Home Health & Hospice

Weekly roundup

Homecare Insider, June 13, 2016

CMS moves prior authorization plan forward

CMS last week announced plans to move forward with its prior authorization demonstration for home health agencies (HHA), despite strenuous opposition to the plan from stakeholders, Congress, and others. The home health prior authorization program has been renamed the “pre-claim review” pilot, and will last three years. 

The pre-claim review pilot will phase in Illinois, Florida, Texas, Michigan, and Massachusetts. It will help CMS ensure that home health services are medically necessary “without delaying or disrupting patient care or access,” according to a CMS press release. The demonstration will begin in Illinois in August, in Florida in October, and in Texas in December. The demonstration will begin in Michigan and Massachusetts in January 2017.

“Medicare will review the documentation to determine if all coverage requirements for home health services are met and will issue a pre-claim review decision generally within 10 days. If the documentation submitted was not sufficient, then the HHA (or beneficiary) may submit additional documentation to support the claim. Once sufficient documentation is submitted, Medicare will make timely payment on the home health services claim following the standard process.”

CMS has announced it will conduct a special Open Door Forum on Tuesday, June 14, to discuss the prior authorization/pre-claim review demonstration.

Source: CMS  

VNAA slams CMS’ decision on prior authorization pilot

Reaction to CMS’ plans to roll out its demonstration of pre-claim review for home health agencies (HHA) was swift and negative in many organizations. Following CMS’ announcemnt, the Visiting Nurse Associations of America (VNAA) and the Alliance for Home Health Quality and Innovation (the Alliance) issued a statement expressing extreme disappointment with the decision.

“We are extremely disappointed  that the [CMS] dismissed the comments and concerns of 122 Members of Congress and almost 250 different healthcare service providers—physicians, hospitals, home health—and pushed forward a prior authorization demonstration for home health care in five states,” the VNAA  stated in a post on its website. “CMS has fast-tracked implementation of a far-reaching and high-impact program over the strong concerns and objections of multiple stakeholder groups. VNAA and the Alliance believe this demonstration will jeopardize patients in the five impacted states who will not receive timely care.” 

Source: VNAA

Can’t get no (MAC) satisfaction?

The annual MAC Satisfaction Indicator (MSI) is now available on each of the Medicare Audit Contractors’ web sites, according to the National Assocation for Home Care and Hospice (NAHC). The survey is an opportunity for home health and hospice providers to offer feedback on their respective MACs.

The MSI is designed to gauge Medicare providers’ satisfaction with the performance of their MAC. It doesn’t measure satisfaction with other Medicare contractor types, such as Recovery Audit Contractors or Zone Program Integrity Contractors.

The MSI opened last month and will remain open until CMS provides a closing date. The survey can be accessed at each Home Health and Hospice MAC:

Source: NAHC

Panel: Home Health Star Rating system needs tweaks

At last month’s Technical Expert Panel (TEP) meeting, experts reviewed the first year of performance data for the home health Patient Care Star Ratings. Based on the first year’s information, the TEP recommended some revisions for the Home Health Quality of Patient Care (QoPC); and advised additional analyses to support the ratings’ ongoing maintenance and improvement.

Star ratings are important to help consumers and their family members choose a home health agency, according to the summary, but some panleists raised concerns about the nature of the  current  QoPC star rating, including the concern that patients may not fully understand the relative nature of the rating, or know that a three-star  rating indicates care in line with the majority of providers; and might be confusiong the QoPC star rating and the Patient Survey star rating, given the differences in the ratings’ methodologies.

The panel  recommended changes including:

  • Explore adding data sources or quality measures that are not based on self-reported OASIS data or consider weighting measures differently based on their data source
  • Explore ways of capturing provider improvement or change in ratings on the website so  users have a better historical view of a provider’s rating
  • Explore new ways of presenting the information on Home Health Compare to make the  information more accessible to consumers.
  • Apply the HHCAHP's clustering algorithm used in the Patient Survey star rating methodology to  the QoPC methodology and examine correlation between the two ratings

Source: Abt Associates