Home Health & Hospice Week

CMS to start knocking on doors to recruit.

A demonstration project that could result in more referrals to home care is looking for volunteers--but there's a catch.

The Centers for Medicare & Medicaid Services is testing patient assessment, outcomes and payment across the post-acute spectrum--home health agencies, skilled nursing facilities, inpatient rehab facilities and long-term care hospitals. CMS has pilot tested the Continuity Assessment Record and Evaluation (CARE) tool in those providers already (see Eli's HCW, Vol. XVI, No. 27).

Now CMS wants to conduct a full-fledged demonstration in early 2008, and the agency needs volunteers. But the 26-page assessment tool will be a major added burden to HHAs, experts fear.

CMS appears to recognize that it will have a hard sell with the demonstration. "Providers may ... be targeted for recruitment from analysis of Medicare administrative files and will be contacted," CMS says in a release about the project.

The agency and its contractor, RTI, plan to conduct the demo in 10 "distinct" areas of the country. CMS and RTI will consider characteristics such as corporate ownership, profit status and size for participants.

Hidden bonus: Although the demo will be a paperwork burden for participants, it may end up benefiting the industry in the long run. "A key goal of this project is to generate recommendations for improving CMS payment models," CMS says in the release. Reform includes "aligning incentives among the four PAC settings."

In other words, if home care can provide the same patient outcomes for much less cost than the other inpatient post-acute providers, CMS may encourage more patients to utilize home care. That would bring more patients and more Medicare dollars to agencies.

• Just because Congress is officially on recess doesn't mean there's not lots to do to head off looming payment cuts to home care providers.

The Bush Administration and Congress have continued to wrangle over the State Children's Health Insurance Program (SCHIP) this month, with President Bush again threatening a veto of Congress' legislation reauthorizing and expanding SCHIP. The House's SCHIP bill also calls for a Medicare payment rate freeze for HHAs in 2008, a reinstatement of the 5 percent rural add-on, oxygen payment cuts and elimination of the first-month purchase option for power wheelchairs.

Democrats have launched radio and phone campaigns criticizing Republicans' votes on the SCHIP bill and the Bush Administration has set new requirements for SCHIP expansion that has left states fuming.

The National Association for Home Care & Hospice and the Visiting Nurse Associations of America is fighting back with a joint letter to congressional heads decrying the HHA cuts included in the House bill. If CMS implements the rate freeze and payment cut for supposed case mix creep, "more than 46 percent of home health agencies will be paid less than their cost of providing care to Medicare beneficiaries by 2010," the letter from NAHC and the VNAA warns.

NAHC is also organizing a Sept. 11 "March on Washington" to reach out to agencies' legislators to combat the cuts.

Providers should be contacting their elected representatives at home too, urges the American Association for Homecare. "It is vital that the home care industry redouble efforts on grassroots advocacy and not become fatigued by the process ," AAHomecare urges in a message to members. "Focused attention should be paid to Senate lawmakers who are likely to consider a Medicare package in mid-September."

• Home care has been getting national attention thanks to the coming presidential election, but it may not be entirely flattering.

Sen. Barack Obama (D-IL) participated in the Service Employees International Union's "Walk a Day in My Shoes" program by spending time with a home care aide in the San Francisco area. Obama used the opportunity to call for furnishing benefits such as paid leave and health insurance for home care aides.

But the visit also highlighted home care's importance, maintained the National Association for Home Care & Hospice. Obama's visit showed "the vital role home care plays in the lives of so many citizens," said NAHC's Val Halamandaris.

Sen. Hillary Clinton (D-NY) followed a hospital nurse for her turn in the SEIU's program.

• Palmetto GBA and Cahaba GBA are revising their Local Coverage Determinations regarding dysphagia in home health. Cahaba's general dysphagia LCD (L336) lists documentation requirements for dysphagia treatment including "changes in condition or functional status; History and outcome of previous treatment for the same condition; and other information which justifies the start of care or continued treatment."

And Palmetto says it won't cover home health surface electrical stimulation in the treatment of dysphagia. "There is insufficient scientific or clinical evidence to consider this device as reasonable and necessary for the treatment of dysphagia," the intermediary says in its draft LCD (07HH-004-L). Both LCDs take effect Oct. 1.

Commenters did submit both published and unpublished information supporting use of e-stim for dysphagia, Palmetto admits. But the information "did not provide sufficient evidence to amend the proposed non-coverage LCDs," the intermediary concludes. Speech therapists are concerned that "use of this intervention has spread ahead of the evidence to support its effectiveness in the various target populations," Palmetto maintains.

• Hospice billing is about to get a lot more complicated. CMS will require hospices to include line items on claims that list visits by discipline and by site starting Jan.1.

The limited information collected so far on hospice claims "has restricted Medicare's ability to ensure optimal payment accuracy in the hospice benefit, and to carefully analyze the services provided in this growing benefit," CMS says in July 20 Transmittal No. 1304 (CR 5567).

Last year CMS began requiring hospice claims data on site of service and continuous care. Now CMS will expand the data collection significantly. "For each week, beginning on Sunday and ending on Saturday, hospice providers are to indicate the number of services/visits provided by nurses (registered, licensed and/or nurse practitioner), home health aides, social workers, physicians, and nurse practitioners serving as the beneficiary's attending physician," CMS directs. The line item will also include a code for the site of service.

Clarification: Site of service code Q5003 applies to patients in a nursing home or non-Medicare-covered skilled nursing facility. Q5004 applies to Medicare-covered SNF stays.

The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R1304CP.pdf.

• There's a new road to clinical nurse specialist certification for nurses working in hospice and home care. In a transmittal issued on Aug. 17, CMS notes that it is adding the National Board on Certification of Hospice and Palliative Nurses to the list of recognized bodies for nurse practitioners at the advanced practice level.

The transmittal and a related Medlearn Matters article is at www.cms.hhs.gov/Transmittals/2007Trans/list.asp --search for "Change Request 5639."

• Pediatric Services of America Inc. is voluntarily delisting its stock from NASDAQ, the Norcross, GA-based home care chain says in a release. PSAI will go private once its merger with Portfolio Logic is complete at the end of this month.

• A former Iowa home health agency owner and finance director will have to live with their financial penalties and Medicare exclusions for alleged cost report fraud, says a recent federal appeals court decision.

In 2005, an administrative law judge served Thomas M. Horras, the owner of Hawkeye Health Services Inc. in Knoxville, IA, a civil monetary penalty of $38,000, an assessment of $673,212, and an exclusion from Medicare for seven years (see Eli's HCW, Vol. XIV, No. 19). On Aug. 7, the U.S. Court of Appeals for the Eighth Circuit affirmed the Health and Human Services Secretary's decision upholding that CMP, assessment, and exclusion, as well as lesser ones for Hawkeye executive Christine Richards.

The HHS Office of Inspector General said Horras submitted personal expenses for cars and club memberships, charitable donations, and costs not related to patient care on Hawkeye's cost reports and that Richards had "reckless disregard" for the false claims.

The OIG investigated Hawkeye based on complaints from a former employee and Horras' ex-wife, notes the decision at www.ca8.uscourts.gov/opns/opFrame.html.