Home Health & Hospice Week

Questions remain about appeals decisions’ impact on other agencies.

Medicare plans to give home health agencies more Value-Based Purchasing appeal options if its proposal is finalized, but less time in which to use them.

The new VBP appeals process would include the existing period to review and request recalculation of both the Interim Performance Reports and the Annual TPS and Payment Adjustment Reports, the Centers for Medicare & Medicaid Services explained in the 2017 Home Health Prospective Payment System proposed rule published in the July 5 Federal Register. However, CMS would shorten the timeframe for this first recalculation stage from 30 days to 15 days.

Then CMS would add a second stage of appeals for reconsideration of the Annual TPS and Payment Adjustment Report only. Under the proposal, reconsideration requests “must be submitted within 15 calendar days of CMS’ notice of the outcome of the recalculation request for Annual TPS and Payment Adjustment Report,” noted Iowa health system UnityPoint Health in its comment letter on the rule.

Providers generally expressed approval of the expanded review process. “A robust and transparent appeals process is critical in all administrative processes,” said the Visiting Nurse Associations of America in its comment letter. An “additional layer of appeals strengthens the process and allows HHAs to challenge CMS decisions that are incorrect, arbitrary or capricious.”

Hold MACs To Timelines

But the plan isn’t perfect. Kindred at Home “recommends CMS maintain the current 30-day requirement to submit recalculation requests,” the large chain said in its comment letter.

“Fifteen calendar days, instead of 30 days, does not provide ample opportunity for HHAs, particularly large agencies, to collect detailed data in support of the appeal request,” UnityPoint protested.

And VNAA wants CMS “to enforce firm timelines by which HHAs will be notified of the decision of their appeal and for CMS to appropriately staff the appeals team to meet these targets.”

Further: Simply providing a new appeal level isn’t enough, criticized the National Association for Home Care & Hospice. Agencies need more information about that function. “It is essential that CMS clarify whether a successful appeal that changes the performance scores for a particular HHA correspondingly changes the impact of that HHA in the overall standing of the HHA and other HHAs in the LEF analysis with resulting rate affect,” NAHC exhorts. “If such impact occurs, CMS should clarify what notice will be sent to HHAs in the state and what appeal rights would be available in relation to any adjustment or change.”

Finally, agencies’ lives are hard enough as it is. “We encourage CMS to make the formal appeals process easy and straight-forward for agencies to be able to participate as appropriate,” urged the Association for Home Care & Hospice of North Carolina and South Carolina.