Home Health & Hospice Week

PHE and RCD don’t mix, members of congress tell CMS.

Medicare officials are in the process of bringing oversight activities back in full swing on both the regulatory and reimbursement fronts. But home health agencies and their representatives are putting forth a last ditch effort to secure a delay to a major Aug. 31 deadline.

On July 7, the Centers for Medicare & Medicaid Services announced it was ending the “pause” on the Review Choice Demonstration that has been in place since the beginning of the pandemic (see Eli’s HCW, Vol. XXIX, No. 27). CMS decided to resume RCD on Aug. 31, even though originally it said it would wait until the end of the public health emergency to do so.

With no end in sight to the PHE, last renewed by Health and Human Services Secretary Alex Azar on July 23, CMS indicated RCD would resume in Illinois, Ohio, and Texas and would launch in Florida and North Carolina on that date. The impact in the former three states is somewhat limited because many HHAs continued submitting pre-claim review requests during the “pause” rather than face post-payment review of all the processed claims after the program was restarted.

But in Florida and North Carolina, bringing RCD online will be a major shock to the system for many agencies. “The pandemic is not on ‘summer recess,’” emphasizes Tim Rogers of the Association for Home & Hospice Care of North Carolina. “In fact, it is worsening in our states,” Rogers tells Eli.

In an Aug. 5 meeting, representatives of HHAs in those states presented the demo’s major problems to CMS, including staffing shortages due to quarantine requirements, high rates of COVID-positive patients and staff, and more, Rogers relates.

Congressional allies have weighed in as well. In a July 30 letter to CMS Administrator Seema Verma, Florida Reps. Gus Bilirakis (R), Kathy Castor (D), and Darren Soto (D) urged the agency to reconsider the Aug. 31 deadline.

Florida HHAs are concerned about “being able to meet the RCD administrative requirements while simultaneously handling the many challenges of the coronavirus,” the letter says. From personal protective equipment necessary to advanced infection prevention techniques to limited ordering physician availability, agencies are struggling under the pandemic. “This is all in addition to decreased worker availability due to family and childcare demands resulting from the virus, staff contracting the virus, and additional workers needed to offset the demands of the pandemic,” the members of Congress stress.

“Providers find themselves stretched to their upper limits. Implementing the RCD currently is an unnecessary burden,” the letter underscores. “It is vital that clinicians focus on providing care and decreasing infection transmission as opposed to fulfilling administrative requirements during the PHE.”

Plus: The short prep time is especially problematic considering RCD’s “steep learning curve” and “the many HHA professionals working remotely without the full set of resources they may need to be successful in the RCD,” the members of Congress add.

Bottom line: “We urge CMS to resume the position it took in March to pause the RCD until the PHE has been resolved. We look forward to your action on this important issue,” the letter concludes.

Reaction: But CMS has thus far not budged on the Aug. 31 date.

CMS did slightly tweak some cycle dates for providers in Illinois and Texas, moving the end of Cycle 2 from Aug. 31 to Sept. 30. It made the move “after considering additional stakeholder feedback,” RCD contractor Palmetto GBA says on its website.

That minor change left reimbursement expert M. Aaron Little with BKD in Springfield, Missouri feeling “lukewarm,” he says. The slightly beneficial tweak “shortens the window of the cycles, potentially allowing those providers with qualifying affirmation rates to be allowed to select a different RCD option,” Little observes. “But, I don’t see any language that offers any kind of extension to the Aug. 31 resumption date.”

HHAs and their reps haven’t given up hope quite yet.

“The fight is not over for us,” vows Bobby Lolley with the Home Care Association of Florida. After “no official feedback or decision from our meeting” with CMS, “we have elected to make another push,” Lolley reports. Florida agencies are “asking CMS and legislators again to not allow this harmful thing to happen,” he exclaims.

“Our advocacy is far from over,” Rogers agrees. “We are asking agencies to write both Congress and CMS officials directly,” he relates.

“The expansion of Review Choice Demonstration at this time of a surge in the pandemic just does not fit with previous CMS actions to relieve providers of paperwork burdens,” National Association for Home Care & Hospice President William Dombi says in the group’s newsletter.

Critical: “CMS needs to act now, and fast, to make the right decision and delay RCD,” Rogers stresses.

Note: Keep an eye on www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Review-Choice-Demonstration-for-Home-Health-Services for any last-minute announcements.