Advanced Search

Home Health & Hospice Week

Industry Notes:

ALJs MAKE SWITCH TO HHS

Published on Mon Jun 06, 2005

Providers' chances of getting a fair hearing may have just gotten slimmer.

A video conference soon may be the way you have to make your case before an ALJ.

Medicare hearings conducted by administrative law judges (ALJs) switched from the Social Security Administration to the Department of Health and Human Services July 1, HHS says. Providers and beneficiaries have long opposed the move, fearing that the ALJs' decision-making will be compromised by the Centers for Medicare & Medicaid Services' efforts to bring them in line with CMS policies and procedures (see Eli's HCW, Vol. XIII, No. 36).

HHS is forging ahead with its plan to switch many hearings to video conferences instead of in-person meetings, the agency says in a release. HHS expects to meet the 90-day ALJ decision timeframe mandated by the Benefits Improvement and Protection Act of 2000 "by using video teleconferencing technology (VTC) with a state-of-the-art electronic hearings process to provide significantly more access points than currently exist," the agency maintains. "HHS has access to VTC sites in over 1,000 cities nationwide."

Many parties, including prominent lawmakers, have voiced concerns about switching to video conferencing (see Eli's HCW, Vol. XIV, No. 22). HHS offers those detractors an olive branch in its latest release.

"Both VTC and in-person hearings will be offered as appropriate to best meet the needs of all parties," HHS maintains. "To the extent that an in-person hearing is required, that hearing will be granted in the location most convenient to the parties."

Further, ALJs "will travel to various locations around the country to conduct in-person hearings, as needed, which may include the use of local government facilities or other available sites," HHS promises. 

  • The adult day care demonstration that originally was scheduled to begin this month actually will start in February 2006, CMS says in a release.

    Under the project, CMS will choose up to five home health agencies "to partner with medical adult day care facilities to provide medical adult day care services to Medicare beneficiaries as a substitute for a portion of home health services that would otherwise be provided in the home," the agency explains.

    Up to 15,000 beneficiaries will be eligible to enroll in the three-year demo, CMS says. Informationon how to apply for the demo will be in a forthcoming Federal Register notice. 
     
  • CMS has unveiled third-quarter prices for respiratory drugs. The latest fee schedule boosts the price for budesonide, lowers that for ipratropium and puts albuterol back at first-quarter levels.

    CMS initially posted a fee schedule that contained the wrong price for albuterol compound solution but has since corrected that to $2.36. The fee schedule is at www.cms.hhs.gov/providers/drugs/asp.asp. 
     
  • CMS has changed its rules on "voided, canceled and deleted" claims in Transmittal 159 (Change Request 3627), issued June 17. CMS changed some reasons for canceling or deleting claims from the system into reasons to return claims as unprocessable, and vice versa.

    And CMS has removed the specific waiver allowing HHAs to go into the shared system and delete claims, the agency says in the transmittal at www.cms.hhs.gov/manuals/pm_trans/R159OTN.pdf.
     
  • The durable medical equipment industry remains squarely in the sights of federal fraud hunters. In the HHS Office of Inspector General's recent semiannual report to Congress, the OIG cites a number of settlements involving DME companies. They included Polymedica Corp. and its subsidiaries Liberty Medical Supply and Liberty Home Pharmacy Corp.; Novartis Nutrition Corp. and OPI Properties, subsidiaries of Novartis Finance Corp.; and cases involving small DME providers in Florida, Kentucky and Texas. The report is at http://oig.hhs.gov/publications/semiannual.html. 
     
  • Intermediaries and carriers can't extrapolate an error rate from a statistical sample of claims unless they determine that there is a "sustained or high level of payment error," CMS warns in Transmittal 114 (Change Request 3734), issued June 10. The change to statistical sampling instructions is at www.cms.hhs.gov/manuals/pm_trans/R114PI.pdf. 
     
  • The DME industry has friends in high places. Speaking last month to the American Association for Homecare's Washington Leadership Conference, Rep. David Hobson (R-OH) said he plans to introduce legislation to fix some of the problems with the DME competitive bidding system as established by the Medicare Modernization Act, AAH reports.

    Hobson plans to introduce a measure soon and expects bipartisan support, he said. The Ohio lawmaker has long been critical of competitive bidding and was once named "Porker of the Month" for his position by Citizens Against Government Waste. 
     
  • Regional provider Amedisys Inc. plans to purchase Knoxville, TN-based Housecall Medical Resources Inc. for about $106 million, the Baton Rouge, LA-based chain says. Housecall, with annual revenues of $103 million, operates 57 HHAs in Tennessee, Florida, Kentucky, Virginia and Indiana, and nine hospice locations in Tennessee and Virginia, Amedisys says.

    "This acquisition clearly furthers Amedisys' strategic mission to be the premier home healthcare company in the Southeast," says Amedisys CEO William F. Borne. Amedisys may seek to expand the "significant hospice business ... over the next few years."
     
  • VITAS Healthcare Corp. is increasing its presence in the Sunshine State. VITAS has opened a location in Ormond Beach, FL, serving Volusia and Flagler counties. The location is the newest of seven VITAS hospice programs in Florida and the 35th VITAS program throughout the country, the hospice company says.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All