Home Health & Hospice Week

Senate Finance Chair demands answers from CMS.

Federal lawmakers aren't happy with how some Medicare quality improvement money is being spent.

In a Jan. 6 letter to Centers for Medicare & Medicaid Services Administrator Mark McClellan, Senate Finance Chair Charles Grassley (R-IA) asks CMS to account for spending related to its employees' attendance at conferences held at "lavish resorts" sponsored by Quality Improvement Organizations.

The request follows on the heels of an August 2005 request from Grassley asking for various documents related to 15 QIOs, including travel expenses, performance audits, board compensation and more.  The Senate Finance Committee began looking into the QIOs after the Washington Post reported that QIOs' responses to beneficiary complaints were lacking, among other problems.

The QIOs also suffered a blow when an article in the June 15, 2005 issue of the Journal of the American Medical Association said hospitals participating in QIO programs showed no statistically significant differences in quality-of-care improvements compared to non-participating hospitals (see Eli's HCW, Vol. XIV, No. 25).

"Information and documents available to the Committee suggest that the [QIOs'] annual Tri-Regional conference held at the Don CeSar Beach Resort and Spa appeared to be more of a party than a diligent working meeting," Grassley said in the letter to CMS. Photos of the event "suggest a cruise ship atmosphere rather than that of a government working meeting to improve quality of care for Medicare beneficiaries."

"As you look at the photos of the Don CeSar event, you wonder if these contractors are going to luaus and playing golf instead of investigating patient complaints about poor Medicare quality," Grassley says in a release. "And then you have to wonder whether the federal employees who are supposed to make sure the contractors are doing the job we pay them to do are instead going to luaus and playing golf themselves."

The American Health Quality Association, a trade group representing the QIOs, fired back that the QIOs' conferences "are invaluable educational meetings" and that the resort locations are actually cheaper than urban conference sites such as Washington, DC.

Additionally, "AHQA has never inappropriately provided access to property or compensation to government officials," the association maintains.

• Home care providers will get the final word on their 2006 rates if the House votes on the budget reconciliation package as scheduled Feb. 1. House Speaker Dennis Hastert (R-IL) has tentatively slated the vote for that day, according to press reports.

Provisions up for finalization are a freeze to home health agency payment rates, a one-year 5 percent rural add-on for HHAs, a 36-month cap on oxygen rentals and a 12-month cap on durable medical equipment rentals.

"Conventional wisdom holds that defeat of the package is very unlikely" despite mobilized opposition, notes the National Association for Home Care & Hospice. "However, as time goes on and more comes to light about the damage that may be caused by certain provisions in the bill, it could become harder for some members of Congress to support the package."

NAHC urges providers to contact their House representatives to urge them to vote against the bill. The rate freeze "was slipped into the compromise package at the last minute," a NAHC model notice to legislators says. "This misguided action will result in great harm, and must be rejected."

• Providers may have an extra month to submit corrected claims. "During the month of December 2005, providers who typically submit electronic claims via [Direct Data Entry] experienced system issues that left them unable to submit original claims or to correct claims via DDE," regional home health intermediary Associated Hospital Service notes in a Jan. 18 message to providers.

These providers also didn't qualify for an exception to Medicare electronic claim submission requirements, meaning they couldn't submit claims in paper format. "As a result, the system error left the providers unable to submit any claims to Medicare during this period," AHS notes.

CMS is providing an extension to timely filing standards. Affected providers must now submit by Jan. 31 any claim that would otherwise have been untimely after Dec. 31, 2005, AHS explains.

• CMS gives Medicare contractors more administrative and financial flexibility in meeting the timeliness requirements for processing enrollment applications in Transmittal 130, dated Dec. 30, 2005. The carriers still must process 80 percent of applications within 60 days, 90 percent within 120 days and 99 percent within 180 days. They also have 45 days to process 80 percent of change of information requests.

• A few states may be providing better home care reimbursement in the future. In Wisconsin Gov. Jim Doyle's state of the state speech Jan. 14, Doyle (D) said he will propose an expansion of the state's Family Care program. The program provides long-term, community-based services to low-income seniors and people with disabilities.

The program now operates on a pilot basis in five counties, reports the Milwaukee Journal Sentinel. Family Care "is a great dollar savings, and it is far preferred by senior citizens and people with disabilities to be able to live in their homes rather than nursing homes," Doyle said.

In Missouri, Gov. Matt Blunt (R) said in his state of the state address that he would like to boost pay rates for home care providers by $1 an hour, reports The Kansas City Star. The increase would aim to keep residents out of nursing homes.

Blunt defended last year's Medicaid cuts, including ones to DME, according to the Springfield News-Leader. But the governor is willing to work with lawmakers calling for a return of DME funding, Missouri House Speaker Rod Jetton (R-Marble Hill) indicated after the speech.

• Arcadia Resources Inc. has acquired Blairsville, GA-based respiratory supplier HomeLife Medical Inc. for undisclosed terms.

"We have recognized a strong growth opportunity in the DME sector," Arcadia president Larry Kuhnert says in a release. "Recent resolutions over Medicare reimbursement for respiratory services, combined with rapid consolidation of the sector, should bode well for Arcadia."

The acquisition will encourage cross-referrals, says the home nursing, private duty, staffing, DME and pharmacy company based in Southfield, MI.

• New York Health Care Inc. will sell its home care business to Revival Home Health Care, the New York-based company says in a release. The transaction, which is subject to various approvals, will take place for a "significant upfront break-up fee, assumption of approximately $4.3 million in net liabilities and a final cash payment at closing," NYHC says.

• Florida Attorney General Charlie Crist is suing a Florida corporation and owner for selling bogus home care service plans to seniors in that state. "Clearwater-based Intrust Home Care and its president, Roy F. Fitzgerald, are accused of taking more than $146,000 from several dozen elderly Florida residents despite never contracting or paying for any of the home care services they promised to provide," Crist says in a release.

Seniors in Florida, California, Virginia and Illi-nois paid for contracts at annual rates ranging from $700 to more than $7,600. Intrust was supposed to provide help with activities of daily living, housekeeping, meals, excursions, mobility assistance and more, but furnished none of those things, the suit charges.

• Former executives of an Alpharetta, GA orthotics supply company have been charged in a 37-count indictment alleging Medicare fraud, according to a release from U.S. Attorney David Nahmias.

Orthoscript Inc. Chief Operating Officer An-gela Isley is charged as the leader in a scheme to bilk Medicare of $500,000 over a four-year period by billing the program for more expensive supplies than what Orthoscript actually provided to patients. CEO James Arch Nelson aided and abetted Isley, prosecutors say.

The indictment also alleges that Isley and Nelson defrauded the Federal Employee Health Benefit Program by upcoding for products--for example, furnishing a $30 walking boot and billing Medicare $400. Isley and Nelson have pled not guilty to the charges.