Home Health & Hospice Week

Error can't be fixed this late in the game. feds say.

Home health agencies in 16 states are wrestling with Palmetto GBA over what's being called an "improper" hold on request for anticipated payment (RAP) disbursements from Sept. 22 through Sept. 30.

The National Association for Home Care (NAHC) reported on Aug. 21 that the Centers for Medicare & Medicaid Services has indicated they will "step in to see that home health agencies [in the region] are not harmed" by Palmetto's proposed hold.

Background: Although the Deficit Reduction Act of 2005 does mandate a payment hold on Medicare Part A and B claims between Sept. 22 and Sept. 30, a home health RAP is not a "claim" as defined by law, explains NAHC.

Earlier this year, CMS agreed with NAHC that RAPs would not be subject to the hold, the trade group reports. Palmetto, however, announced this month that the delay will affect RAPs.

Though CMS has confirmed that the RAP hold is in error, the agency says that it's too late to fix the problem, which involves the HIGLAS (Healthcare Integrated General Ledger Accounting System) claims accounting system used by Palmetto.

CMS has adopted a suggestion from NAHC that agencies in Palmetto's jurisdiction should receive an advance of estimated RAP payments to cover the payment delay, reports NAHC.

Though the trade group and CMS are still working on details of the planned remedy, NAHC recommends that Palmetto do one of the following:

1. Implement an efficient accelerated payment method that does not require HHAs to submit the high level of paperwork normally required; or

2. Establish an interim payment methodology that permits HHAs to receive an estimated payment for nine days of RAPs, based on their recent history of RAP payments.

• CMS has just released its June revision of the Implementation Manual of the OASIS User's Manual. Besides reflecting the changes from the Final Reporting Regulation (see Eli's Home Care Week, Vol. 15, No. 23), the revisions affect Chapters 1, 2, 4, 5, 8, 9, 10 and 11, CMS notes. The information in the revised manual is effective immediately, the agnency instructs.

Heads up: CMS revised about 50 pages in Chapter 8, the chapter that covers in detail how to answer each of the OASIS questions. Besides the OASIS Manual, other revisions available for download at www.cms.hhs.gov/HomeHealthQualityInits/downloads/HHQIOASISChapters.zip include the HHA System User's Guide Version 4.3, the HAVEN System Reference Manual and the updated HHA Error Message Guide.

• Tyler Wilson will take the helm at the American Association for Homecare, the group announced. His appointment as president and CEO will be effective Sept. 18.

"We are pleased to bring such a veteran of the Washington association world onboard," said Tom Ryan, AAHomecare chairman and CEO of Homecare Concepts. "With his experience in trade associations, legal background, and knowledge of [durable medical equipment, prosthetics, orthotics and supplies], Tyler was the unanimous choice of the committee named to appoint him, the group reports.

• The feds are touting their "Money Follows the Person" program, which aims to support Medicaid initiatives to "rebalance" long-term care services by encouraging more home and community based care and less institutional care.

On Aug. 22, CMS sponsored a teleconference geared to health care providers and others interested in learning more about the demonstration program. In July, the feds announced $1.75 billion in funding for the program, which is authorized under the Deficit Reduction Act of 2005.

For more information, go to www.cms.hhs.gov/NewFreedomInitiative.

• Home health giant Arcadia Resources has announced that it will soon operate walk-in non-emergency health clinics in seven Meijer stores in Michigan. Arcadia announced in June that it would operate health clinics in nine Meijer stores in Indiana.

Arcadia is partnering with Physicians' Organization of Western Michigan (POWM) to establish the clinics. POWM will provide the medical oversight and ensure best practices in clinic operations.

"Alternative-site healthcare is a delivery model that meets the needs of today's consumer," said chairman and CEO John Elliott II in a news release. "We will continue to pursue opportunities to further expand our retail-based health clinics to other markets in the United States."

• An increasing number of Oregon's severely disabled children could receive care at home instead of in nursing homes. That's the intent of a new proposed Medicaid waiver unveiled by the state earlier this month.

The waiver would allow all severely disabled children living at home to receive Medicaid coverage, regardless of family income. But some of the children have disabilities so severe that they won't be able to leave institutional settings for home care.

This waiver application process is already under way, but its approval is uncertain, the paper states. Officials with the Oregon Department of Human Services plan to submit the waiver application by the end of the year.

• Amedisys Inc. has added another home health agency to its collection.

The Baton Rouge, LA-based home health company recently acquired an HHA in Cumberland County, North Carolina.

"We are pleased to expand our presence in North Carolina," stated William Borne, CEO. "The Certificate of Need requirements in North Carolina make this acquisition particularly appealing. We continue to evaluate similar acquisition opportunities in and near the states we currently serve and maintain our intention to selectively acquire companies that fit our acquisition profile."