Home Health & Hospice Week

Medicaid benes would hire and manage their own assistants under proposed rule.

If your business relies on Medicaid revenues, get ready for a possible change.

The Centers for Medicare & Medicaid Services wants Medicaid beneficiaries to be able to hire, manage and fire their own personal care assistants, rather than get aide services through a home health agency. In a proposed rule scheduled for publication in the Jan. 18 Federal Register, CMS sets out a self-directed care option for Medicaid-funded personal services.

Beneficiaries could even hire their own family members to furnish aide services, CMS notes in a press release. "This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom," Kerry Weems, CMS acting administrator, says in the release.

Under the proposal, beneficiaries would receive a cash allowance to hire workers or purchase items that would help maintain independent living. "The beneficiaries also have the option to have their cash benefit allotment managed for them," CMS allows.

States choosing to offer self-directed care would have to also make available "traditional agency-delivered services" if beneficiaries decided they wanted to discontinue self-directed care.

And states "must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants," CMS adds. "States must also train potential participants in ways to manage their budgets and assess their personal care needs."

Opponents of self-directed care argue that beneficiaries could be overwhelmed or taken advantage of under the system.

CMS will take comments on the proposed rule until Feb. 19. The 109-page notice is at www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2229P.PDF.

• Take advantage of an upcoming session to learn--and air concerns--about mandatory accreditation for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). CMS is sponsoring an audioconference on the topic on Jan. 22 from 1:00 to 2:30 p.m. ET.

Must: Participants are required to register in advance for the session, which is titled "DMEPOS Accreditation 101." To register, go to www.2.eventsvc.com/palmettogba/012208.

• The cap on outpatient therapy services under Part B will be $1,810 this year, CMS says in Jan. 19 Transmittal No. 1407 (CR 5871). The cap applies to physical and speech therapy combined and separately to occupational therapy. The cap doesn't apply to therapy services furnished under a home health plan of care.

Automatic exceptions to the therapy caps will also stay in effect this year as legislated by Congress, CMS notes in the transmittal. However, the manual exception process expired in 2007.

Part B therapy providers that want to qualify a patient for the automatic exception must use modifier KX on the therapy line item, CMS instructs. "Contractors may scrutinize claims from providers whose services exceed caps more frequently than is typical," the agency warns.

The memo includes the list of ICD-9 codes that qualify a service for the automatic exception. The memo, including full exception instructions, is at www.cms.hhs.gov/transmittals/downloads/R1407CP.pdf.

• If you're confused about National Provider Identifier requirements, you can call into a CMS roundtable on the topic Feb. 6 from 2:30 to 4 pm ET, the agency says in a message to providers. "This call will focus on the status of the Medicare implementation and a related question and answer session."

Start now: If you've been billing successfully with your NPI-legacy number pair, now is the time to try a small batch of NPI-only claims, CMS exhorts. "If the results are positive, begin increasing the number of claims in the batch." CMS will require NPI-only claims starting May 23.

CMS will post registration details for the roundtable online at www.cms.hhs.gov/NationalProvIdentStand.

• Hospices and home health agencies stand to benefit from the conclusions of a new federal report.

The report, from the Government Accountability Office, takes a look at the best--and most challenging--aspects of end-of-life care, highlighting four programs that include home- and community-based care options that help patients meet end-of-life needs.

To read the report, "End-of-Life Care: Key Components Provided by Programs in Four States" (GAO-08-66), go online to www.gao.gov/cgi-bin/getrpt?GAO-08-66.

• Home health agencies with tight budgets may not appreciate the new increase in the Internal Revenue Service standard rate for mileage. The new rate of 50.5 cents per mile is up from 48.5 cents in 2007, the IRS notes in a release. However, many agencies do not reimburse employees for travel up to the IRS limit, observers point out.

A press release about the limit is at www.irs.gov/newsroom/article/0,,id=176030,00.html.

• While Part D drug plans may have made billing for Medicare patients more complicated, they have helped seniors gain drug coverage. In 2005, 33 percent of all seniors did not have any prescription drug coverage. Today, thanks to Medicare Part D, 80 percent of that group--so 92 percent of the nation's seniors--now receives coverage, leaving only 8 percent of all seniors in the United States without prescription benefits, according to a recent report in policy journal Health Affairs.

Huge gap: But many remain unaware that the government will subsidize the drugs of low-income beneficiaries. Between 3.4 and 4.7 million eligible low-income beneficiaries are not currently receiving the government's prescription subsidy, according to a survey conducted by the Kaiser Family Foundation, the Commonwealth Fund and the Tufts-New England Medical Center. Among those low-income beneficiaries, almost one-third face monthly prescription bills of $100 or more, the researchers report in Health Affairs.

African Americans remain more likely to lack prescription drug coverage than their white and Hispanic counterparts, the article reports; 12 percent of African Americans lack any form of prescription drug coverage. Other "sociodemographic characteristics significantly associated with lacking prescription coverage" include an age of 75 or older; an income level at or below 150 percent of the poverty line; a rural residence; and a lack of post-secondary education.

Almost 20 percent of the seniors who participate in Part D still delayed purchasing a prescription because they were concerned about the drug's cost, the study found. Advocates call on Medicare to advertise its low-income subsidy more widely.

• In New Jersey, a state grand jury indicted a Newark HHA, its owners and an employee of falsely billing Medicaid $1 million for services never rendered or that were ineligible for Medicaid payment.

Touch of Life Home Health Care Agency, its owners Kimberly D. Hall and Willie T. Cureton, and office coordinator Ollie Sabrina Kimble billed for visits rendered at ineligible sites, according to a release from New Jersey AG Anne Milgram. "Medicaid regulations do not permit billing for personal care assistants and home health aides services in Class C boarding homes and residential health care facilities because such facilities are already paid for by the State for personal care services for the residents," the release notes.

Hall billed for aide services when her personal assistant license was revoked and also lied on her Medicare application, the state charges. Kimble directed other assistants to fill out fraudulent time sheets, the affidavit alleges.

• Two major for-profit hospice chains will become one. Dallas-based Odyssey HealthCare Inc. plans to buy Scottsdale, AZ-based VistaCare Inc. for $147.1 million, the publicly traded chains say in respective press releases. The acquisition will bring Odyssey up to 110 locations in 31 states.

Both for-profit chains have been plagued with their share of problems and executive shake-ups. Odyssey has seen earnings challenges due to per beneficiary caps and a 2006 $13 million settlement with the HHS Office of Inspector General over whistleblower char-ges of billing for ineligible patients (see Eli's HCW, Vol. XV, No. 26).

VistaCare had two Indiana locations decertified in 2005 (see Eli's HCW, Vol. XIV, No. 38) and has had trouble hitting some earnings goals due to the per bene caps. Odyssey went public in 2001, while VistaCare did so in 2003.