Home Health & Hospice Week

Your relationship with Medicare+Choice payors could be in for a shake-up in the new year. Beginning Jan. 1, M+C plan enrollees will have the right to an expedited review by a Quality Improvement Organization when they disagree with their M+C plan's decision that Medicare coverage of their home health agency, skilled nursing facility or comprehensive outpatient rehabilitation facility services should end, the Centers for Medicare & Medicaid Services pointed out in a recent notice to providers. HHAs, SNFs and CORFs will be responsible for delivering the first of the two termination notices required in the new process, and may be on the hook for many other appeals-related duties as well (see Eli's HCW, Vol. XII, No. 20, pp. 154-157). More information about the new process, which stems from the high-profile Grijalva lawsuit, is at www.cms.hhs.gov/medlearn/mcprogram.pdf. The Data Assessment and Verification (DAVE) project will begin to assess the accuracy and reliability of OASIS assessment data in 2004, CMS says. Until now, it's been used in nursing homes only (see Eli's HCW, Vol. XII, No. 13, p. 99). DAVE will be implemented nationally in January, CMS has announced. The project also aims to support quality improvement efforts, CMS integrity initiatives addressing payment accuracy, and payment policy development, the agency says. CMS has said it plans to share problems found via DAVE with surveyors. More information is at www.cms.hhs.gov/providers/psc/dave. A new HCPCS code for combinations of albuterol sulfate and ipratropium bromide inhalation solutions goes into effect Jan. 1, durable medical equipment regional carrier Palmetto GBA says. Suppliers should use J7621 for both manufactured (non-compounded) preparations as well as compounded preparations, the DMERC says in a notice on its Web site. Suppliers should use the code instead of billing separately for albuterol (J7618, J7619) and ipratropium (J7644), Palmetto explains. You can give your two cents to the HHS Office of Inspector General on new or changed safe harbors to the anti-kickback statute. In its annual Federal Register solicitation of proposals to protect innocuous business arrangements from the extremely broad anti-kickback law, the OIG also welcomes suggestions for topics to be addressed in future special fraud alerts. The request is at www.access.gpo.gov/su_docs/fedreg/a031212c.html. On the heels of CMS Administrator Tom Scully's departure, Department of Health and Human Services Secretary Tommy Thompson has announced he won't stay on in his position if President Bush wins a second term in office. Meanwhile, Thompson named Dennis Smith as CMS Acting Administrator to temporarily replace Scully. Smith is Director of CMS' Center for Medicaid and State Operations. Deputy Administrator and Chief Operating Officer Leslie Norwalk will "continue to be the CMS lead in carrying out the Medicare legislation signed into law by the President last week," according to [...]