Home Health & Hospice Week

But practical help may be a ways off.

Home health agencies are finding a sympathetic reception to their complaints about soaring gas prices from one influential lawmaker.

Sen. Tim Johnson (D-SD) plans to introduce legislation that will reimburse HHAs on a cost basis for their fuel expenses, he says in a release. "Rather than a fixed rate, Johnson wants reimbursement rates changed to a cost-based plan, covering the true cost of the service provided," the release says.

Johnson also wrote to Health and Human Services Secretary Mike Leavitt, calling on the department to investigate the effect of rising prices. "I am concerned that recent increases in the price of gasoline will adversely impact beneficiary access to these critical services," the senator said in the letter.

Proposed Bush Administration reimbursement cuts to HHA rates would hinder agencies' ability to combat the high gas prices, Johnson charges.

"I think that we may have to look at the way we reimburse for home health and allow adjustments for fuel costs," South Dakota's other senator, John Thune (R), told the Associated Press. "This is going to be a factor in whether or not a lot of these home health agencies are able to survive."

Robert Dockter, CEO and Administrator of South Dakota's Eureka Community Health Services, says high gas prices and other pressures have forced his HHA to reduce its service area by half to a 20- to 25-mile radius, Johnson's release notes.

• Now that the hospice conditions of participation have finally arrived, you might be wondering about the HHA CoPs. The Centers for Medicare & Medicaid Services has established a September 2008 deadline for the HHA CoPs' publication, according to the semiannual regulatory agenda in last month's Federal Register. The notice would have to be another proposed rule, because CMS issued the last proposed rule more than 11 years ago.

The agenda puts the DME surety bond and enhanced supplier enrollment requirements in its long-term action section, with due dates of 2010 and 2009, respectively.

• The OIG showcased an Iowa HHA owner in its list of enforcement actions for the first half of 2008. HHA owner Floyd Seibert and his lawyer James Golden were ordered to pay $5.7 million in restitution for Medicare and pension plan fraud, according to the OIG's semiannual report for the time period.

Seibert concealed his relationship with his various business entities, located across five states and "sold" goods and services from one of his companies to another of his companies at inflated costs, improperly passing the inflated costs on to Medicare, the OIG charges. Seibert also fraudulently passed on non-Medicare costs to the program.

Another issue: The report also reiterated the OIG's findings about hospice patients served in nursing homes. "On average, beneficiaries in nursing facilities spent more time in hospice care and were associated with higher Medicare reimbursements for hospice care than beneficiaries in other settings," the watchdog agency notes.

• The Joint Commission has added a national patient safety goal about central line infections for home care providers in 2009. The new safety goal reads, "Implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections. (Note: This requirement covers short and long term central venous catheters and PICC lines.)"

"These additions build on an existing Goal to reduce the risk of health care-associated infections, and recognize that patients continue to acquire preventable infections at an alarming rate while receiving health care," the Oakbrook Terrace-based accrediting body says.

Other NPSG changes include a complete revamp of the much-criticized medication reconciliation goal and a clarification in the medication goal.

More details are at www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals.

• The new hospice conditions of participation finalized this month will also affect hospice aides. Registered nurses must visit the hospice patient at least every 14 days to check on the aide's services, say the new CoPs issued in the June 5 Federal Register (see Eli's HCW, Vol. XVII, No. 21). But the RN has to directly supervise the aide in a visit only once a year, points out the National Hospice and Palliative Care Organization.

• New York plans to create a state registry of home health aides in the wake of a largely aide-related fraud crackdown under Medicaid. "A publicly accessible registry with background information on aides is a critical first step in improving government oversight and ending the fraud in this rapidly growing industry," says New York Attorney General Andrew Cuomo in a release.

Legislation is pending in the state legislature to require the Internet-based registry.

The state's "Operation Home Alone" crackdown has uncovered thousands of fraudulent home health aide certifications and led to the convictions of dozens of uncertified aides, registered nurses, managers of schools that provided false certifications, agencies that employed aides and nurses and Medicaid recipients complicit in no-show billing schemes, the release notes.

"A statewide registry ... will better equip providers with reliable, consistent and timely information on state-approved home health aide training programs and individuals credentialed through those programs," says the Home Care Association of New York State in a release. That further supports "the home care community's efforts to ensure the best possible patient care."

• Home care providers may have more patients to serve than ever. Life expectancy for U.S. residents reached a record high of 78.1 years in 2006, according to a report released by the National Center for Health Statistics at the Centers for Disease Control. That figure is compared with a previous high of 77.8 years in 2005.

Life expectancy was 80.7 years for women and 75.4 years for men, NCHS says. More information is at www.cdc.gov/nchs.

• Get used to a new acronym for benefit integrity purposes. "The program safeguard contractors (PSCs) will be transitioning to zone program integrity contractors (ZPICs) in the near future," CMS says in June 13 Transmittal No. 259 (CR 6003). ZPICs will have seven zones, CMS notes in the Medicare Program Integrity Manual update.

• You have new non-cancer length of stay numbers to benchmark yourself against. Hospice NCLOS rates by region and state are available at Palmetto GBA's Web site. The highest NCLOS was 0.37 (77.7 days) for Alzheimer's Disease in the Southwest region. For a link to the rates, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "NCLOS rates" in the subject line.