Home Health & Hospice Week

Whether the coming health care reform battle will help or hurt home care providers may soon be revealed.

Members of Congress are working fast and furiously on health care-related legislation. In addition to President Obama's 2010 budget proposal and the Senate Finance Committee's health care options series of papers (see Eli's HCW, Vol. XVIII, No. 19, p. 148), Sen. Edward Kennedy (D-Mass.) is now spearheading a health care reform plan that is expected to have wide influence.

Kennedy and Senate Finance chair Max Baucus (D-Mont.) met with the president June 2 to discuss overhauling the health care system, notes the New York Times. Kennedy's plan, advanced in the Senate Health, Education, Labor and Pensions Committee, contains provisions that affect home care, notes the National Association for Home Care & Hospice.

It hopes to curb costs by focusing on reducing hospital readmissions and managing chronic care patients. It also supports increased Medicaid financing for a variety of self-directed services to keep beneficiaries in their homes and out of institutions.

Republicans are working on putting together their own overall health care reform proposal, according to press reports.

Meanwhile, members of Congress quickly are introducing their legislation that champions home care in order to have it on the table during the budget negotiations. Sens. Kent Conrad (D-N.D.), Pat Roberts (R-Kan.), Tom Harkin (D-Iowa), and John Barrasso (R-Wyo.) recently reintroduced the "Rural Hospital and Provider Equity Act" (S. 1157), which would reinstate the 5 percent rural add-on for HHAs, allow nurse practitioners and physician assistants to certify home health plans of care, and provide incentives for telehealth in home care, NAHC notes.

And Sen. John Rockefeller (D-W.Va.) introduced an end-of-life health care bill (S. 1150) that would increase the frequency of hospice surveys to every 36 months, make hospice a required Medicaid benefit, and would allow hospice care even when children are pursuing curative treatment, NAHC says.

Congressional committees that have jurisdiction over Medicare are expected to hammer out their reform bills very soon. Home care proponents are hopeful that reform packages will benefit home care, but are worried that in light of reports from the Medicare Payment Advisory Commission and others, lawmakers will use home care spending as a funding source for other health care system changes.

• The HHS Office of Inspector General isn't letting law- and policymakers forget about its suggestions for home care providers as they hammer out health care reform. In its annual "Compendium of Unimplemented Office of Inspector General Recommendations," which combines the OIG's old Red Book on unimplemented monetary recommendations and Orange Book on unimplemented nonmonetary recommendations, the OIG summarizes its Medicare-related suggestions from its recent reports.

For home health agencies: The Centers for Medicare & Medicaid Services should require physicians to examine patients before ordering home care services and to see home care patients every 60 days, the OIG recommends. CMS should also more strictly identify and prevent duplicate Medicare and Medicaid payments for home health services like medical supplies and therapy.

For hospices: CMS should improve oversight of hospices, namely by increasing hospice survey frequency, the OIG advises.

For suppliers: CMS should strengthen the supplier enrollment process by conducting more unannounced site visits, increasing prepayment review, performing more rigorous background checks, requiring reenrollment every three years, and setting new minimum hours and inventory amounts. The OIG also wants the rental period for oxygen further reduced to 13 months and cuts to payments for nonroutine maintenance and servicing of concentrators.

The oxygen changes would net Medicare $3.2 billion, the OIG maintains. "Based on the 2006 median fee schedule amount, Medicare will allow $7,215 for 36 months for concentrators that cost $587, on average, to purchase," the report says.

Resource: The report is online at www.oig.hhs.gov/publications/docs/compendium/compendium2009.pdf.

• You don't have to worry about therapy

caps for patients who received outpatient Part B services in the first quarter of the year. Due to delays in updating the claims system, "claims for outpatient therapy services provided during the January -- March 2009 quarter, that were submitted and processed prior to April 6, 2009, were not applied to the 2009 calendar year (CY) therapy cap limitations,"

regional home health intermediary Cahaba GBA explains in an e-mail to providers.

The free ride means some of your Part B outpatient therapy patients will get some extra room in their caps this year. (The caps do not apply to therapy furnished under a home health plan of care.)

CMS won't go back and apply the amounts that have already been billed toward the cap.

But it will apply any amounts billed after April 6 to the cap, Cahaba explains.

• CMS has requested proposals for the portion of the quality improvement organizations' (QIOs') 9th Scope of Work set to begin on Aug. 1 and continue through July 2011. The Home Health Quality Improvement National Campaign will focus on working across settings to reduce preventable hospitalizations and improve management of patients' oral medications, according to NAHC.

• Durable medical equipment suppliers in Florida are getting singled out for more fraud-fighting attention. To allow Medicare beneficiaries to report Medicare fraud, CMS has established a dedicated hotline for the Zone Program Integrity Contractor (ZPIC) in Zone 7, which includes the state, CMS says in May 29 Transmittal No. 499 (CR 6504).

Region D DME Medicare Administrative Contractor CIGNA will begin placing the special SafeGuard Services ZPIC fraud hotline phone number on Florida beneficiaries'

Medicare Summary Notices (MSNs), CMS says in the transmittal. The MSNs will be sorted by ZIP code.

• Getting used to a new "Home" key function in Direct Data Entry (DDE) isn't the only problem home care providers are facing with the latest DDE update.

Intermediaries earlier announced that the "HOME" key in the DDE inquiry and entry screens would temporarily default to the "SC" field instead of the "PAGE" field, effective June 1 through July 6, due to system updates (see Eli's HCW, Vol. XVIII, No. 20, p. 160).

Now they have discovered a problem related to the update. "Providers are unable to delete and re-enter revenue codes lines in FISS DDE," RHHI National Government Services says in an e-mail to providers. "We have reported the problem and are awaiting a resolution."

The problem affects claims in the Return toProvider (RTP) file and that are being adjusted, intermediary Cahaba GBA says in an e-mail.

In the meantime, NGS and Cahaba offer a work-around for the problem. For a copy of the work-around instructions, please e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "DDE Work-around" in the subject line.

The problem won't be resolved until the new system updates take place July 6, Cahaba says.

• If you are choosing to opt out of the Medicare program when its DME accreditation requirements take effect in September, you may want to take one extra step first.

If you fail to notify CMS of your termination, Medicare will revoke your enrollment and bar you from future Medicare participation, notes the American Association for Homecare. Instead, to keep your future options open, you should inform CMS of your voluntary termination with an amended CMS-855S form, the trade group advises.

Tip: Pharmacies that will not become accredited and will no longer provide DME can still provide drugs and biologicals, AAHomecare points out. Just fill out an amended 855S and check the appropriate boxes in Section 2 for the drugs and biologicals you'll furnish.

Resource: The 855S form is online at www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf.

• Hospices scratching their heads over their Medicare reimbursement for transfer patients are getting a helping hand from RHHI Cahaba GBA.

Patients receive payment for only one level of hospice care a day: routine home care (RHC), continuous home care (CHC), respite, or general inpatient care (GIP). In a transfer situation, Medicare uses the level to which the patient was transferred to determine payment for that day, Cahaba explains in its June provider newsletter.

For example:Apatient under RHC is transferred to GIP on April 1. April 1 is billed as a GIP day, Cahaba illustrates.

If a hospice patient dies in GIP or respite care, that day is paid at the GIP or respite care level, Cahaba adds.

• An indication that the home care financial picture is looking bleaker may be in how hospitals are handling their home care units.

Two hospitals recently announced they are selling or closing their home care programs -- Gritman Medical Center in Moscow, Idaho and Evangelical Community Hospital in Lewisberg, Pa. Gritman will sells its home health agency and hospice to Family Home Care and Hospice of Spokane, reports the Moscow-Pullman Daily News.

Evangelical will discontinue its program, says The (Sunbury) Daily Item.

MidState VNA & Hospice in Meriden, Conn. also has announced it is closing, reports the Record-Journal. The VNA, which has operated for 96 years, will close in July, putting 65 people out of work. The VNA's 325 patients will transfer to other home care organizations in its parent Hartford Health Care system's umbrella, the newspaper says.

On the other hand, St. Luke's Hospital in Chesterfield, Mo. is opening a new home care division, St. Luke's Home Health Services. The agency will start with 15 staffers, according to the St. Louis Business Journal.

• Regional chain LHC Group Inc. has entered into a home health joint venture with East Alabama Medical Center in Opelika to provide home nursing in Auburn, Ala. and the surrounding area, LHC says in a release.

The joint venture covers five counties in the certificate of need (CoN) state, LHC points out. The agency has annual revenues of about $2.7 million.