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Home Health & Hospice Week

Industry Notes:

DRAFT SPECS FOR NEXT OASIS VERSION RELEASED

Published on Tue May 13, 2003

The home health industry is one step closer to V code implementation with new data OASIS specifications that will go into effect in October.

The Centers for Medicare & Medicaid Services has released the draft specs for OASIS 1.40 to help software developers and others prepare for the change, it says. The specs specify that V and E diagnosis codes will not be allowed in M0190, M0210 or new item M0245, but will be allowed in M0230 and M0240 (see Eli's HCW, Vol. XII, No. 13, article, Diagnosis Coding).

Home health agencies also must start using the standardized branch identification number issued by the state in M0016 for assessments completed Jan. 1, 2004 and later, CMS says.

Interested parties can download the draft specs at www.cms.hhs.gov/oasis/datasubm.asp. CMS plans to release the final version by Aug. 31.

  • In other OASIS news, CMS has issued Microsoft Word files of the reduced OASIS dataset so HHAs can cut and paste if they modify their own assessment forms. "Use of a new reduced OASIS assessment form is completely optional" until Oct. 1 when M0245 is required, CMS reminds agencies. The files are at www.cms.hhs.gov/oasis/oasisdat.asp.

  • The government would like to see HHAs pushed out of Medicaid home care services for the disabled in many cases, but it might mean more business for home medical equipment suppliers.

    Disabled Medicaid beneficiaries are more satisfied when they participate in consumer-directed care, a program where they receive a home care allowance and have wide flexibility in how to spend it, reports the Department of Health and Human Services and the Robert Wood Johnson Foundation. Beneficiaries often hire friends or family members as their caregivers and can purchase assistive equipment or home modifications with the funds.

    Patients using the Cash and Counseling program "appeared to get better care than those receiving services through home care agencies," according to a study of a consumer-directed care demonstration program in Arkansas. The demo project also maintains beneficiaires' health and safety, HHS says.

  • New rules for determining provider-based status will go into effect for grandfathered entities July 1, CMS notes in April 18 program memorandum A-03-030. Entities considered provider-based in October 2000 qualified for grandfathering.

  • HHAs that missed the Home Health Quality Initiative Open Door Forum March 27 may want to brush up on the measure now that its implementation is imminent. CMS has posted a 44-page transcript of the call, which gives an overview of the project, at www.cms.hhs.gov/quality/hhqi/OpenDoorTranscript.pdf.

  • In the largest Medicaid fraud settlements in U.S. history, drug giants Bayer Corp. and GlaxoSmithKline have paid a total of $344 million for allegedly engaging in an illegal "lick and stick" scheme, U.S. Attorney Michael Sullivan reports. The Department of Justice maintains Bayer and GSK engaged in "private labeling" for HMO giant Kaiser Permanente where the companies gave Kaiser a low price, then affixed slightly different labels to the products they sold the HMO.

    The new labels allowed the drugmakers to avoid reporting the discounted Kaiser prices to the federal government. Medicaid requires drug companies to pay rebates to the program to ensure that it receives the lowest price offered to other purchasers. Bayer bore the brunt of the settlements, paying $257 million including a $5.6 million criminal fine. GSK is paying $87.6 million.

  • Brentwood, TN-based American Home-Patient has reported a refreshing $8.2 million profit for its fourth quarter of 2002, compared with a net income of $2.7 million in the fourth quarter of 2001, while revenues shrunk slightly from $82.9 million to $82.2 million. The company declared a $2.4 million loss for 2002 as a whole, which included a write-off due to an accounting snafu.

    The company also insisted it was close to emerging from bankruptcy, with the likelihood of paying off all creditors according to the reorganization plan the company and its unsecured creditors were proposing to confirm in an April 23 hearing before the bankruptcy court. AHP had to restate its 2001 earnings and earnings for the first half of 2002 because it incorrectly accounted for certain fees in its financial reports, which led to the 2002 loss.

  • Clearwater, FL-based Lincare Holdings Inc. made $52.9 million in the first quarter of 2002, compared to $45.2 million the year earlier, while revenues rose 16 percent to $265.2 million. Lincare bought four companies in Iowa, Maine, Nevada and Tennessee.

    Meanwhile, Lincare entered into a consent decree April 11 with Missouri state regulators on behalf of its local pharmacy, which allegedly distributed contaminated doses of nebulizer drugs to patients (see Eli's HCW, Vol. XII, No. 11, article "Fraud and Abuse"). Lincare agreed to notify in writing all patients who hadn't been contacted by phone, and to recall all potentially contaminated products.

    The company also agreed to let state regulators inspect the pharmacy and its records for at least 30 days before resuming compounding drugs, reports the St. Petersburg Times. A court must ratify the consent decree.

     

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