Home Health & Hospice Week

Last-minute legislation also addresses recovery audits, wage index, respite care.

Home health agencies that furnish outpatient Part B therapy won't have to apply therapy caps to all patients in 2007.

In addition to leaving home care payment rates untouched for next year in the bill passed Dec. 8 and 9 (see Eli's HCW, Vol. XV, No. 44), Congress extended the exceptions process to the $1,780 cap on outpatient therapy. The caps don't apply to therapy furnished under a home health plan of care.

To qualify for the automatic exception to the therapy cap, patients must have one of the diagnosis codes the Centers for Medicare & Medicaid Services lists in Feb. 15, 2006 Transmittal No. 855. (For more information on how to qualify patients and bill for the exception, see Eli's HCW, Vol. XV, No. 9.)

Audit alert: HHAs' reprieve from Recovery Audit Contractors may be coming to an end. CMS excluded agencies from the RAC demonstration that began this year, although durable medical equipment providers were still included (see Eli's HCW, Vol. XV, No. 17). The bill, the Tax Relief and Health Care Act of 2006, expands the RAC program to all states.

However, RACs are unlikely to focus on HHAs any time soon, experts tell Eli. That's because RACs are more likely to spend resources auditing big-ticket claims such as those for hospitals, they predict.

Report coming: The bill also requires the Medicare Payment Advisory Commission to issue a report evaluating the wage index. The report due in June 2007 will include possible alternatives on ways to compute the wage index, says the Connecticut Association for Home Care.

"CAHC has been advocating for revisions to the calculation of the Medicare wage index ... and welcomes this turn of events," the trade group says in its newsletter. "We are pleased that Congress has expressed its intent that wage index reform should be explored in all health care settings, not only hospitals."

A summary of the health provisions of the bill is at http://waysandmeans.house.gov/media/pdf/taxdocs/hr6408healthsummary.pdf.

Caregiver support: Congress also authorized a bill that would establish a federal program for respite care for individuals who provide long-term care for relatives, according to press reports. And the bill would provide for grants to statewide respite care service providers.

• Sen. Harry Reid (D-NV) is getting flack for helping a Nevada hospice in the budget bill. Reid and Sen. John Ensign (R-NV) secured inclusion of a provision granting satellite status to the Pahrump office of the Nathan Adelson Hospice of Las Vegas, according to a release from Reid. The then-Health Care Financing Administration denied the location satellite status back in 1999. NAH appealed but got no response from HCFA, the release says.

CMS granted the satellite status in 2005, but sought overpayments for $3.8 million from NAH because it wouldn't grant the status retroactively, Reid says.

"This would not have been warranted had the facility been granted satellite status in the first place," the release says. "Senators Ensign and Reid worked together to retroactively designate the facility in Pahrump satellite status, thereby erasing nearly $4 million of payments that NAH would have had to make, even though they could not afford to and would not have remained open as a result."

The case deserved special consideration, the senators argued. "Nathan Adelson Hospice has provided health care and assistance to the terminally ill in Southern Nevada for almost 30 years," said Ensign, a member of the Senate Health, Education, Labor and Pensions Committee. "When I learned of this problem I knew it had to be resolved because closing our hospice is unacceptable since so many Nevadans rely on the quality care at Nathan Adelson."

But the New York Times blasted the measure, among others, as an "obscure" provision of interest "to just a few lawmakers." Senate Minority Leader Reid "got special treatment" for his state, the Times said.

• If you'd like to hear what the HHS Office of Inspector General has to say, you can propose new safe harbors or special fraud alert topics. The OIG is soliciting input on both issues until Feb. 9, 2007, according to a notice in the Dec. 11 Federal Register.

"This annual notice solicits proposals and recommendations for developing new and modifying existing safe harbor provisions under the Federal anti-kickback statute," the OIG says. It also solicits recommendations for "developing new OIG Special Fraud Alerts."

• It's official: The 3.3 percent increase to home health agency prospective payment system rates will take effect Jan. 1. CMS has issued the final rates and instructions to contractors in a Dec. 15 transmittal, CR 5423 (see rates in HCW. Vol. XV, No. 40).

HHAs that don't report data from at least one OASIS assessment will see a 2 percent reduction to those rates, CMS reminds contractors.

Don't forget: In 2007, agencies will see a switch to the full Core-Based Statistical Area (CBSA) wage index, a slightly increased fixed dollar loss ratio of 0.67 and expiration of the 5 percent rural add-on.

• Don't forget to keep an eye out for M0175 recoupments that are slated to start next month. Overpayment letters for incorrect answers to the OASIS item on prior inpatient stays are scheduled to hit the mail Jan. 18. Providers will have an incredibly short 16 days from the letter's issuance to respond if they want to appeal (see Eli's HCW, Vol. XV, No. 38).

• CMS will send a list to regional home health intermediaries of the HHAs that will have a 2 percent reduction in their payments in 2007 because of failure to report OASIS data. CMS will send the list to the RHHIs by the end of the year, CMS' Wil Gehne said in the Dec. 20 Open Door Forum for home care providers.

• If you're served by RHHI Associated Hospital Service and have an electronic Gateway Mailbox, you can say goodbye to paper Additional Development Requests (ADRs). AHS will no longer issue paper ADRs to providers with mailboxes because it will furnish them electronically, the intermediary says in an email message to providers.

AHS will test the new mailbox delivery by furnishing both paper and electronic ADRs from Jan. 16 to Feb. 2, it says. "This will allow providers to confirm that they are getting the ADR letters via the Gateway Mailbox."

Tip: "You will need to establish a process for retrieving ADR letters from the Gateway Mailbox to ensure that they arrive in the medical records department for timely submission to Medicare," AHS advises.

• A North Carolina home health agency has learned the hard way that thorough background checks are essential--and not always easy.

If officials at an Apex home care agency had typed the name Donna Rakestraw into a state correction department database, they would have pulled up a history of multiple felony convictions and two stretches behind bars, reports the Raleigh News & Observer.

Officials at Mary's Home Care Services allege that Rakestraw provided a false name and other identification when she went to work for the agency.

Authorities suspect that Rakestraw used debit cards and checks to make withdrawals and purchases after opening a joint checking account with one patient. She is charged with obtaining property by false pretenses.