Home Health & Hospice Week

Will your state fund more home care?

At the same time federal lawmakers are considering slashing home care's Medicare budget, state lawmakers are giving home care providers a boost.

In New York, Gov. Eliot Spitzer (D) proposed a freeze to hospital and nursing home reimbursement rates under Medicaid in 2008, but left home health agency payment rates intact, according to press reports.

"We will no longer subsidize empty hospital and nursing home beds," says Spitzer, who favors closing and consolidating such facilities. "It's a waste of money."

Legislation: In Wyoming, the state senate passed a bill that aims to help seniors stay in their homes rather than go to nursing homes and other institutions. The bill proposes increasing funding for home care and increasing pay rates for home care workers, reports the Wyoming Tribune-Eagle.

Recommendation: In Pennsylvania, a panel appointed by Gov. Ed Rendell (D) says that state's residents need greater access to palliative care and hospice. The report recommends providing patients greater access to home care for terminal patients, according to the Associated Press.

Although nine out of 10 Pennsylvanians say they would prefer to die at home, nearly half of all deaths in the state occur in hospitals, noted state Secretary of Aging Nora Dowd Eisenhower, who led the task force.

Rendell included end-of-life care provisions in a health care reform proposal he announced last month, AP says. His plan calls for expanding hospice services for the dying.

Study: Meanwhile, Ohio needs to invest more in home care if it hopes to contain its Medicaid budget, a new study says. The state ranks 49th out of 50 states serving Medicaid long-term care clients in home and community-based settings, found the study conducted by Levin, Driscoll and Fleeter and commissioned by the Ohio Council for Home Care.

In 2003, Ohio's annual nursing home Medicaid spending per patient was about $56,000, while Medicaid spending on home care per patient was less than $12,000 annually, the trade group says in a release.

If Medicaid patients in Ohio selected home care over nursing home care, Ohio would have annual savings of $28,000 per long-term care patient--an annual Medicaid savings of almost $900 million, the study estimates.

• Get ready to defend your contusion diagnosis code claims. Regional home health intermediary Cahaba GBA is launching widespread review of home health claims with a primary diagnosis of 920.xx-924.xx (Contusion with intact skin surface).

Cahaba is throwing open the scrutiny after an earlier probe of 84 providers' claims found an error rate of 43 percent, the intermediary explains on its Web site. More information is at www.cahabagba.com/part_a/whats_new/20070131_skin_surface.htm.

• Home care providers served by new regional home health intermediary National Government Services, which replaced Associated Hospital Service and United Government Services Jan. 1, are seeing more changes.

As part of the integration of NGS, the intermediaries that formerly were AHS and UGS will be standardizing medical review denial reason codes and the numbering system for pre-payment review edits, NGS says in a message to providers.

• If you're having Medicare claims rejected for managed care coverage reasons, they may still pay. "Incorrect Managed Care enrollment data was applied to some of the CWF eligibility files and for approximately a two week period, numerous claims have rejected/cancelled incorrectly," intermediary NGS says in a message to providers.

The data has been corrected and now CMS is trying to stop the incorrect payment recovery, says intermediary Palmetto GBA on its Web site. Pal-metto estimates up to 300,000 of its claims may be affected by the problem. Providers don't need to take action, contractors will return their payments, the intermediaries say.

More information is at www.cms.hhs.gov/Transmittals/downloads/R262OTN.pdf.

• Home care providers would receive compensation for furnishing telehealth under a bill proposed last month by Sen. John Thune (R-SD). The Fostering Independence Through Technology Act of 2007 (S. 321) would "establish pilot projects under the Medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies," according to a release.

• The Home Oxygen Patient Protection Act (H.R. 621) has new life in the new Congress. The first co-sponsors of the act have appeared in the Congressional Record, reports the American Association for Homecare.

The bill, introduced last month by Rep. Tom Price, MD (R-GA), would change Medicare oxygen policy to the way it was before the Deficit Reduction Act of 2005 was signed into law.

• Long-term care insurance continues to make home care a reality for some beneficiaries. Nursing home care represented the biggest slice of the long-term care insurance benefits pie in 2006, reports the American Association for Long-Term Care Insurance, a trade group based in Westlake, CA.

Home care accounted for 34 percent of the $3.3 billion total. Assisted living costs accounted for 30 percent of the total. Nursing home care topped the list, securing 36 percent of benefits.

Eight million Americans have long-term care coverage, either through an employer or through policies they purchase on their own, says the association.

• The home health mergers & acquisitions market is hopping. Amedisys Inc. has purchased Horizons Hospice Care Inc., a hospice agency in the Montgomery, AL area. The Baton Rouge, LA-based company expects Horizons to have $1.4 million in annual revenues, it says in a release.

"This purchase is representative of our strategy to expand our ability to offer hospice services in the markets that we serve," Amedisys CEO William Borne says in the release. The regional chain has three hospice locations in Alabama and 16 in the Southeast.

And Norcross, GA-based PSA Healthcare will acquire the pediatric assets of  Texas-based Wilkerson Health Care Inc. PSA paid about $268,000 for Wilkerson's pediatric nursing business in the Temple, TX market with Wilkerson retaining its accounts receivable, PSA says in a release.

Net revenue for the acquired business in the last 12 months was about $700,000, PSA says. The company will incorporate the business into its existing Austin location.

Finally, Charleston, IL-based Carle Foundation Hospital has acquired Dynamic Home Care in the same city, reports the Decatur Herald & Review. Carle will merge Dynamic's operations with its own Carle Home Care Services unit, the newspaper says. The merger will add pediatric home care to Carle's services.

• The owner of a Florida durable medical equipment company has been indicted in a Medicare fraud scheme.

DME supplier Elsa Dominguez, owner of Carib Med Services Inc., was arrested on Jan. 30--along with physician Julian Torres and Marcos Martinez--after a Miami grand jury returned an indictment against them earlier in the day.

How it worked: Prosecutors accuse Domin-guez and Martinez of paying $20,000 in kickbacks to Torres to prescribe medically unnecessary equipment and supplies for Medicare patients. Carib submitted $2 million in claims to Medicare for the unnecessary equipment and was paid about $1 million, according to the indictment.

The 18-count indictment charges the defendants with one count of conspiracy to defraud Medicare and to commit various federal crimes. It also charges the defendants with five counts of health care fraud.