Home Health & Hospice

Weekly roundup

Homecare Insider, June 6, 2016

Legislators slam home health prior authorization proposal

A CMS proposal to require a prior authorization screening for home health services would be “an administrative nightmare” and could produce barriers to care that could harm patients, according to 116 lawmakers in the U.S. House of Representatives. In a letter to CMS Acting Administrator Andrew Slavitt and Department of Health and Human Services (HHS) Secretary Sylvia Burwell, the legislators requested that CMS withdraw the proposed demonstration project requiring prior authorization for Medicare home health services, which was posted in the Federal Register in February.

The legislators’ letter stated “Prior authorization has never been applied to postacute care within fee-for-service Medicare. We encourage you to refrain from moving forward with the proposed demonstration project in order to avoid delays or a disruption in patient care and prevent restrictions on patient access to home health services.”

Source: RevCycle Intelligence

What’s new in CMS’ proposed FY17 hospice payments

The new quality measures for the Hospice Quality Reporting Program payment determination, which would be in effect for FY19 and subsequent years, include a pair of measures regarding hospice visits when death is imminent and one measure for comprehensive assessment at admission. What does this mean for your agency?

This month’s Homecare DIRECTION takes a closer look at the Fiscal Year 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Check out the June issue for this and other key information, including coding of traumatic wounds and surgical complications, vital preparations for CMS surveys, and training for care of patients with Alzheimer’s disease.

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Health system measures benefits of palliative care in home health

UnityPoint Health (UPH), an integrated health system (IHS) that operates in Iowa, Illinois and Wisconsin, has boosted its palliative care at home and hospice services by increasing awareness of these services within home settings, and harnessing data to prove the value.

UPH implemented metrics beginning in 2005 to measure the effectiveness of its growing reach with palliative care, Home Health Care News reported last week. The IHS measures clinical, financial, operational and customer satisfaction metrics for palliative care across inpatient, community, and clinic settings six months before and after an initial consult. Most of the consults took place in inpatient settings.

Data have revealed that reaching more patients has had a big impact on hospital utilization and overall cost savings across the IHS, Home Health Care News reported last week. The initiative has reduced readmissions by 50% for inpatient settings and 70% for outpatient settings between 2012 and 2015.

Source: Home Health Care News

Court: CMS ‘applied the wrong law’ in home health agency case

The United States Court of Appeals for the Tenth Circuit, in Kansas City, Kansas, last week ruled in favor of a home health agency in a case in which CMS allegedly used the wrong regulations to determine the agency had overbilled Medicare. In addition, the court blamed CMS’ feverish rulemaking pace for its own confusion.

Caring Hearts Personal Home Services, Inc., provided physical therapy and skilled nursing services to homebound Medicare patients. However, in a recent audit, CMS found that Caring Hearts had provided services to at least a handful of patients who didn't qualify as homebound or for whom the services rendered weren't “reasonable and necessary,” court documents stated. As a result, CMS ordered Caring Hearts to repay the government more than $800,000. Caring Hearts argued that its services were consistent with CMS regulations at the time the services were delivered.

“Medicare is, to say the least, a complicated program. [CMS] estimates that it issues literally thousands of new or revised guidance documents (not pages) every single year, guidance providers must follow exactingly if they wish to provide health care services to the elderly and disabled under Medicare's umbrella. Currently, about 37,000 separate guidance documents can be found on CMS's website—and even that doesn't purport to be a complete inventory,” the justices wrote.

As a result, CMS applied the wrong law, according to the court. “The agency didn't apply the regulations in force in 2008 when Caring Hearts provided the services in dispute. Instead, it applied considerably more onerous regulations the agency adopted only years later.”

Source: Findlaw.com