NHPCO and NAHC Issue Update on Certifying Physician Enrollment Requirements
NHPCO Summary at a Glance
May 1, 2024, a new hospice claims edit will be implemented. This edit, associated with the condition of payment finalized in the Fiscal Year (FY) 2024 Hospice Wage Index final rule, requires that the hospice certifying physician(s) be enrolled in Medicare or have a valid opt-out on file. This has raised many questions and concerns about the implementation of the edit from both hospice providers and Electronic Health Record (EHR) companies due to lack of clarity and conflicting information in instructions and guidance.
Two key points for hospices to know at this time are:
- As long as the Attending Physician field on the claim contains the NPI of a physician that is enrolled or validly opted-out, the edit that goes into effect on May 1 will allow the claim to process and be paid.
- The edit that goes live on May 1 will only verify the physician listed in the Attending Physician field on the claim. On October 7, 2024, a new edit will go live that will verify the physician listed in the Attending Physician field on the claim and the physician listed in the Referring Physician (Other Physician) field on the claim.
NHPCO and NAHC are working on a Frequently Asked Questions document and plan to publish this in the near future. Any questions can be directed to [email protected]. |
President Biden and Secretary Becerra Discuss Medicaid Access Rule
NAHC Report
Recent comments from leaders within the Executive Branch foreshadow a required passthrough within the Medicaid Access Final rule, which will likely be released before the end of April. On Tuesday, April 9th, President Joe Biden addressed a gathering of advocates focused on the “care economy,” a term used to encompass the childcare and long-term care workforces. As part of his remarks, the President promised, “in the coming weeks, we plan to release new rules to strengthen staffing standards in nursing homes, to get homecare workers a bigger share of Medicaid payments.”
On Thursday, April 11th, Secretary Becerra provided additional details on the Medicaid Access Rule, telling a separate group of advocates for care economy workers that the Administration would advance a rule, “that lift the wages of homecare workers, because what it will do, it will say every time we make a payment to whoever is getting the money to do the service, 80% of it has to go to the worker. 80%. No more of this, ‘well, we have a high overhead,’ or we had to increase our executive wage. No, 80% of dollars paid out must be focused on the workers.”
The remarks from these leaders refer to the Medicaid Access Rule, which was initially proposed in May 2023 and contains a provision that would mandate 80% of all Medicaid payments for homemaker, home health aide, and personal care services be paid as compensation to direct care workers. While well intentioned, the rule does not account for the various regulatory and statutory requirements associated with delivering these services, such as nurse supervision, electronic visit verification, travel mileage reimbursement, or other necessary expenses. Additionally, the rule would place a significant burden of monitoring and enforcing the requirements on state governments. For these reasons, States from all political leanings expressed significant concerns with the provision.
The Medicaid Access Rule is currently at the Office of Management and Budget for review, which is the final clearance step before rules are released. The Final Rule is expected before the end of April.
Becerra Remarks: https://www.youtube.com/watch?v=DjIDu1C5UP8
Biden Transcript: https://www.whitehouse.gov/briefing-room/speeches-remarks/2024/04/09/remarks-by-president-biden-on-the-care-economy-washington-d-c/ |
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In Hearing, Senators Split Down Party Lines on How to Best Support Home Care, Other Long-Term Care, Workers
McKnight’s Home Care / By Adam Healy
Calls for greater support for direct care workers have reached lawmakers’ ears, but a hearing revealed a partisan split on how to best grow, retain and professionalize this critical workforce.
“If we claim that their work as caregivers is essential, we should accord them the status of a professional,” Sen. Bob Casey (D-PA) noted in his opening statement during a Senate Special Committee on Aging hearing on Tuesday. “Numerous studies indicate that insufficient staffing is directly correlated with lower quality of care, worse health outcomes for people receiving long-term care, and increased burden on family caregivers … It’s time to make the smart choice for families and communities and strengthen our long-term care workforce.”
This workforce, which includes individuals who work in patients’ homes or residential facilities, is in need of better wages, more pathways to employment and safer working conditions, Casey, chair of the committee, said. Earlier this week he introduced the Long-Term Care Workforce Support Act, which would use federal funds to invest in care worker wages and training opportunities, according to an analysis by PHI.
Casey is also in favor of two soon-to-be released regulations: the nursing home minimum staffing mandate and Medicaid Access Rule, which contains the controversial 80/20 provision. The provision would require that 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers. The Office of Management and Budget concluded its review of both rules, which are expected to be finalized by the middle of May, according to news outlet Axios.
State-by-state approach
Many Republican senators, however, are not in favor of such federal initiatives. They expressed that workforce development initiatives should be left up to the states.
“Giving more power to the federal government usually means spending more money, almost all of which we borrow, we don’t actually have,” Sen. Mike Braun (R-IN), ranking member of the committee, said during the Tuesday hearing. “These [proposed] solutions are sometimes very partisan in nature as well.”
As many as 80% of facilities do not currently have the staff to meet the proposed nursing home staffing requirements, and implementing such a rule could lead to closures, he said. Home care providers also have criticized the rule. In an October letter to Congress, some suggested that imposing strict staffing minimums for nursing homes would draw potential workers away from home health agencies that are also in need.
“We need innovation at the state and local levels,” Braun said in his prepared remarks. “We don’t need the federal government forcing a one-size-fits-all approach.”
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CMMI’s Proposed TEAM Model Offers Another Risk-Based Opportunity For Home Health Providers
Home Health Care News By Andrew Donlan
Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives.
The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge.
CMS said that the model would build on the already existing Bundled Payments for Care Improvement Advanced (BPCI-A) and Comprehensive Care for Joint Replacement models. The proposed model would launch on Jan. 1, 2026, and run for five years, ending at the end of 2030.
“TEAM would be a mandatory episode-based alternative payment model in which selected acute care hospitals would coordinate care for people with Traditional Medicare who undergo one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital,” CMS wrote. “As part of taking responsibility for cost and quality during the episode, hospitals would connect patients to primary care services to help establish accountable care relationships and support optimal, long-term health outcomes.”
Given those all-important 30 days post discharge involved in the TEAM model, home health providers will naturally play a role in helping hospitals achieve high-quality outcomes.
The National Association for Home Care & Hospice (NAHC) is still awaiting further details, but sees home health agencies as squarely involved in the Innovation Center’s proposal.
“Much of the specifics are still to be decided,” NAHC President William A. Dombi told Home Health Care News. “Home health agencies can be expected to be significantly involved with the participating hospitals given the nature of the surgical patients that will be targeted, such as hip fractures and joint replacement patients.”…
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