Home Health & Hospice Week

Obama begins announcing appointments affecting Medicare.

Come January, Medicare will have a whole new set of leaders influencing how the federal program pays you.

President Elect Barack Obama has an-nounced former Senate leader Tom Daschle as his Secretary of Health and Human Services, the department which houses the Centers for Medicare & Medicaid Services. Daschle is expected to spearhead Obama's health care reform initiative.

The Visiting Nurse Associations of Amer-ica applauds the appointment. Daschle's "willingness to consider innovative strategies makes him more likely than most to recognize the role home health care can play in reducing costs and improving quality," VNAA's Andy Carter says in a release.

Obama and Daschle haven't yet announced a candidate for CMS Administrator, although Em-ory University professor Kenneth Thorpe, unsuccessful House candidate Judith Feder from Vir-ginia, and physician Dora Hughes have been ru-mored as possibilities.

Obama also has nominated Congressional Budget Office Director Peter Orszag as the new director of the White House Office of Management and Budget.

Providers will see some different political leadership in addition to Obama. House Democrats have named Rep. Henry Waxman (D-Calif.) as Chair of the Energy and Commerce Committee. The committee is one of two in the House with jurisdiction over Medicare.

One issue the Obama administration plans to tackle is rising health care costs. Observers expect widespread cuts to Medicare Advantage plans as part of the initiative.

More ammunition: Two studies published in the journal Health Affairs from Mathematica Policy Research and the Medicare Payment Ad-visory Commission say that MA plans are increasing costs for Medicare but not improving care. About one-quarter of Medicare beneficiaries are now enrolled in MA plans, the New York Times reports.

• CMS has named the new regional home health intermediary for six New England states. National Heritage Insurance Corp. will take over the regional home health intermediary work for Connecticut, Maine, Massachusetts, New Hamp-shire, Rhode Island, and Vermont, CMS says in a release. NHIC will also assume the Part A/Part B Medicare Administrative Contractor (MAC) duties in the region.

NHIC will take over the business from the current National Government Services RHHI, CMS explains. However, NHIC will subcontract with NGS for RHHI work.

Affected providers should be able to breathe easy thanks to the contracting arrangement. "NHIC subcontracting the [home health and hospice] functions will make it appear for these states like nothing changed," consultant Tom Boyd with Rohnert Park, Calif.-based Boyd & Nicholas tells Eli.

The region has 313 home health agencies and 147 hospices, CMS says. It also has 2.3 million RHHI beneficiaries and represents 6.4 percent of the national RHHI workload.

The transition will be complete by May 2009, CMS says. This timeline will be tight for contractors taking over new areas, Boyd expects.

Providers should be on the lookout for potential problems from the MAC transition, according to a lesson learned by therapists in California. Part B therapists experienced some major problems with the shift from NHIC to Pal-metto GBA, according to the American Physical Therapy Association. To begin with, therapists had difficulties contacting the contractor's customer service department and experienced delays in processing enrollment applications.

Once enrolled, many providers were un-aware of a new local coverage determination (LCD) they had to abide by and therefore received denials, APTA says. In addition, the new LCD had "an extensive crosswalk," in which ICD-9 codes were linked to CPT codes for reimbursement -- and certain ICD-9 codes were excluded from coverage. To top it off, providers and patients had difficulties determining dollars accrued toward the therapy cap, as well as difficulties in resolving outstanding issues from the previous contractor, NHIC, according to APTA. Providers in other parts of the country may experience similar problems as CMS implements contracting reforms, APTA warns.

Palmetto GBA resolved the issue by putting out a revised LCD in response to APTA's and its California chapter's complaints. The revised LCD eliminated the existing ICD-9/CPT crosswalk and replaced it with a list of ICD-9-CM codes for reporting physical medicine and rehabilitation services. Palmetto told APTA that if claims are denied due to the crosswalk and contain an ICD-9 code that is included on the new list of ICD-9 codes in the revised policy, it will reprocess those claims automatically and make the appropriate payment adjustments, according to the trade group.

• States are limiting their budgets for home care, thanks to the rough economy. At least 15 states facing budget shortfalls are cutting funding for personal care home care services, reports the Wall Street Journal.

The cuts are making wait times worse for seniors and disabled residents, the Journal says. In Florida, the wait list for one home care service doubled to 8,505 people in the year ending in July 2008. Some states, like Alabama, are cutting aide programs altogether.

• If you use the new hospice discharge for cause code once it takes effect Jan. 1, you should realize it doesn't indicate a discharge from the hospice benefit altogether. Hospices can use "H2" when they discharge a patient for cause, such as for staff safety, explains RHHI Cahaba GBA in its Decem-ber newsletter for providers. But you'll need to use occurrence code 42 if you want to discharge the patient from the benefit entirely.

Tip: Don't use occurrence code 42 if the patient merely is transferring to another hospice, Cahaba instructs in the Newsline.

• The number of your patients covered by Medicare Advantage Special Need Plans (SNPs) may go down due to new SNP guidelines from CMS. "Special needs plans are a type of Medicare Advantage plan that serve only beneficiaries living in institutions, eligible for both Medicare and Medicaid, or living with severe or disabling chronic conditions," CMS explains in a release.

Now CMS has defined 15 chronic conditions required for SNP eligibility, which will take effect in 2010. "This should help ensure that the specialized services provided by SNPs are being targeted to the appropriate populations," CMS acting administrator Kerry Weems says in the release.

The conditions include dementia, cancer, diabetes, and chronic heart failure. More information, including details on the 15 conditions specified, is at www.cms.hhs.gov/SpecialNeedsPlans.

• Hospice patients with the longest lengths of stay are those with Alzheimer's disease and related disorders, according to the latest non-cancer length of stay (NCLOS) data from RHHI Pal-metto GBA. About 31 percent of hospice patients with Alzheimer's had LOS exceeding 210 days in the first half of 2008. The shortest LOS was for renal disease, where only 5 percent had stays exceeding 210 days, Palmetto says in its December newsletter for providers.

For more NCLOS data from Palmetto, including how to request your own NCLOS rates, go to http://www.palmettogba.com/rhhi, click on "Hospice" under the "Articles" heading in the left-hand column, and scroll down to the Oct. 24 entry.

• Advanced Home Care in High Point, NC will merge with Unified Home Care in Rockingham County, N.C., reports the Business Journal of the Greater Triad Area. Unified, a home health agency owned by Moses Cone Health System and Morehead Memorial Hospital, was established in 1997 through a merger of the home health divisions of Annie Penn Hospital and the Rockingham County Health Department.

Through the merger, Morehead Memorial will become a part owner of Advanced, the newspaper says. Advanced has 26 branches throughout North Carolina, Tennessee, and Virginia and is a joint venture of 12 health systems in those areas.

• The economy may be rocky, but that's not slowing down regional chains making HHA acquisitions.

Almost Family Inc. will acquire the assets of the Medicare-certified home health agency owned by Fairfield Medical Center in Ohio for undisclosed terms, the Louisville, Ky.-based chain says in a release. The HHA generated about $1.2 million in Medicare revenue in 2007.

The acquisition is the first in a series that Almost Family plans to make in the Midwest, CEO William Yarmuth says in the release.

And LHC Group Inc. has acquired Whis-pering Pines Health Services Inc. in Antlers, Okla. The HHA serves 47 counties and marks LHC's entrance into its 16th state, LHC says in a release.