Home Health & Hospice Week

Contracting reform will mean intermediary shuffle for some agencies.

Remember those Medicare contracting regions CMS announced for DME suppliers back in February? Well, they're going to apply to home health agencies too.

The Centers for Medicare & Medicaid Services is switching from using regional home health intermediaries to four specialty "Medicare Administrative Contractors" (MACs) for HHAs and hospices under its new contracting reform initiative, CMS officials confirmed in the March 24 Open Door Forum for home health.

There will be four reconfigured regions (see Eli's HCW, Vol. XIV, No. 9). Some examples of the changes including moving the District of Columbia and Maryland from Region B to Region A, and Virginia and West Virginia from Region B to Region C.

"These jurisdictions will be substantially more alike in size than the existing fiscal intermediary and carrier jurisdictions," CMS says on its contracting reform Web site. "CMS designed the new MAC jurisdictions to balance the allocation of workloads."

HHAs have been largely unaware that CMS has already made the changes to their intermediary jurisdictions, protested Bob Wardwell with the Visiting Nurse Associations of America in the forum. Home care providers want to be sure to have input on the coming changes, maintained Wardwell, a former top CMS official.

While the switch to the new durable medical equipment MACs is expected to come at the beginning of 2006, it is less clear when the HHA and hospice MACs will begin operating. CMS is putting the MAC contracts up for bid as part of the reform process.

CMS soon will announce a special Open Door Forum on the Part A MACs for next month, staffers said.

Other issues addressed in the forum include:  COPs. HHAs in Florida are turning in their Medicare provider numbers and electing to serve the lucrative private pay market, reported Gene Tischer with the trade association Associated Home Health Industries of Florida. That's because Medicare conditions of participation are too stringent and caregivers are in high demand, Tischer insisted.

As the aging population surges, "the public payors have got to start taking a much harder look at the level of regulation imposed on providers," Tischer urged CMS in the forum.

Since the COPs have been delayed for years, now might be a good time to revisit and update them accordingly, Wardwell suggested in the forum that drew more than 650 callers.

A CMS official said it would be "hopefully not too much longer" before the COPs are finally published. The agency originally proposed the revised COPs in 1997.
  OASIS. CMS continues work on a study examining collection of OASIS data on private pay patients, an agency official reported. The Medicare Mo-dernization Act specifies that CMS can't require HHAs to resume collecting or transmitting OASIS data for non-Medicare, non-Medicaid patients [...]