hospice and Palliative Care Organization’s Virtual Interdisciplinary Conference. 

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.

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. 

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."

States lack resources to support new Medicaid waiver programs, association asserts McKnights Home Care, by Adam Healy; 4/22/24 Medicaid 1115 waivers, which are commonly used to improve or expand home- and community-based services, face serious challenges as understaffed state programs are increasingly incapable of moving proposals through the administrative “pipeline,” the National Association of Medicaid Directors said in a recent letter. “The tough reality is that the Center for Medicaid and CHIP Services, which has taken many steps to streamline its administrative processes, simply does not have the staff resources to move forward all of the waivers in its pipeline,” Kate McEvoy, executive director of NAMD, wrote in the letter. 

Medicare Advantage fight shifts to 340B arena Modern Healthcare, by Alex Kacik; 4/22/24Hospitals' fight to boost Medicare Advantage reimbursement has extended to plans' pay for 340B drugs. The hospitals’ plea to adjust Medicare Advantage pay stems from regulation aimed at making providers that participate in the drug discount program whole after the Supreme Court reversed 340B rate cuts that were in place from 2018 to 2022.

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.  

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.

Care for Alzheimer's on Medicaid is unorganized, frustrating, inhumanThe Indianapolis Star, by Darcy Metcalfe; 4/14/24What it is like to die of Alzheimer’s in America? Without a doubt, it is nothing as it is portrayed on NBC’s hit series This is Us. At the end of this series, the character Rebecca dies from Alzheimer’s and falls peacefully asleep, snuggly tucked in her warm bed at home, surrounded by family and 24-hour skilled nursing care. Throughout the six seasons of This is Us, I simultaneously witnessed my father’s slow dying from Alzheimer’s in a reality that was worlds away from Rebecca’s. ...

Potential CMS measure shows divide over quality training standards Modern Healthcare, by Mari Devereaux; 4/12/24 Hospitals may soon be required to provide set quality training to staff as part of a Medicare reporting program, but health systems and advocacy organizations are split on whether the standardization of quality-related skill sets is necessary to improve patient care.