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Home Health & Hospice Week

Industry Notes:

PROVIDERS EYE MEDICARE PROVISIONS IN STIMULUS BILL

Published on Tue Jan 06, 2009

Hospices would benefit from $134 million provision.

Home care providers are hoping for the best as Congress hammers out its economic stimulus legislation.

So far hospices are the only home care providers specifically targeted for help. In the version of the bill the House passed Jan. 28, the budget neutrality adjustment factor (BNAF) cuts that took effect Oct. 1 would be retroactively delayed for one year. That provision would mean an extra $134 million in hospice payments, the Associated Press reports. The bill overall will cost $819 billion.

But so far the Senate version of the bill does not contain the measure. And it may not be likely to, if lawmakers heed the AP article that was critical of the provision as the product of intense lobbying.

The Alliance for Care at the End of Life,which is the National Hospice & Palliative Care Organization's lobbying arm, spent close to $1 million and employed 10 outside lobbyists last year, AP notes. National hospice chain VITAS Healthcare Corp. also spent $330,000 lobbying Congress last year, employing six outside lobbyists to make its case, AP adds. Numerous VITAS employees including executives made political contributions totaling $100,000 over two years.

Rep. Dave Camp (Mich.), the top Republican on the Ways and Means panel, admits the provision is a "good one." But he also told AP, "It isn't necessarily a stimulative one. We'd like to see this bill, which is being done so quickly, limited to things that really will grow the economy and create jobs."

NHPCO's Jonathan Keyserling told AP that the measure will save hospice programs from closing and from eliminating thousands of jobs.

Other bill provisions that will benefit home care providers less directly are funding for health information technology and Medicaid spending.

The Senate was negotiating its version of the bill at press time. Then the houses of Congress must agree on a compromise, approve it, and send it to President Obama.

• Spanish-speaking callers to 1-800-MEDICARE are seeing improvements, but the Centers for Medicare & Medicaid Services should take more steps to ensure they are properly serviced.That's according to a new report from the Government Accountability Office, "Medicare: Callers Can Access 1-800-MEDICARE Services, but Responsibility within CMS for Limited English Proficiency Plan Unclear" (GAO-09-104).

The 1-800-MEDICARE contractor, Arlington,Va.-based Vangent, provides bilingual customer service representatives and telephone interpreters, the report notes. Thanks to those efforts, the system has "shorter average wait times for Spanish-speaking callers," the GAO says.

But CMS has failed to make sure the program adheres to the Department of Health and Human Services limited English proficiency (LEP) plan, the GAO says. For example, it hasn't instituted a complaint mechanism about language issues.

In response to the report, CMS has appointed a LEP contact in its Office of Equal Opportunity and Civil Rights, notes CMS Acting Administrator Kerry Weems in comments on the report.

For calls overall, Vangent met "most standards and some targets" regarding caller access from July 2007 to July 2008, GAO says. The report is at www.gao.gov/new.items/d09104.pdf.

• If you're looking for a way to explain the complicated home health prospective payment system to patients or referral sources, you may want to tap a revised Medicare resource. CMS has issued an updated version of the Home Health Prospective Payment System Fact Sheet.

The four-page brochure reviews home health coverage criteria and PPS components like case mix adjustment, wage adjustment, outliers, LUPAs, and PEPs. It's available at www.cms.hhs.gov/MLNProducts/downloads/HomeHlthProspPymtfctsht09-508.pdf.

• The amount in controversy (AIC) level for administrative law judge appeals is remaining the same in 2009, but the level for federal court appeals is going up.

For a Medicare provider to request an ALJ hearing, the AIC must be at least $120, the same as it was in 2008, CMS notes in Jan. 30 CR 6295 (Transmittal No. 1676). The federal court threshold has increased to $1,220 as of Jan. 1. That's up from $1,180 in 2008 (see related story, p. 44).

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R1676CP.pdf.

• The Medicare program might take lessons learned from HH PPS and apply them to other provider sectors. The Wall Street Journal recently examined the possibility of CMS adopting bundled payments for other providers not currently under prospective pay.

CMS is currently running a demonstration program where it splits bundled payments between hospitals and physicians. Top politicians and policymakers have expressed enthusiasm for the idea, according to the Journal.

But the idea comes with a lot of complications. Detractors point out potential care access problems, payment difficulties between the parties, and case mix adjusting difficulties.

• You'd better sock away your physician documentation for a while. In a little-noticed provision of the 2009 Physician Fee Schedule final rule, CMS is now requiring home health agencies and hospices to retain documentation from ordering and referring physicians for seven years, the National Association for Home Care & Hospice reports.

"The newly adopted enrollment regulation increases the length of time that the Plans of Care must be retained for both home health agencies and hospices from the existing Medicare conditions of participation (COP) requirements," NAHC notes. Legal experts often advise providers to keep records and documentation for 10 years, which is the limit for False Claims Act liability, the trade group adds.

• Economic difficulties might be leading another state to wait-list residents waiting for home care. The ADvantage waiver program administered by Oklahoma is about 21 percent over budget, reports the Tulsa World newspaper.

The program could be $12 million in the red by July 1, state officials say. DHS is proposing a wait-list as one means of containing the budget overrun, the newspaper says.

The program has about 23,000 clients, and DHS officials said it saves about $20,000 per person in nursing home costs.

• An accused fraudster has been using home care to soak potential providers for money,according to the U.S. Federal Bureau of Investigation. Jeffrey McLain, who operated the Georgia Home Health Care License and Certification Institute Inc. (GHLCI), along with numerous other businesses in Marietta, Ga., claimed his clients would become millionaires in one year or less by opening Medicaid home care operations, the FBI says in a release.

GHLCI charged $85 for attendance and $2,400 for kits at conferences where McLain advised individuals to open Medicaid home care operations and separate non-profit charitable organizations. The non-profit would solicit Medicaid beneficiary information, then sell the information to McLain's business or their own home care business,he claimed.

More than 15 individuals lost more than $200,000 in the scam, the FBI claims. GHLCI and McLain targeted Christian and minority audiences for the conferences.

Afederal grand jury has indicted McLain on mail and wire fraud charges, the FBI adds.

• National chain Amedisys Inc. has entered the Yuma, Ariz. market with the purchase of Arizona Home Rehabilitation and Health Care and Yuma Home Care, the Baton Rouge, La.-based company says in a release.

The agencies had revenue of $4.8 million in a nine-month period, Amedisys says in the release. Terms of the deal were not disclosed.

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