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Home Health & Hospice Week

Industry Notes:

HOME CARE LEGISLATION MAKES HEADWAY

Published on Fri Jul 30, 2004

HHA, DME bills see action.

Despite the lack of hope that bills proposing home care improvements will achieve passage this year, two such pieces of legislation are gaining support in Congress.

As expected, Rep. Greg Walden (R-OR) and 29 bipartisan cosponsors introduced on July 22 legislation in the House aiming to extend the 5 percent payment add-on for rural home health agencies for two years, to April 2007. Sen. Susan Collins (R-ME) introduced the same legislation in the Senate July 15 (see Eli's HCW, Vol. XIII, No. 26).

Proponents hope building support for the 5 percent add-on extension will pave the way for passage for the provision next session.

And a bill aiming to repeal payment cuts to oxygen, nebulizers, hospital beds, wheelchairs, diabetic supplies, and air mattresses has gained 27 bipartisan cosponsors since its introduction. Reps. David Hobson (R-OH) and Harold Ford, Jr. (D-TN) introduced H.R. 4491, which would block cuts slated for January 2005, on June 2 (see Eli's HCW, Vol. XIII, No. 21).

"While the bill may not see action this year, broad support sends a powerful message about the importance of homecare and builds momentum for a legislative remedy in the 109th Congress," says the American Association for Homecare.

  • The Federal Aviation Administration is proposing to allow oxygen patients to bring AirSep LifeStyle Portable Oxygen Concentrators on airplanes with them, according to a notice in the July 14 Federal Register. Typical compressed oxygen cylinders are considered hazardous materials and aren't allowed on planes without special conditions and restrictions. As a result, most airlines simply ban oxygen.

    But the AirSep concentrator takes oxygen from ambient air and isn't considered a hazardous material. So far AirSep is the only concentrator evaluated by the FAA, but other devices may be approved as well, the agency expects.

    More information is in the notice at www.access.gpo.gov/su_docs/fedreg/a040714c.html.

  • The Centers for Medicare & Medicaid Services is clearing up a billing problem resulting from the switch to allow nurse practitioners to act as attending physicians for hospice patients. Carriers had denied NP services billed as the hospice attending, CMS explains in a new Medlearn Matters education article at www.cms.hhs.gov/medlearn/matters/. But now the carriers will go back, reopen and pay those claims if they were billed with a GV modifier.

    If they were billed without GV modifiers, the NP must bring the incorrectly denied claims to the attention of the carrier to get paid, CMS instructs. Or the NP can just rebill the claim with the modifier.

    NPs were allowed to act as hospice attendings starting Dec. 8, 2003.

  • Military health benefits program TRICARE is switching over to using the Medicare home health prospective payment system, the National Association for Home Care & Hospice reports. TRICARE is phasing in PPS in its regions from July to November of this year.

    To get paid by the program, which has some extra requirements such as preauthorizations and OASIS verifications, agencies must be a participating provider with the program, NAHC notes.

  • Thanks to litigation, Medicare intermediaries will be performing complex medical review on 100 percent of home health demand bills, CMS says in July 23 Transmittal No. 82. The implementation date for the new mandate is Aug. 23, the transmittal says.

  • West Virginia will pilot a Medicaid waiver program aimed at keeping seniors in their homes and out of nursing homes.

    Under the waiver approved by CMS, the state will pay for adult residential care services to be furnished in beneficiaries'homes instead. Those services include personal care, homemaker, chore, attendant care, companion, medication oversight, therapeutic social and recreational programming, transportation, and periodic nursing evaluations.

    The program will add 150 residents in each of its three years and will pilot in Moundsville, Williamson, Wheeling and Huntington, CMS says in a release.

  • A physician's level of comfort in discussing death, his medical ethics training and his religious affiliations could affect whether a patient is offered end-of-life options such as hospice, says a study in the International Journal of Gynecological Cancer.

    In a survey of 900 members of the Society of Gynecologic Oncologists, 8 percent of physicians said they would avoid telling a patient that they have a terminal condition while only 75 percent said they would disclose to patients with inoperable cervical cancer before initiating treatment, that their disease is incurable.

  • HHAs that want to brush up on their home health prospective payment system bundling responsibilities can check out the home health consolidated billing master list at www.cms.hhs.gov/providers/hhapps/default.asp?. CMS updated the file July 12.

    The Excel file contains all codes ever bundled, including dates they were included and excluded from the list and relationships between ingoing and outgoing codes.

  • You might want to help yourpatients steer clear of a problem with the new prescription drug cards: inaccurate information on what pharmacies accept them.

    Passive acceptance agreements are used by prescription drug card sponsors to identify pharmacies participating in the program. The approach enables some sponsors to list pharmacies as accepting their cards simply because the stores didn't specifically opt out of participation, says a July 6 letter to Health and Human Services Secretary Tommy Thompson from Reps. Henry Waxman (D-CA) and Louise Slaughter (D-NY).

    The result, according to Waxman: "Many pharmacies that do not participate -- and have no intention of participating -- with drug-card sponsors are listed as participants on the Medicare Web site."

    Slaughter's staff surveyed 10 independent pharmacies in her home district and found that the Medicare.gov Web site showed inaccurate information for all 10. For four of the New York pharmacies, the Web site vastly overstated the number of discount cards the stores accepted, the lawmakers report. In total, the site listed 45 cards as being accepted at one of those four pharmacies when the store itself reported to Slaughter's staff that it didn't accept the cards at all.

    On the other side of the coin, for six of the 10 pharmacies the Medicare.gov site under-reported the number of cards accepted. These six pharmacies told Slaughter's staff that they accepted all the discount cards. However, the Medicare.gov site listed them as participants in only some of the programs.

    Illustrating the severity of errors that can result from relying on the opt-out approach, the lawmakers also turned up a couple of pharmacies that Medicare.gov listed as card participants even though the pharmacies are out of business, in one case "for at least three years."

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