Home Health & Hospice Week

Watchdog agency finds inappropriate instances of respite care use, new report says.

Harsh scrutiny continues for the Medicare hospice benefit.

The HHS Office of Inspector General undertook a study of hospice respite care following a recent report comparing hospice for nursing home beneficiaries versus those in other settings (see Eli's HCW, Vol. XVII, No. 1). The report found that Medicare spent 25 percent more on hospice services for nursing home residents.

In 2005, only 2 percent of hospice beneficiaries received respite care, which is short-term inpatient care meant to give caregivers a break, the OIG notes in the report. "Most of these beneficiaries received the care for a total of [five] days or less," it adds.

But the watchdog agency still found a number of instances of potentially "inappropriate" care. Fifty-four beneficiaries received respite care longer than the five consecutive days allowed by Medicare, the OIG says. "And 62 beneficiaries received respite care while residing in nursing facilities, even though respite care is designed to relieve the beneficiary's caregiver."

The report is online at www.oig.hhs.gov/oei/reports/oei-02-06-00222.pdf. • You may know a lot more about your future payment rates a month from now. Senate Finance Committee Chair Max Baucus (D-MT) says he will send Medicare legislation straight to the Senate floor rather than having the committee conduct a markup of the bill. That will happen in mid-May, observers predict.

What exactly the bill will contain is still up for grabs. But cuts for other Medicare providers still seem likely, since Congress is looking for funds to avoid the 10 percent cut to physicians' rates that hits July 1. And HHAs with their double-digit profit margins are at the top of the list for rate reductions.

Spreading the word: Scores of home care providers visited their elected representatives in Washington, D.C. and told their stories on April 8 as part of the National Association for Home Care & Hospice's annual March on Washington conference. • Medicare is now receiving more than 98 percent of claims with a National Provider Identifier, CMS says in a message to providers. But providers need to focus on the next step--NPI-only claims, which CMS will require May 23.

After testing small batches of NPI-only claims and making sure those process smoothly, test other HIPAA transactions, the agency advises. Remember that providers must be able to accept NPI-only remittance advice transactions.

More NPI information is at www.cms.hhs.gov/NationalProvIdentStand and providers can apply for an NPI at https://nppes.cms.hhs.gov. • Your state may pay for more home care now that CMS is making the rules to do so easier. CMS has proposed allowing state Medicaid programs to offer home- and community-based services (HCBS) without requiring a demonstration waiver.

"States will now be able to set their own [...]