In The News

Is CMS’ Proposed Home Health Rate Cut Legal? Other Court Decisions Suggest No

Home Health Care News / By Andrew Donlan
 
The entire home health industry is anxiously awaiting the release of the final payment rule for 2023, which should be released by the Centers for Medicare & Medicaid Services (CMS) at some point over the next two weeks.
 
The anxiousness is due to the home health proposed payment rule, which included a 4.2% aggregate decrease in payments – or $810 million – and an avenue for future CMS clawbacks of perceived overpayments to providers.
 
Industry leaders and stakeholders have advocated against those cuts relentlessly over the past few months. They’ve also tried to gain traction on legislation, namely through the Preserving Access to Home Health Act, which was introduced in both the Senate and House in the summer. The final route to avoid payment cuts would be through legal action, though multiple sources have told Home Health Care News in the past that they’d like to avoid that at all costs.
 
However, if they did decide to go that route, there is recent and mounting legal precedent to suggest that the courts would side with the home health industry and against CMS and its ability to make as drastic cuts as the ones put forth in this year’s proposed rule.
 
Multiple sources have also told HHCN that the following could be the under-the-radar tool that could save the home health industry from cuts, either now or later.
 
Prior to 2020, CMS proposed a series of policy changes for hospitals, one of which would have reduced payment for hospitals, specifically through the 340B drug pricing program. Broadly, 340B hospitals are generally those that serve lower-income or rural populations.
 
Those cuts represented an about $1.6 billion impact on those 340B hospitals annually.
 
That impact won’t be felt moving forward, though, because the U.S. Supreme Court ruled unanimously against CMS and the U.S. Department of Health and Human Services – and thus, against the rate cuts – in American Hospital Association (AHA) v. Becerra on June 15. 
 
In the hospitals’ case, they were going to see a significant and disruptive cut to reimbursement that they believed would hurt patient care. The same goes for home health providers and their looming potential cuts. Both believe CMS is not statutorily able to cut payments in the ways in which they did, or could be. In AHA’s case, they were ruled correct by the court.

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RSV, Other Viruses Making it Hard to Find a Bed in Children’s Hospitals 

Washington Post /By Fenit Nirappil and Ariana Eunjung Cha

Children’s hospitals are under strain in the United States as they care for unusually high numbers of kids infected with RSV and other respiratory viruses.

It’s the latest example of how the pandemic has upended the usual seasonal patterns of respiratory illnesses, denying a respite for health-care professionals ahead of a potential hectic winter as the coronavirus, influenza and other viruses collide.

Respiratory syncytial virus, a common cause of cold-like illness in young children known as RSV, started surging in late summer, months before its typical season from November to early spring. This month, the United States has been recording about 5,000 cases per week, according to federal data, which is on par with last year but far higher than October 2020, when more coronavirus restrictions were in effect and very few people were getting RSV.

“It’s very hard to find a bed in a children’s hospital — specifically an intensive care unit bed for a kid with bad pneumonia or bad RSV because they are so full,” said Jesse Hackell, a doctor who chairs the committee on practice and ambulatory medicine for the American Academy of Pediatrics.

Nearly three-quarters of pediatric hospital beds are occupied, according to federal health data. Rhode Island, the District of Columbia and Delaware report more than 94 percent of pediatric beds occupied. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported between 85 and 90 percent of beds occupied. The data is limited to facilities that report the information.

Several children’s hospitals in the D.C. area have been at capacity for weeks; 18 children were waiting for a room in the ICU on Tuesday at Children’s National in the District.

D.C. Realtor Kate Foster-Bankey was more attuned to RSV after she started hearing from clients whose children were afflicted with the virus in recent weeks, including one whose child was admitted to Children’s National.

Then her 3-year-old daughter Isabelle fell ill, becoming lethargic, complaining of a fast heartbeat and not eating. They waited two hours in the packed waiting room of a pediatric urgent-care center where Foster-Bankey, a mother of four, was used to seeing only a handful of patients.

During a follow-up visit Tuesday, Isabelle was transported by ambulance to the emergency room of a children’s hospital, where she tested positive for RSV and had to wait until the following morning for a bed.

“It sounds like in covid, we gutted our pediatric care,” said Foster-Bankey, 41. “Kids shouldn’t have to wait in a waiting room with a bunch of other sick kids for hours.”

At Connecticut Children’s Hospital, the emergency room is so full that patients are being triaged in hallways. Teens with bone fractures and appendicitis are being diverted or transferred to adult-care centers to create additional space for respiratory patients. Hospital officials are considering the possibility of enlisting the National Guard to set up tents and care for the influx of patients.

Over the past nine days, 110 children with RSV have come in to the emergency room, and at times as many as 25 children with RSV were waiting for an inpatient bed, said Juan Salazar, physician in chief at Connecticut Children’s. He said that for the first time in his career he has had to mandate doctors in other specialties such as endocrinology and rheumatology work with RSV patients — a situation reminiscent of the “all hands on deck” approach many adult hospitals took in March 2020, when the coronavirus began to sweep through the United States.

“During my tenure here I haven’t seen anything like this,” said Salazar, who has worked in infectious diseases for 30 years.

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Reminder: Medicare Credit Balance Reports Due

As a reminder, the Medicare Credit Balance Report for the quarter ending September 30th is due by October 30, 2022. If we do not receive a completed CMS-838 form and/or certification page for an individual provider transaction access number (PTAN) timely, we will suspend all claim payments at 100%.

Use the myCGS Portal to:

  • Ensure your report is legible and received timely. Don't worry about delivery delays or technical issues with fax transmissions. myCGS allows you to complete and submit the required information electronically and instantly.
  • Receive confirmation. myCGS will send a message to your inbox to confirm receipt of the form.
  • Check status. Once accepted, myCGS will also send a message with a submission ID you can use to check the status.

Avoid suspension of your Medicare payments! Reference the myCGS User Manual (Financial) for step-by-step instructions and submit your Medicare Credit Balance Report in  myCGS today!

For general questions about the Medicare Credit Balance Report, please reference our website or call the Provider Contact Center:

Home Health and Hospice – 1.877.299.4500 (Option 4)

 

Med Advantage VBID Evaluation, Including Initial Take on MA VBID Hospice Component Model

CMS has released its second evaluation report for the overall MA VBID model.  This report includes the first "take" on the MA VBID Hospice Component model.  There is also a summary document of the evaluation of the hospice model.  Initial impressions include that a small  number of patients were enrolled under the model (less than 10,000 for CY2021) and only a small number received transitional concurrent care benefits. [NAHC] will be conducting further analysis.  In the meantime, following are links to the relevant document:

Hospice summary document:  innovation.cms.gov/data-and-reports/2022/...

Full evaluation report:  innovation.cms.gov/data-and-reports/2022/...  NOTE:  Chapters 6, 7, and 8 address the hospice component.

Appendices:  innovation.cms.gov/data-and-reports/2022/...

 

A Closer Look at the Tech Needed for New Care-at-Home and Aging-in-Place Models

Healthcare IT News / By Bill Siwicki
 
Connecting care teams and enabling information sharing among hospitals, group practices and, most importantly, families is crucial to helping more senior citizens get healthcare at home.
 
As people age, the subject of caring for loved ones enters the conversation. Most find this discussion escalating while events are already in motion.
 
Ashish V. Shah experienced this firsthand with his aging father. And after his dad's death, he learned how pockets of information among care teams were not shared in a meaningful way that might have delayed the fateful event.
 
Shah realized there was no easy mechanism for care teams from different providers to share information that could help patients age in place, so he set out to create one. Now he is CEO of Dina, which makes an AI-powered platform for care-at-home models.
 
Seven out of 10 people require assisted living care in their lifetimes. Studies show that most elderly people would prefer to stay at home and age rather than be moved to an assisted living facility.
 
Healthcare IT News sat down with Shah to discuss health IT's role in aging in place.
 
Q. Please describe the experience you had with caring for your aging father, and what you learned about information not being shared in a meaningful way.
 
A. Anyone who has cared for an aging parent knows it can be a challenging experience. Shortly after my previous company, Medicity, was acquired by Aetna, my father suddenly passed away. Unfortunately, this is something that you hear a lot in healthcare ventures – there's often a personal connection.
 
In my case, I'm trying to solve a problem that our family experienced. My dad was a senior citizen. He was being seen by in-home caregivers and in and out of senior centers.
 
After he passed unexpectedly, we spent time with those folks who saw a meaningful decline coming, and yet that information wasn't being shared with the formal healthcare team, definitely not his insurance company, and not with his family in a way that we could intervene to try to change his care trajectory. They were an untapped resource with a critical and objective perspective.
 
At Medicity, we were serving 1,300 hospitals, facilitating lots of data exchange across hospitals, primary care and labs, but nothing we were doing was ever going to touch the home and community. And as I dug into it more and more, I found that my story, unfortunately, is not unique. It's going to be one that grows in nature.
 
So, both out of professional and personal need, we looked for an opportunity to organize the home and community-based care ecosystem and make it easier for health systems, ACOs and health plans to extend their reach and visibility into the home, in an effort to help people maximize their healthy days at home. We launched Dina in 2015, and we've been very focused and committed to bringing the vision to life.
 
As an industry, we have two problems to solve. One is when you are a really engaged family caregiver. How do we make life easier for that person? The second is, how do we give less-engaged family members the visibility into what's happening with a loved one?
 
For us at Dina, that means how do we activate and coordinate the very best in-home care, and how do we unlock visibility into how that care is progressing to the people who are typically not part of that process, such as insurance companies, physicians, health systems, etc.

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