Home Health & Hospice Week

Complaints pile up about the agency's regulatory relief in the face of natural disasters.

Providers furnishing home care in the face of a hurricane have their work cut out for them--but the feds don't seem to be helping lighten that load.

The Centers for Medicare & Medicaid Services has denied an emergency oxygen waiver request for hurricane-harried Florida.

In the wake of Hurricane Wilma, the Florida Association of Medical Equipment Services asked CMS to allow durable medical equipment companies to provide emergency oxygen to Medicare beneficiaries without a prescription. But the agency said it would not make any blanket waivers and that providers should instead contact their regional offices to report problems.

The group is asking its members to contact their legislators about the issue.

Likewise, the National Association for Home Care & Hospice isn't pleased with CMS' response to its Hurricane Katrina requests. A recent addition to CMS' Katrina Q&As "offers minimal relief," NAHC says. The association asked CMS to lift the partial episode payment (PEP) policy for evacuated patients, "but CMS refused to honor this request," it notes.

The agency also shot down a bid to expand the role of nurse practitioners and other physician auxiliaries in ordering home care. And "CMS did not relax current regulations applicable to hospice providers in any way," the association rails.

The new Q&As are online at www.cms.hhs.gov/katrina.

Despite the industry's hurricane-related regulatory complaints, Southern Florida HHAs forged ahead in the face of Hurricane Wilma destruction.
 
Traffic jams caused big problems for traveling home care workers, reports the South Florida Sun-Sentinel. Without functioning traffic lights after Wilma, nurses took 10 hours to see five patients instead of the usual eight to 10 patients, Vivian Kaplan, owner and administrator of Elite Home Health, told the paper.

Elite nurses visited patients starting the day after the storm and walked into neighborhoods that were blocked to traffic, the Sun-Sentinel says. Caregivers with National Home Care in Broward County stayed with patients up to four days to help them ride out the storm, said Administrator Michael Greaves.

Long lines at the gas pump post-hurricane were a big pain for home care workers. Elite clerical workers waited in gas lines for up to four hours to fill up visiting nurses' tanks, according to the newspaper.

• Medicare's free HAVEN software has caught up with the new diagnosis codes that took effect Oct. 1. HHAs can download a new code database for HAVEN, which transmits OASIS data, at www.cms.hhs.gov/oasis/hhnew.asp.

"Once the new [database file] has been installed, warning messages will be generated for assessments containing ICD-9-CM codes that are invalid," CMS explains. "Assessments with invalid ICD-9-CM codes will be accepted when submitted."

• Missouri DME providers could soon face competitive bidding at the state level.
 
A state audit has found that DME competitive bidding could save Missouri more than $5 million in Medicaid funds. However, the state's director of medical services has raised concerns about the proposal, including its negative impact on small businesses, according to news reports.

Missouri's Medicaid program recently stopped covering a number of DME items, including hospital beds, wheelchair batteries and respiratory equipment. For a copy of the audit, visit www.auditor.state.mo.us.

• There's a new batch of Remittance Advice (RA) codes and Reason Codes for you to learn.

New codes that take effect Jan. 1 include RA code N348 (You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier). The entire code list is in a Nov. 4 transmittal online at www.cms.hhs.gov/manuals/pm_trans/R743CP.pdf.

• You now can get all of your National Provider Identifier information in one place.

CMS has launched an NPI Web site at www.cms.hhs.gov/providers/npi/default.asp. All health care providers covered by HIPAA are required by law to apply for their NPI, CMS reminds providers.

• Home care workers are soldiers in the army against health care fraud.

A Texas home care provider stands accused of furnishing fake flu shots to corporate customers, thanks to a nurse's sharp eyes.

U.S. Attorney Chuck Rosenberg filed criminal charges against Iyad Abu El Hawa, owner of Comfort & Caring Home Health in Houston, for his participation in administering bogus flu shots at company-sponsored health fairs as a part of a Medicare fraud scheme, Rosenberg's office has announced.

On Oct. 19 and 20, 2005, a contract nurse that El Hawa hired to administer flu vaccines to Exxon-Mobil employees "became alarmed upon learning from an employee of El Hawa that the employee stayed up all night filling syringes in anticipation of the ExxonMobil event," Rosenberg alleges.

The nurse reported to the Federal Bureau of Investigation that the employee was not aware of the lot numbers that manufacturers use to identify vaccines. The nurse also furnished the FBI with two of the syringes that El Hawa's employee had prepared for use at the ExxonMobil event.

When the FBI visited El Hawa at his Comfort & Caring offices, agents and inspectors allegedly saw El Hawa "throwing a bag of syringes into a dumpster located across the street from his offices," Rosenberg says. The FBI seized the syringes and records that listed 14 patients' names and Medicare and Medicaid numbers, which El Hawa supposedly planned to use to bill the health care programs for the fake flu vaccines.

Preliminary analyses on the seized syringes concluded that the fluid in the syringes is not the flu vaccine and may be a "purified form of water."

• Gentiva Health Services Inc.'s profits declined while revenues grew in the quarter ended Oct. 2. Gentiva reported net income of $4.3 million on revenues of $219.6 million for the quarter, compared to a $4.4 million profit on $198.1 in revenues for the quarter ending Sept. 26, 2004.

The earnings figures include a $1.4 million settlement from Gentiva's cost report appeal with the Provider Reimbursement Review Board, the Melville, NY-based chain says. The company also reduced its earnings forecast for 2005 due to an expiring TriWest contract and the impact of Hurricane Wilma on Gentiva's South Florida operations, among other items.

The company also announced that its contract with CIGNA HealthCare will be scaled back to exclude coordination of respiratory therapy and certain durable medical equipment services as of Jan. 31. The change could cost Gentiva up to $40 million in revenues in 2005, it says.

Gentiva will continue to coordinate for CIGNA home nursing and related services through its CareCentrix network of credentialed, third-party providers or through the company's own home care locations, it says. And it will coordinate home infusion services and certain other specialty medical equipment including insulin pumps and wound suction devices.

• Walgreens Home Care is buying Home Pharmacy of California, one of the largest independent home infusion companies in California with offices in Burbank, Corona and Ventura. Terms of the agreement were not disclosed.

"Home Pharmacy of California's reputation as a leading provider of infusion services, as well as their dedication to superior patient care, makes this acquisition an excellent strategic and cultural fit for us," says Ron Allen, Deerfield, IL-based Walgreens vice president of home care services.

• LHC Group Inc.'s home care business grew in the quarter ending Sept. 30. LHC reported operating income of $5.0 million on revenues of $26.9 million for its home care division in the quarter, compared to a $4.9 million operating income on revenues of $22.3 million for the same period in 2004.

Hurricanes Katrina and Rita affected LHC's earnings (see Eli's HCW, Vol. XIV, No. 36), and the Lafayette, LA-based regional chain expects more fallout in the following quarter, it says.

Overall, LHC reported net income of $2.8 million on revenues of $41.3 million for the quarter.

• CMS is reducing the paperwork required for supplying immunosuppressive drugs. Beginning April 1, 2006, suppliers will no longer have to submit the Durable Medical Equipment Regional Carrier Information Form when providing the drugs for Medicare beneficiaries.

Section 1861(s)(2)(J) of the Social Security Act no longer imposes a limitation on the period of time for coverage of immunosuppressive drugs. Therefore, information captured on the form such as dates of the beneficiary's transplant and other diagnosis information can be obtained through other means.

For more details including the specific codes involved, see CMS Program Transmittal 745 at www.cms.hhs.gov/manuals/transmittals.

• The Visiting Nurse Service of New York won't take part in Medicare Health Support, Medicare's newest disease management initiative, after all, CMS says in an Oct. 28 transmittal about the project (CR 3953). The program with United HealthCare Services Inc., EverCare has been cancelled, CMS says (see Eli's HCW, Vol. XIV, No. 30).