Home Health & Hospice

Weekly Roundup

Homecare Insider, February 15, 2016

CMS aims to launch pilot prior authorization program in 5 states

CMS intends to start a Medicare Probable Fraud Measurement Pilot for home healthcare services, according to a notice that was February 5 in the Federal Register. Under the program, home health agencies would be required to perform prior authorization before processing claims for home healthcare services.

“This demonstration would help assure that payments for home health services are appropriate before the claims are paid, thereby preventing fraud, waste, and abuse. As part of this demonstration, we propose performing prior authorization before processing claims for home health services in Florida, Texas, Illinois, Michigan, and Massachusetts,” CMS stated.

Not everyone agrees with this statement, however. The Visiting Nurse Associations of America (VNAA) last week blasted the demonstration project in an email message to its members, stating it would do little to weed out fraud and would delay needed care by requiring approval from Medicare contractors before services are approved. The VNAA urged members to oppose the pilot program.

Public comments on this notice must be received by April 6.

Source: Federal Register, VNAA

Study: Hospice care is absent for some dying patients

In the final days of life, many patients suffer from more severe symptoms, and their families need both education and emotional support from hospice professional staff. However, a recent study found that routine homecare visits for hospice patients during their last two days of life varied widely by race, geographic location, and day of the week, according to the Journal of the American Medical Association (JAMA) website. More than 12% received no hospice homecare visit in their last two days of life.

Researchers conducted a retrospective cohort study of all Medicare hospice beneficiary patients who died in hospice services while receiving routine home care in the last two days of life. The study spanned the year starting October 1, 2013 and ending September 30, 2014.

Of the 661,557 patients in the study, 81,478 (more than 12%) received no professional staff visits in their last two days of life. Hospice patients in Wisconsin had the best chance of receiving hospice homecare service in their final two days—just under 4% did not get these visits. However, nearly 20% of patients in Alaska didn’t receive hospice homecare during their final two days. Black patients were less likely to have any visits than were white patients (15% versus 12%).

In addition, patients who died on a Sunday were more than three times less likely to have a visit compared with those who died on a Tuesday, according to the study.

Source: JAMA


Louisiana hospital inks deal with home health giant

Home health provider LHC Group has partnered with Baton Rouge General Hospital to be the preferred home health provider for all Baton Rouge General patients. Under terms of the partnership, announced last week, LHC will also open an office at the Mid City campus of Baton Rouge General, a nonprofit, full-service community hospital with 590 beds in multiple locations. LHC Group is based in Lafayette, Louisiana, about 60 miles southwest of Baton Rouge. The company employs more than 10,000 people in 25 states.

Financial terms of the joint venture were not disclosed.

Source: Baton Rouge General Hospital


New Jersey rule change would expand home health aides’ role

The state of New Jersey is considering a regulatory change that would allow registered nurses to delegate some duties to a home health aide. The proposed rule change would allow home health aides to administer medication and provide other minor medical help that, by state law, is currently performed by nurses.

The proposed change follows a small voluntary pilot program conducted by researchers at Rutgers university, which demonstrated that home health aides (called certified homemaker-home health aides in New Jersey) can help patients with feeding tubes, pain medication, and wound cleaning while still providing high-quality care.

The level of oversight would be up to the supervising registered nurse, according to the NewsWorks website. To delegate some tasks, nurses might need to train home health aides and increase communication between health providers.

The New Jersey Board of Nursing has approved the rule change, but the Christie administration must legally vet the modification.

Source: NewsWorks