Home Health & Hospice Week

Your therapists could qualify for grandfathering, thanks to CMS' change of heart.

Some home health agencies and their therapists have dodged a regulatory bullet.

In the physician payment final rule the Centers for Medicare & Medicaid Services issued Nov. 1, the agency addresses therapist requirements for numerous settings, including home care. The rule sets out new requirements for physical therapists and PT assistants--but the new standards won't take effect until 2010.

And PTs currently practicing will qualify for a grandfathering clause that could exempt them from the new educational requirements, the rule explains. Originally, CMS didn't plan to extend the grandfathering to therapists in home health or hospice.

Commenters on the proposed rule said "there is no justification for the absence of a grandfathering provision for ... Home Health settings," CMS notes in the final rule. "Many also ... recommended that sufficient time be allowed before implementation of the new standards for new professionals to meet their training."

New requirements: PTs must graduate from a Commission on Accreditation in Physical Therapy Education-approved program, a successor organization or a program outside the U.S. deemed to be substantially equivalent. PTAs must also graduate from a CAPTE-approved program for assistants or an equivalent outside the U.S. and pass a national exam.

Occupational therapists must graduate from an Accreditation Council for Occupational Therapy Education-approved program and take the exam by the National Board for Certification in Occupational Therapy, Inc. OTAs must also graduate from an ACOTE-approved program and take the national exam.

"We will apply the grandfathering provision in all settings," CMS relents in the final rule.

Grandfathering will apply up to the new deadline for those who are licensed. "Therapists and assistants who met the qualifications of their State's practice act ... prior to December 31, 2009, will not be required to upgrade their qualifications," CMS explains in the rule. Therapists in states without licensure will have to comply with the new requirements, however.

Or those PTs and PTAs who qualify without licensure will be grandfathered if they meet Medicare requirements before Jan. 1, 2008, CMS adds.

Resource: More details on the new requirements are at www.cms.hhs.gov/PhysicianFeeSched/downloads/CMS-1385-FC.pdf starting on p. 1012.

CMS also removed a proposal to require therapists to practice without an interruption for two years to qualify for and maintain grandfathering.

• Medicare has finalized a 10 percent cut to physicians' Medicare payment rates, and that's putting pressure on lawmakers to find the money to avoid the docs' cut--which could be bad news for home care.

Physician groups are lobbying hard to get members of Congress to pass legislation quickly averting the cut. CMS issued Nov. 1 the final rule instituting the 10.1 percent decrease.

"Congress must step in to replace the cut with payment increases that keep up with medical practice costs," the American Medical Association says.

But home care providers fear legislators will use cuts to home health agencies and durable medical equipment suppliers to fund the physician payment fix.

Hang in there: Congressional observers say a Medicare legislative package may be pushed back to early next year.

• Emergency preparedness is the topic of an Oct. 24 letter CMS sent to surveyors.

"Public Health Emergency Frequently Asked Questions--All Hazards" updates state survey agency (SSA) directors about work being done to provide effective emergency response by health care providers, including home health agencies. Though the letter addresses SSA staff, it will help HHAs understand what CMS will expect of them during an emergency, says the National Association for Home Care & Hospice.

• You'll have one less thing to worry about when Jan. 1 hits. CMS has bumped back its NPI requirement for primary fields to March 1, it says in a recent message to providers. Starting in March, providers must use their NPI in the billing, pay-to and rendering fields.

"Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008," CMS warns.

Back in limbo: And CMS will allow legacy numbers by themselves in secondary fields--such as those for referring physicians--"until further notice," the agency says. That's a backtrack from the agency's earlier instruction to use NPIs in secondary fields by May (see Eli's HCW, Vol. XVI, No. 38).

• Get ready for more scrutiny of your long-stay hospice patients with dementia. Regional home health intermediary Cahaba GBA will continue a widespread review of patients with ICD-9 code 290.50 (arteriosclerotic dementia) and a length of stay greater than 240 days.

In its probe review of such claims from April to September, hospices racked up a 58 percent error rate, Cahaba says. Among the 35 providers reviewed, 61 percent of denials were due to lack of support for six-month prognosis; 16 percent were due to missing, incomplete or untimely certification; and 15 percent were due to lack of response.

• LHC Group Inc. is punting on the question of how the prospective payment system refinements will affect its financial performance.

The Lafayette, LA-based chain is waiting until Congress resolves this year's Medicare issues  before providing 2008 guidance, including PPS' impact, the company says in its latest earnings release. Pending issues include the possible return of the 5 percent rural add-on and the proposed legislation to delay the case mix creep cut.

Meanwhile, the company that operates mainly in rural areas crowed about its 19 acquisitions and 20 start-ups so far in 2007. LHC plans to have 30 start-ups next year, it says in the release.

LHC reported net income of $6.0 million on revenues of $77.5 million for the quarter ended Sept. 30, compared to a $5.3 million profit on $58.6 million in revenues for the same period in 2006.

LHC also announced an acquisition of controlling interest in two Alabama hospitals' home health agencies. The company entered into partnership agreements with Huntsville Hospital in Huntsville and Decatur General in Decatur. Both are members of the HealthGroup of Alabama.

HGA HomeCare-Huntsville and HGA HomeCare-Decatur have a 13-county service area, bringing LHC's coverage to 39 counties in Alabama, the company says in a release. Annual revenue for the locations is $3.2 million.

• Home care giant Gentiva Health Services is projecting annual revenues of $1.25 billion to $1.29 billion for 2008 under PPS refinements. "We approach 2008 with both optimism and caution," Gentiva CEO Ron Malone says in its latest earnings release. "Our industry faces reimbursement uncertainties." Gentiva singles out the case mix creep cut for vigorous opposition.

The Melville, NY-based company revised downward its 2007 revenue projections due to elimination of low-margin business, it says. The new range is $1.22 to $1.24 billion, down from the $1.24 billion to $1.27 billion figure cited earlier.

Gentiva increased its net income significantly in the quarter ended Sept. 30, with an $8.2 million profit on $309.1 million in revenues. That's compared to $5.3 million in net income on $286.2 million in revenues for the same period in 2006.