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Home Health & Hospice Week

Industry Notes:

Hold Off On HIPAA Agreements With Intermediaries, Carriers

Published on Sat Jul 19, 2003

You might not have as many Health Insurance Portability and Accountability Act business associate agreements to pull together as you thought.

The Centers for Medicare & Medicaid Services lays out the ground rules for fiscal intermediaries and carriers as far as dealing with the business associate provisions of the HIPAA privacy standards in May 23 program memorandum AB-03-078. In a nutshell, FIs and carriers are business associates of Medicare itself - not of individual health care providers.

CMS orders FIs and carriers not to sign business associate agreements with providers unless "the provider, physician, supplier or other health plan is doing work on behalf of the Medicare contractor." The memo is at www.cms.hhs.gov/manuals/pm_trans/AB03078.pdf.

  • The Senate Finance Committee was poised at press time to vote on its Medicare reform package, which included a seven-year payment freeze for durable medical equipment, an increase to the Part B deductible and a rural add-on for home health agencies. The House is still working on its version of the Medicare reform bill, which adds a prescription drug benefit to the program.

  • A new supplement to the OBQI manual explains the new three-bar outcome reports and three-column case mix reports under the outcome-based quality improvement measure. "The pdf file contains a brief narrative followed by an appendix with illustrative reports and a second appendix with the 'how-to read' guidelines," CMS says on its OASIS Web site at www.cms.hhs.gov/oasis/obqi.asp#supp.

    Home health agencies should print up the supplement and add it to their existing OBQI manuals, CMS urges.

  • HHAs in Connecticut and Massachusetts may be in line for a paperwork break when it comes to dual eligible beneficiaries. CMS plans a new demonstration project that uses sampling to determine the Medicare share of home health claims for services provided to dual eligibles and paid for by Medicaid, according to May 30 program mem-orandum A-03-046.

    The process will replace the cumbersome assembly of Medicare documentation from agencies for all dual-eligible claims the state may have paid erroneously. "This process will eliminate the need for the HHAs to assemble, copy, and submit large numbers of medical records," the memo says.

  • Florida will implement a much wider consumer-directed care program for Medicaid home care services, the Department of Health and Human Services says in a release. The state piloted consumer-directed care in the national "Cash and Counseling" demonstration project, and now expects more than 2,000 beneficiaries to use the expanded program.

    "Consumers and their families will be involved in planning all aspects of service delivery, including but not limited to the hiring, direction and appraisal of service providers," HHS explains. "A 'support broker' and a financial management service will assist" with the process, including payroll.

  • Indiana plans to hire 80 new nurse care managers to expand its disease management program for Medicaid beneficiaries with diabetes, chronic heart failure and asthma, HHS says in a release. The Coordinated Care Management program also will provide DM for enrollees whose health care costs rank in the top 10 percent for program expenditures.

    High-risk enrollees will receive one-on-one nurse care management while beneficiaries with less intensive conditions will receive nurse management via telephone, HHS says. Indiana plans to serve 26,000 enrollees under the program.

  • Disease management is also a high priority for end-stage renal disease patients. A four-year demonstration project unveiled May 29 will give participants a choice between two new ESRD reimbursement models: a fee-for-service option offering a single bundled payment covering both core treatment costs and ancillary services, and a managed care option under which participants - perhaps partnering with an insurer - would provide all Medicare services for dialysis patients in return for risk-adjusted capitated payments.

    The demo will replace a system under which CMS underpays ESRD providers for treatment while overpaying them for ancillaries like drugs and vi

    tamins to make up for it, notes CMS Administrator Tom Scully. A notice soliciting applications appears in the June 4 Federal Register at www.access.gpo.gov/su_docs/fedreg/a030604c.html, with applications due Aug. 28.

  • The Joint Commission on Accreditation of Healthcare Organizations will serve as a national accrediting organization for Medicare and Medicaid hospice facilities for another six years, CMS says in a May 30 Federal Register notice. CMS's reapproval of JCAHO - which is based on a determination that the accrediting body's standards are at least as rigorous as those laid out in Medicare's conditions of participation - extends JCAHO's deeming authority through June 19, 2009.

  • Clearwater, FL-based Senior Home Care Inc. has acquired HomeCare Holdings Inc. in Ft. Lauderdale, reports the Tampa Bay Business Journal. HomeCare's employees will retain their jobs.

    Senior Care's purchase is part of its plan to first set up a dominant presence in Florida, then expand to contiguous states, reports the Journal. Senior Care received a multi-million dollar investment from venture capital firm Summit Partners earlier this year (see Eli's HCW, Vol. XII, No. 8, p. 64).

  • After considering headquartering in Charlotte and Atlanta, Housecall Medical Resources Inc. has settled on Nashville, reports the Nashville Business Journal. The move comes after Washington, DC-based Allied Capital Corp. purchased the company that furnishes home nursing, infusion, oxygen, home medical equipment, hospice and other services for $37 million.

    The acquisition was funded through a combination of Allied Capital debt and equity, a senior lender and three unnamed executives of Centennial Healthcare, reports the Journal. Housecall, formerly a subsidiary of Adventist Health Systems, operates 59 offices in five states.

  • For-profit hospice chain VistaCare Inc. has opened a Medicare-certified office in Phenix City, AL, the Scottsdale, AZ-based company says. The office that serves 14 Alabama counties with a staff of 17 marks the company's first foray in the state.

  • A new medical supply company started by former American HomePatient execs is planning a series of buyouts in New York state, reports the Rochester Business Journal. Empire Health Resources Inc., started by former managers for AHP location PrimaCare Health Resources of Rochester Inc., has purchased Halprin Medical & Surgical Supply Inc. in Canandaigua for undisclosed terms.

    Empire hopes to buy a series of suppliers in upstate New York, retaining local names and staff at the firms it acquires, reports the paper. The company has obtained financing from the Capital Formation Group of Rochester and M&T Bank and is negotiating with other acquisition targets in Syracuse, Buffalo and Albany.

  • Tempe, AZ-based O2 Science has acquired Fife, WA-based Respicare. The location is the respiratory company's second in Washington state and eighteenth in the U.S.

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