Home Health & Hospice Week

Federal court rules against provider arguing over director compensation.

A federal court has shot down a bid for medical director reimbursement from a Louisiana home health agency owned by chain LHC Group Inc.

Last February, the Provider Reimbursement Review Board ruled against Lafayette-based Acadian HomeCare when it upheld about $40,000 in disallowances for medical director compensation in 1999 (see Eli's HCW, Vol. XV, No. 15). In a 3-2 split decision, the PRRB sided with intermediary Palmetto GBA because Acadian had 13 medical directors for seven branches and paid two directors for being on 24-hour call.

In its case before the U.S. District Court for the Western District of Louisiana, Acadian argued that "the Medical Directors were not a luxury but a necessity to its goal to provide quality patient care," according to the Court's May 15 decision (06-577). The PRRB decision was "plainly erroneous and ... not rationally supported," the home health agency claimed.

But the Court ruled in favor of the Department of Health and Human Services. "Because the regulations expressly state that these [medical director] services are not reimbursable by Part A in the home health context, the Board was entirely reasonable and rational in disallowing them," the decision says.

Opportunity: For tips on keeping your medical director compensation on the right side of the law, sign up for Eli's Aug. 8 audioconference, "Spot the Compliance Pitfalls Before They Cost You Big," by attorney Robert Markette, Jr.  You can obtain information online at http://www.audioeducator.com/ or by calling 1-800-874-9180.

• Home care aides should have the support of federal labor laws that "ensure that the aides, entrusted with the care of the most vulnerable Americans, are treated with professionalism, fairness and dignity," said a June 15 editorial in the New York Times.

The opinion piece ran in response to the U.S. Supreme Court's decision in the closely watched case Long Island Care At Home Ltd. v. Coke, which centered on the question of whether home health agencies are allowed to apply the "companionship exemption" to the Fair Labor Standards Act (see Eli's HCW, Vol. XVI, No. 22). The Court held that the companionship exemption does apply to aides employed by third parties, including HHAs.

The Court's decision "makes no sense for a nation of aging baby boomers," another editorial in the Philadelphia Inquirer states.

Both editorials recommend that Congress revise federal minimum wage and overtime laws to include home care workers.

• The HHS of Inspector General took back from providers $2.9 million in Medicare and other federal funds from October 2006 to March 2007. The recoveries were due to alleged fraud and abuse, according to the OIG's latest semiannual report to Congress.

The OIG excluded nearly 1,300 people and organizations from Medicare and other federal health care programs, and brought civil and criminal actions against more than 320, according to a press release.

A sweep of South Florida durable medical equipment suppliers made the OIG's highlight list, but the report, available at http://oig.hhs.gov/publications/docs/semiannual/2007/semiannualfirsthalf07.pdf, makes few references to home health agencies and doesn't mention hospices.

• The return of the 5 percent add-on for rural HHAs isn't totally out of the budget picture.

Sens. Kent Conrad (D-ND), Pat Roberts (R-KS), Tom Harkin (D-IA) and Pete Domenici (R-NM) have introduced a bill (S. 1605) that would restore the add-on and allow nurse practitioners, clinical nurse specialists, certified nurse midwives and physicians' assistants to certify home health plans of care in both rural and urban areas, the National Association for Home Care & Hospice notes.

But HHAs overall are still at great risk of payment cuts, warns the American Association for Homecare. "Medicare bills are percolating in Congress right now and cuts to home care are being considered," the trade group says.

• Get ready for some PS&R changes. The Centers for Medicare & Medicaid Services plans to implement a redesigned provider statistical & reimbursement (PS&R) report system for cost reports ending July 31 or later, the agency says in a message to intermediaries. That's moved back from a previous February 2007 due date.

In other words, any PS&R report with a "through" date of July 31 or after will be on the redesigned system.

The intermediaries won't be able to generate interim PS&R reports for a short time during the transition, CMS warns. "Interim PS&R reports are not a requirement, and the inability to produce these reports will be temporary," the agency maintains. "This will not have any impact on cost report due dates."

• If you've been feeling the medical review heat on claims for hospice patients without cancer, you're not alone.

Palmetto GBA conducted probe reviews of hospice claims for non-cancer patients for 252 providers from December 2006 through March 2007, the regional home health intermediary says in a question-and-answer set from its April 3 hospice coalition meeting. Palmetto selected 15 percent of its hospices for the non-cancer length of stay (NCLOS) review.

• Pediatric Services of America Inc. has paid $2.9 million in cash to acquire select pediatric assets of The Care Group of Texas Inc., Norcross, GA-based PSAI says in a release. The acquisition includes The Care Group's pediatric private duty nursing business in the Houston, TX market.

• The much-disputed acquisition of National Home Health Care Corp. by investment firm Angelo Gordon & Co. is one step closer to completion. NHHC shareholders have approved the sale, which went forward after the firm sweetened its buyout offer.

Scarsdale, NY-based NHHC expects the deal to close by Sept. 10, it says in a release. Shares fell 7 cents to $12.58 after the announcement.

Four days before the announcement, NHHC announced a loss of $244,000 on revenues of $27.9 million for the quarter ended April 30, compared to $722,000 in net income on $25.0 million in revenues for the same period in 2006.

Professional fees related to the troubled sale cost the company $1.4 million during the quarter, according to the earnings release.