Home Health & Hospice Week

Be sure your HME claims will stand up under the microscope.

Providers of home medical supplies are likely to face even greater claims scrutiny in the coming months.

A report from the Government Accountability Office released March 6 highlights a slew of abuses.

Among the stories in the report: Medicare paid for leg braces for patients with amputated limbs even after paying for prosthetics for the same individuals.

The GAO concludes that the Centers for Medicare & Medicaid Services needs to do more to reduce the $700 million a year the agency spends improperly for durable medical equipment.

The report also notes that Medicare has bought multiple home hospital beds for the same beneficiary in a single month.

The report was requested by former Senate Finance Committee Chair Charles Grassley (R-IA).

To read "Medicare: Improvements Needed to Address Improper Payments for Medical Equipment and Supplies," go to www.gao.gov/cgi-bin/getrpt?GAO-07-59.

• The 110th Congress hasn't forgotten about therapists' and their patients' cries for help. Last month lawmakers re-introduced legislation S. 450/H.R. 748, the Medicare Access to Rehabilitation Services Act of 2007, according to the American Physical Therapy Association.

This bill would completely repeal the therapy cap on outpatient physical therapy benefits, as opposed to the current system where therapists may file for exceptions--which expires at the end of the year.

"Passing this important legislation to completely repeal the therapy caps is the best long-term policy solution--rather than passing '1-year fixes,'" commented APTA President R. Scott Ward.

"We should not limit the therapy and recovery options available to our nation's seniors, especially the oldest and sickest on Medicare," said Sen. John Ensign (R-NV), one of four senators and five House members who re-proposed the bill.

Current law limits Medicare coverage of Part B outpatient therapy services, including those furnished in the home, in 2007 to $1,780 for physical therapy and speech language pathology together and $1,780 for occupational therapy. The caps don't apply to therapy furnished under a Part A home health plan of care.

 • A California state lawmaker has proposed legislation that would require private duty home care agencies to obtain state licensure. Assembly member Dave Jones (D-Sacramento) wants California's Department of Consumer Affairs to license agencies and distribute a list of those who are licensed, Jones says in a release.

Licensure would require background checks on all home care aides, investigation of complaints made by clients, annual assessments of employee performance and annual aide job training. The bill "ensures that consumers will know what services are to be delivered and what protections and coverage they should have when they receive home care services from an organization," California Association for Health Care Services at Home President Joe Hafkenschiel says in the release.

• Medicaid funding for certain medical equipment should start flowing again in Missouri. A federal judge has ordered the state to restore Medicaid coverage for medical equipment for one month and to submit a new plan for what will be covered in the future.

The state cut the program in 2005, dropping coverage for such things as feeding tubes, crutches and hospital beds for low-income Missourians, reports the St. Louis Post-Dispatch.

The reductions made little sense, opponents claimed, because some things were covered while others weren't. The program covered wheelchairs, for example, but not canes.

States are not required by law to provide Medicaid coverage for durable medical equipment. But Judge Dean Whipple said in the March 2 ruling that if Missouri decided to cover only some of the equipment, it needed to follow a Medicaid requirement that it use a reasonable standard to decide what is covered.

• CMS' Office of the Actuary has released a report detailing "National Health Expenditure Projections 2006-2016," and it could be bad news for home care providers hoping to escape a proposed payment freeze next year.

Medicare spending for home health is expected to increase 10.8 percent in 2006, according to CMS actuaries. Medicaid spending on home health will grow even faster, rising from 14.0 percent in 2005 to a projected growth rate of 19.8 percent in 2006.

Overall spending growth on home health, including public and private, will average 8 percent through 2015, according to the report in Health Affairs.

In the next 10 years the United States will double its overall spending on health care, CMS says. Spending for 2006 should total $2.1 trillion, but that number stands to rise to $4.1 trillion in 2016.

Despite the home health growth, overall growth in health care spending has actually slowed slightly, says CMS. Health care spending growth should drop from 6.9 percent in 2005 to 6.8 percent in 2006. If 2006 growth does indeed drop, it would mark the fourth consecutive year in which federal spending growth decreased.

• The Visiting Nurse Associations of America has tapped a state trade association exec to be its next leader. VNAA has chosen Andy Carter, president of Ohio Children's Hospital Association, to take over as its CEO when longtime head Carolyn Markey retires in June, according to a release.

• Home health agencies should note these trends in the way America cares for the aging. Middle-class families intent on keeping their loved ones at home as they age are increasingly turning to the "gray market" for aides, notes a March 1 article in the New York Times.

In a nutshell: The exploding need for long-term care is reshaping home care, driving more of it underground. Gray-market aides may be less expensive for families paying out of pocket for care, but they are also "usually untrained, unscreened and unsupervised," the article cautions.

The article also notes an increase in for-profit upscale agencies providing trained aides to the private-pay market, as well as the addition of national chains offering more modest services. That shift in the marketplace concerns some.

"Consumers are always in jeopardy when there's an opportunity to make a lot of money," Val Halamandaris, president of the National Association of Home Care, told the Times. "Sometimes it works out beautifully, and sometimes it doesn't. But nobody's policing it; that's for sure."

• National Home Health Corp. is battling with minority shareholders over its pending sale. Scarsdale, NY-based NHHC agreed in November to be bought for $11.35 per share by investment firm Angelo Gordon in conjunction with Eureka Capital Management and members of NHHC's management team, according to filings with the Securities & Exchange Commission and press reports.

But NHHC had other offers, including two bids by Premier Home Health Care Services Inc. for $12 per share, that it rejected, according to NHHC press releases.

Lawndale Capital Management, which owns 7 percent of NHHC's stock, protests that the Angelo Gordon "insider" buy-out isn't the best deal for shareholders. "The directors of NHHC have acted in a manner that places the interests of the Fialkow family and senior management before those of NHHC's independent shareholders," Lawndale accuses in a March 1 letter to NHHC's Board Members.

"The Board's rapid fire rejection of a clearly superior offer from Premier is further evidence that the current process reeks of corruption by insiders," charges the letter filed with the SEC. Lawndale demands a rejection of the Angelo Gordon "take-under" and an open and fair auction from potential buyers, among other items, according to the letter.

• Regional chain LHC Group Inc. reported blockbuster earnings for the latest quarter.

The Lafayette, LA-based long-term care company, which went public in June 2004, reported net income of $6.9 million on revenues of $64.2 million for the quarter ended Dec. 31, 2006. That's compared to a $3.2 million profit on $42.7 million in revenues for the same period in 2005.

That growth is largely due to a surge in the company's home care business unit, LHC says in a release. Revenues for the company's long-term care facilities in the quarter increased only slightly while home care revenues jumped from $29.6 million to $51.6 million.

• Amedisys Inc. continues its acquisition campaign with a San Antonio, TX-based home health agency and hospice. The Baton Rouge, LA-based regional chain bought OptimaCare Home Health Inc. and MissionPlus Healthcare for undisclosed terms, it says in a release.

Amedisys expects the companies to have annual revenues of $5.4 million. Optima will be the chain's sixteenth home health location in Texas and Mission Plus will be its first hospice location in the state, Amedisys CEO William Borne says in the release.