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Put the Brakes on PAYGO, Providers Tell Congress
McKnights Home Care | By Diane Eastabrook
The National Association of Home Care & Hospice and the National Hospice and Palliative Care Organization recently urged Washington lawmakers to prevent the statutory Pay-As-You-Go sequestration cuts to Medicare from taking effect at the end of this congressional session.
In a letter to House and Senate leaders, NAHC, NHPCO and five other provider groups said failure to waive PAYGO would result in $38 billion in cuts to Medicare next year, which would have a devastating and destabilizing impact on healthcare access.
“In previous years Congress has stepped in to pass legislation to avoid triggering PAYGO,” the letter stated. “Congress once again needs to waive these cuts, to prevent them from taking effect in 2023. We urge Congress to prevent these cuts. Now is not the time for reductions in Medicare payments to providers.”
Home health also is contending with a $635 million cut scheduled to take effect in 2023 related to the final Medicare home health rule.
The Pay-As-You-Go Act of 2010 requires across-the-board reductions in Medicare payments to providers, including home health and hospice agencies. Congress paused a 4% PAYGO cut in 2020 at the beginning of the COVID-19 pandemic. The cut was supposed to resume this year, but Congress voted in late 2021 to delay it another year.
PAYGO is aimed at preventing the introduction of any new laws that would increase projected budget deficits. |
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Informational Memo - Private Duty Nursing (PDN) Temporary Administrative Approval Process Extension (Dec. 6, 2022)
The purpose of this Informational Memo is to inform stakeholders of an extension to the temporary administrative approval process for PDN services through at least Feb. 28, 2023, and what this means for members and providers. Based on stakeholder feedback, the Department also intends to use this memo to clarify ongoing PDN benefit information for members and stakeholders and reiterate provider responsibilities related to the PDN benefit.
Read Full Memo |
Help HHAU and HCAOA Pass the Homecare for Seniors Act!
The Homecare for Seniors Act is gaining serious momentum in Washington, DC, and we need your help to get it passed and signed into law!
As you may know, the bill would allow home care services to be paid for with money from a Health Savings Account. Senator Kyrsten Sinema (D-AZ), the sponsor of the bill, has formally asked Senate leaders to add this bill to an end-of-the-year package of bills, making it much more likely that it will pass.
PLEASE CLICK HERE to have a pre-written letter sent to your member of Congress and your Senators asking them to support the Homecare for Seniors Act now! Make your voice heard in Washington and help make homecare more affordable!
Thank you for your advocacy! |
Now Available– Final OASIS-E Instrument and OASIS-E Changes from Draft to Final Instrument & Manual
The final OASIS-E instrument, effective January 1, 2023, is available in the Downloads section on the OASIS Data Sets page. A log of changes from the draft to final instrument and Manual is also available in the Downloads section on the OASIS Users Manuals page. |
Providers Cheer CMS Proposal to Streamline Prior Authorizations
McKnight’s Home Care | By Diane Eastabrook
Provider advocates are applauding a proposed rule by the Centers for Medicare & Medicaid Services that would speed up prior authorization of healthcare services by payers.
The proposal would require Medicare Advantage (MA) plans, Medicaid and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to streamline their prior authorization processes. Payers would be required to respond to urgent requests for healthcare services within 72 hours and standard requests within seven calendar days. They would also be required to include a specific reason when denying requests and publicly report certain prior authorization metrics.
“We are very pleased that CMS has recognized the value and importance of expediting prior authorizations in MA plans and Medicaid,” National Association for Home Care & Hospice President and CEO William Dombi told McKnight’s Home Care Daily Pulse on Wednesday. “Patient needs warrant quick and accurate decisions by payers.”
The proposal also includes other administrative guardrails, including a requirement that certain payers implement standards that would allow patient data be exchanged seamlessly between payers when a patient switches coverage or when they have concurrent coverage.
CMS Administrator Chiquita Brooks-LaSure said the goal of the rule is to “improve the care experience across providers, patients and caregivers — helping us to address avoidable delays in patient care and achieve better health outcomes for all.”
CMS will accept public comment for the proposed rule through March 13, 2023.
The agency isn’t the only group in Washington taking aim at prior authorization by payers, especially among MA plans. Legislation that would require MA plans to streamline the process sailed through the House last September and is pending before the Senate.
MA plans have also come under fire from government watchdog Office of Inspector General for denying and delaying services to older adults covered under those plans.
Read Full Article |
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