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Home Health & Hospice Week

Industry Notes:

LEGISLATIVE PICTURE BODES WELL FOR HOME CARE

Published on Tue Mar 03, 2009

Congress rejects President's proposal for HHA cuts -- for now.

Lawmakers seem to be receptive to home care providers' arguments for leniency this session.

Both the House and Senate Budget Committees approved budget resolution legislation that does not include any cuts to home health agencies,notes the National Association for Home Care & Hospice. The full House and Senate still have to pass the legislation and agree on a single resolution, but it looks promising that lawmakers will specify no home care cuts.

What this means: Congress' budget resolution isn't binding and is just a blueprint for the 2010 budget, but it shows which way lawmakers are leaning -- and that appears to be away from the billions in HHA payment cuts the Obama administration proposed in its budget plan (see Eli's HCW, Vol.XVIII, No. 10, p. 74).

The Obama proposal was "flying against political will," concludes consultant Pat Laff with Laff Associates in Hilton Head Island, S.C.

Tough times ahead: But don't think next year will look rosy without the proposed cuts, Laff warns. The scheduled 2.75 percent reduction for case mix creep is likely to match any inflation increase, resulting in nearly flat reimbursement rates for 2010, he predicts.

And it's far from sure that the cuts will stay out of the budget, NAHC reminds its members.Congressional leaders are still hoping to perform a major health care overhaul per the president's wishes,and that will need major funding that must come from somewhere in the budget.

"It is still imperative...to continue the fight to keep these cuts out of the final Medicare legislation this year," NAHC urges.

• Like the economy, Home Health Compare's national averages show declines.

From the beginning of publicly reported outcomes on the Home Health Compare Web site in November 2003 until November 2007, the national averages either stayed the same or improved. But 2008 ended that trend.

The two measures that stayed at the same percentage over all those years were "Patients who needed urgent unplanned medical care" at 21 percent and "Patients who had to be admitted to the hospital" at 28 percent. However, the November 2008 data showed a worsening of both those averages, with each of them increasing by 1 percent.

Of the other 10 measures, one improved,two got worse, and seven remained unchanged from a year before. "Patients who got better walking or moving around" improved from 42 percent to 44 percent -- 10 percentage points better than the original 34 percent five years before. The two measures that got worse were "Patients who get better getting in and out of bed" -- going from 54 percent to 53 percent -- and "Patients whose bladder control improves" - going from 50 percent to 48 percent.

• Medicare's new rules for durable medical equipment surety bonds have hit the books. In March 27 CR 6392 (Transmittal No. 287), the Centers for Medicare & Medicaid Services spells out the requirement for new providers to obtain $50,000 surety bonds by May 4 and existing suppliers to obtain them by Oct. 2.

Bonds are required based on National Provider Identifier numbers, so each NPI must have its own $50,000 bond, CMS explains. Suppliers can obtain a bond for multiple NPI locations, but the bond must be in the amount of $50,000 for each number. For example, a supplier with 10 NPIs would need a $500,000 bond to cover them.

Each "adverse action" imposed on a supplier will raise the required bond amount by $50,000. So for example, a supplier with one NPI and a revocation of Medicare billing privileges would need a $100,000 bond.

Resource: More details are in the transmittal online at www.cms.hhs.gov/transmittals/downloads/R287PI.pdf.

• HHAs wondering what a pay for performance system would look like under Medicare may want to take a peek at CMS's new P4P pilot project for skilled nursing facilities.

As with the ongoing home health P4P demonstration project, SNFs will receive bonus payments if they have high outcome scores or are among the most improved, CMS notes in a release. SNFs in Arizona, Mississippi, New York, and Wisconsin are eligible to participate in the demo that will run from 2009 to 2012.

• Florida home health agencies may soon have more than the state's new anti-kickback law to deal with. Florida legislators have introduced new legislation aimed at curbing fraud and abuse in the state's Medicaid program, particularly regarding home care.

State Sen. Don Gaetz (R), who co-founded and sold hospice chain VITAS, sponsored the bill that would require home care orders from physicians not affiliated with the agency and would share 25 percentof qui tam case proceeds with whistleblowers.

"Miami-Dade has become a cesspool of fraud and abuse because we've allowed a proliferation of providers," Gaetz tells the Tallahassee Democrat.

The legislation would also target recruitment of patients, filings for non-existent patients, and orders for unnecessary devices or procedures. And the state would create a database so operators of fraudulent companies could be prevented from reincorporating new clinics or home services.

• Regional chain LHC Group Inc. is entering into a joint venture with North Mississippi Medical Center -- Hamilton in Alabama, the company says in a release. The venture covers six counties in the certificate of need (CON) state. The agency has annual revenues of $900,000, LHC says.

LHC also has entered into a hospice joint venture with 89-bed Levi Hospital in Hot Springs,Ark., to provide hospice services in the central part of the state. LHC and Levi Hospital have had a home health joint venture in place since December 2005, the company notes in a release.

• Madison County Hospital in London, Ohio is offloading its home care business. The hospital is transferring its 58-patient load to Universal Home Health & Hospice Inc. in Bellefontaine by May 1, reports The Madison Press newspaper. Universal has offered jobs to the hospital's 14 home care employees, the hospital says.

• The Department of Health and Human Services may soon have an official leader, and CMS may not be far behind. Two Senate committees have conducted confirmation hearings for Obama administration nominee for HHS Secretary, Kansas Gov.Kathleen Sebelius. A date for a full Senate vote isn't yet set, but will be some time after Congress' two-week Easter recess that begins April 6.

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