Home Health & Hospice Week

Plus: Increased DOL enforcement, more data-gathering for patients, and another year of sequestration cuts are up for consideration.

For instance: President Biden released his budget proposal on March 28, and it includes a significant funding bump for Medicare surveys. “The Budget … includes nearly $500 million to Centers for Medicare and Medicaid Services Survey and Certification, a 24-percent increase, to support health and safety inspections,” says the 153-page budget document from the White House and Office of Management and Budget.

“This investment will strengthen health, quality, and safety oversight for approximately 67,000 participating Medicare or Medicaid provider facilities,” the Department of Health and Human Services’ “Budget in Brief ” summary document says. “Survey workloads and costs continue to increase due to factors such as a growing number of beneficiaries and surveyor wage growth, as well as an increase in serious complaints against facilities, which can lead to costly ongoing enforcement activities once a deficiency is identified,” HHS says in the 174-page overview.

“The COVID-19 pandemic has underscored the Survey and Certification program’s critical oversight role for holding nursing homes and other facilities accountable to meet minimum infection control standards and protect public health for beneficiaries in these facilities from COVID-19,” HHS continues. While the survey focus is often on nursing homes, “CMS projects that states will have the resources to fully complete surveys for all provider types, including complaint surveys, statutorily required surveys, and non-statutory surveys” at the increased funding level.

“This level of survey completion, which has not been projected since the submission of the FY 2017 President’s Budget, would permit the program to provide oversight for the relevant facility types and is the first step in shifting from a reactive to proactive posture,” HHS maintains.

The Biden administration also looks to step up fraud-fighting activities. “The budget requests $899 million in discretionary [Health Care Fraud and Abuse Control program] funding, $26 million above the FY 2022 enacted level,” HHS says. “This additional investment is projected to total $6.6 billion over the ten-year budget window and yield $13.6 billion in Medicare and Medicaid baseline savings, returning more than double the investment,” the agency adds.

Of the $899 million proposed, $692.2 million would go to CMS, $97.2 million to the Department of Justice, and $109.6 million to the HHS Office of Inspector General, HHS indicates. “Together CMS, DOJ, and HHS OIG will invest in innovative program integrity tools to fight fraud, waste, and abuse in a changing healthcare landscape. New advancements in predictive modeling and artificial intelligence will allow CMS to enhance existing efforts to reduce improper payments, prevent fraud, and target bad actors, while limiting burden,” the agency says.

For example: “CMS is exploring methods of using machine learning to conduct more rapid review of chart documentation to improve payment accuracy,” HHS offers.

CMS Aims To Boost Med Review 1000%

And Medicare medical review is “a top priority for increased investment,” HHS stresses. “CMS has a long-term goal to increase the percentage of fee-for-service claims subject to medical review, which currently stands at less than one-tenth of one percent, to one percent,” HHS relates. That’s a whopping ten-fold increase.

Increasing the surveillance is worth it, HHS maintains. “Medicare program integrity activities, inclusive of medical review, yield a robust rate of return to the Trust Funds of over $8 for every $1 spent based on a three-year rolling average,” according to the budget brief.

Other proposed 2023 budget items affecting home health and hospice agencies include:

• More data-gathering. “This proposal would add a new category of standardized patient assessment data, ‘drivers of health,’ for postacute care providers” to collect on patients, HHS says. “These data could include, for example, transportation, housing, social isolation, and food insecurity.”

• Healthcare workforce. The budget requests $13.3 billion for the Health Resources and Services Administration, which is $41 million above FY 2022 enacted. Among other programs, HRSA would use funds for “training the next generation of the health workforce — including physicians, nurses, community health workers, and other professionals — through scholarships and loan repayment programs in exchange for working in underserved communities,” HHS notes.

• Telehealth. “The president’s budget … supports ex­tending telehealth coverage under Medicare beyond the COVID-19 Public Health Emergency to study its impact on utilization of services and access to care,” notes the American Hospital Association in its analysis of the proposal. “The budget requests $45 million for HRSA to promote telehealth among providers and others. This is a 25 percent increase over the FY 2022 actual,” AHA points out.

• Sequestration cuts. The budget would add another year of Medicare sequestration provider rate cuts, extending them through 2032, notes the National Association for Home Care & Hospice in its budget analysis. “They are currently in place through 2031,” NAHC notes.

• HCBS. The budget includes $500 million for Home and Community-Based Supportive Services and $70 million for Native American Nutrition and Supportive Services, “an increase of $135 million above FY 2022 enacted for both programs, to help older Americans … live independently and with dignity,” HHS says. “The budget includes authority to use up to one percent of funds appropriated for Home and Community-Based Supportive Services for demonstration grants to develop and evaluate innovative approaches to service delivery. [The Administration for Community Living] anticipates testing innovations in transportation, modernization of senior centers, intergenerational programming, and access to technology.”

The budget also proposes increasing funding for the Family Caregivers and Lifespan Respite Care programs. “The COVID pandemic has highlighted the importance of allowing people to stay in their own homes instead of a nursing home, where they are much safer from infections and where most people prefer to be,” the National Committee to Preserve Social Security and Medicare notes in its budget analysis. The boost to HCBS supports that goal.

• DOL enforcement. Increased funding for the Department of Labor’s Wage and Hour Division and Occupa­tional Safety and Health Administration would mean more scrutiny from these entities.

Remember: This budget blueprint is far from a done deal. “Congress has final say on government spending,” NAHC reminds agencies. But the budget proposal “does provide a window into the president’s priorities and where his administration wants to direct its efforts going forward,” the trade group notes.

“Congress is under no obligation to adopt all or any of the president’s budget,” agree attorney Emily Felder and policy advisers Laura Johnson and Adam Steinmetz with law firm Brownstein Hyatt Farber Schreck in online analysis of the budget proposal. “Instead, the president’s budget request is used to indicate the president’s recommended spending and revenue levels along with policies the administration wants to prioritize. Since both the House and Senate are still narrowly controlled by Democrats, they will be more inclined to entertain the priorities that the Biden administration has put forth,” Felder, Johnson and Steinmetz offer.

In other words, stay tuned.

Note: See the Biden administration budget overview at http://www.whitehouse.gov/wp-content/uploads/2022/03/budget_fy2023.pdf. The HHS budget document is at https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.