Tell Congress to Stop the Medicaid HCBS 80/20 Pass Through!

NAHC Report

In the Medicaid Access Rule CMS finalized a requirement that no less than 80% of all Medicaid payments, including but not limited to base payments and supplemental payments, be spent on compensation to direct care workers, for homemaker services, home health aide services, and personal care services. This requirement applies to services delivered under sections 1915(c), (i), (j), (k), and potentially also 1115 of the Social Security Act as well as those delivered through managed care contracts. Notably, it would not apply to 1905(a) State plan personal care and home health services.

The rule defines “compensation” narrowly as:

• Salary and wages;
• Benefits (such as health and dental benefits, paid leave, and tuition reimbursement);
• The employer share of payroll taxes for direct care workers; and
• Other remuneration as defined by the Fair Labor Standards Act

Importantly, the rule’s definition neglects to include other crucial costs necessary to provide services.

There are significant negative outcomes that would occur if the 80-20 provision is finalized, including:

• This provision will reduce, not increase, access. Individuals who rely on HCBS to live their lives in home-based settings will lose services, particularly if providers cannot meet these new requirements or are forced to restrict innovative, value-added care supports.
• The provision appears to have been arbitrarily created and not based on data or an explained rationale.
• The restrictive threshold definitions will serve to limit resources for caregiver support and other enhanced care-focused operations, resulting in reduced quality, health and safety, and oversight in HCBS.
• The blanket approach undermines state autonomy, creates stark inequities across and within states, limits the ability to modify program requirements, and penalizes providers and states that have more regulation and oversight.
• The provision seeks to establish precedent that CMS/HHS has the authority to dictate how state Medicaid dollars are spent by private entities.
• CMS imposes this mandate with no existing or planned infrastructure for collecting and reporting out accurate information, financing to support added resource needs, or data to ensure that the dollars are being distributed as intended.

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NAHC President Bill Dombi: Hospices in for a ‘Bumpy Ride to New Era’

Hospice News / By Holly Vossel

The Medicare Hospice Benefit is ripe for change nearly four decades after its establishment, but moving the needle will include a heavy lift around evolving regulations.

This is according to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC). The hospice industry is undergoing tremendous changes amid rising demand and increased regulatory oversight, Dombi said at NAHC’s Financial Management Conference in Las Vegas.

“Hospice has been on a long-standing honeymoon,” Dombi told Hospice News at the conference. “But hospice has moved into a new era. It’s a very mature benefit at this point and all signs are that people in Congress and at [the U.S. Centers for Medicare & Medicaid Services (CMS)] think it’s overdue for some reform. Hospice is facing potential massive reform.”

Among the signs of major reform on the horizon is an intensified survey and auditing climate in recent years, Dombi stated.

More than half (52.9%) of hospice providers reported undergoing more than one audit simultaneously within a six month period in a survey from LeadingAge, the National Partnership for Healthcare and Hospice Innovation (NPHI), NAHC and the National Hospice and Palliative Care Organization (NHPCO).

NAHC and NHPCO have since recently affiliated, with a new organization name yet to be announced.

Hospices will need a sharp compliance focus with ongoing internal assessments around their admission processes and care delivery approaches to navigate forthcoming changes, according to Dombi. Issues of fraud in the hospice industry echo events that previously affected the home health space, and providers can learn from that prior experience, he said…

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US Judge Elects Not To Block Non-Compete Ban, Spelling Trouble For Home Care Providers

Home Health Care News / By Andrew Donlan
 
A U.S. judge decided not to block the Federal Trade Commission’s (FTC) ban on non-compete agreements this week, continuing an ongoing saga that home care providers are paying close attention to. 
 
Broadly, the ban on non-competes is seen as generally positive for home care leaders, who can now freely move on to better career opportunities. It likely won’t affect caregivers much, as many already work for more than one agency. 
 
Where it will likely have an effect, however, is in non-solicitation agreements. Those keep clients from using home care agency caregivers, and then ultimately hiring those caregivers directly and cutting out the agency. A non-solicitation is different from a non-compete, of course, but some states are already viewing them in the same light, which could be a major threat to home care operators. 
 
The FTC in April banned non-competes in a 3-2 vote. It was a major change in direction, specifically because non-compete laws were historically handled on a state level. Some states – like California and Connecticut – already had very strict laws against non-compete agreements. Other states were less strict. 
But this ban comes from the federal level. 
 
“The rulings and the positions are going beyond just the traditional non-compete agreement into client service agreements that have direct-hire provisions or penalty provisions not allowing the client to hire the caregiver away,” Angelo Spinola, the home health, home care and hospice chair at the law firm Polsinelli, recently told Home Health Care News. “That’s a big concern with what the FTC is doing – that they’re going to take that position and apply the term non-compete very broadly. If you look at the language of the final rule, it absolutely suggests that’s going to be their enforcement position.”…

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CMS Issues Home Health Claims Processing Fix

NAHC Report

The Centers for Medicare & Medicaid Services has issue Change Request 13684 that provides instructions to the Medicare Administrative Contractors (MACs) to ensure home health claims submitted more than 24 months from the date of admission are not returned in error due to Notice of Admission records being purged from the Fiscal Intermediary Shared System (FSS).

During the processing of a Home Health (HH) prospective payment system claim, the claim is matched to the corresponding Notice of Admission (NOA) to determine the NOA receipt date. The NOA receipt date is then used to apply any applicable late NOA penalty to the claim payment. The NOA receipt date is stored in FISS in the HRAP (Request for Anticipated Payment) file). If an NOA receipt date is not found in the HRAP file, the claim is returned to the provider with reason code 19963.

Previous instructions stated where a corresponding NOA cannot be found and the claim From date is 24 months or more after the claim Admission date, the contractor shall send the claim Admission date to the HH Pricer in the RECEIPT DATE field.” In these cases, the NOA is assumed to have been received in the past and subsequently purged. However, a claim may have a From date within 24 months of the Admission date but a Through date that falls after 24 months. In these cases, the claim cannot be processed because the NOA will be purged.

This CR revises the criteria for reason code 19963 to send the claim Admission date to the HH Pricer in the RECEIPT DATE field in these cases also. Several home health agencies have reported a significant number of claims impacted by this issue claims and have had to rely on intervention by the MACs.