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Home Health & Hospice Week

Trainee Services Don't Qualify For Medicare Payment

Published on Fri Aug 29, 2003

Your home health aide trainee's skills don't have to be wasted, but they won't directly add to your bottom line either.

Home health agencies may train aides in the home setting, but the trainee's services won't qualify for Medicare payment, the Centers for Medicare & Medicaid Services has told the National Association for Home Care & Hospice in a letter responding to questions on the issue. Aides also can be trained in the nursing home setting, CMS adds. Aides must complete at least 16 hours of classroom training before hands-on training can begin.

A registered nurse or licensed practical nurse must supervise aide training in the home one-on-one, CMS says. Supervising nurses must meet certain requirements.

Competency training in the home is allowed as well, CMS explains. But again, such services aren't billable to Medicare.

  • Medicare legislation in Congress has hit a roadblock. Senate Finance Committee Chairman Charles Grassley (R-IA) has pulled his staff from negotiations between the House and Senate to protest the lack of attention to rural issues, the Wall Street Journal reports. House Ways & Means Committee Chair Bill Thomas (R-CA) is running the negotiations.

    Many observers already doubt the success of the legislative package, which will require agreement on controversial issues including a new prescription drug benefit. Lawmakers may consider splitting the package into one bill for the drug benefit and another for other Medicare concerns, possibly including a home health copay and competitive bidding for durable medical equipment.

  • The OASIS item most responsible for downcoding (reducing payment by putting an episode in a less severe category) is M0230 - primary diagnosis, says regional home health intermediary Palmetto GBA on its Web site.

    From January through March, 57 percent of HHA downcodes at Palmetto were due to M0230, the RHHI says. A whopping 49 percent of the incorrect codes were for diabetes.

    For tips on avoiding downcodes, see Eli's OASIS Alert at www.eliresearch.com.

  • Health care receivables financier DVI Corp. and two subsidiaries have filed for Chapter 11 bankruptcy in the U.S. Bankruptcy Court for the District of Delaware, the Jamison, PA-based company says. The company is hoping the reorganization bankruptcy will allow "an orderly sale of assets" and is in talks with a few potential buyers, it says.

    Hingham, MA-based Occupational Health + Rehabilitation Inc. has announced that Capital-Source Finance, a subsidiary of Chevy Chase, MD-based CapitalSource Inc., is buying its receivables, as well as other providers' accounts, from DVI.

    DVI has hired Latham & Watkins as legal counsel and AlixPartners as "crisis managers," it says in a release. An AlixPartners principal has replaced Michael O'Hanlon as DVI's chief executive officer. DVI's chief financial officer also was put on administrative leave, reports the Philadelphia Inquirer.

    DVI's troubles became publicly known when auditors Deloitte & Touche resigned over accounting irregularities earlier this year (see pdf of Eli's HCW, Vol. XII, No. 25, p. 199). DVI has set up a special committee of independent directors to investigate the allegedly improper activities.

  • Meanwhile, the first domino has fallen in the securities fraud case surrounding collapsed financier National Century Financial Enterprises, to whom DVI is compared.

    NCFE executive Sherry L. Gibson plead guilty Aug. 18 to securities fraud charges and admitted preparing or directing others to prepare false financial information for investors, according to press reports. The Securities and Exchange Commission filed a complaint against Gibson demanding fines and restitution, and she is barred from serving as an officer or director of a public company ever again.

    Gibson will face sentencing in three months and could get five years in prison and a $250,000 fine. However, she's expected to get a lenient sentence in exchange for cooperating with government investigators.

    Department of Justice and SEC lawyers continue to investigate NCFE's other officers as well as other entities related to the company's allegedly fraudulent activities. NCFE declared bankruptcy last year.


  • There were 33 home care-related mergers and acquisitions announced and/or completed in the second quarter of 2003, down 25 percent from 44 deals in the first quarter, says The Braff Group. But total home care deals for the first six months - 77 - were still up 15 percent over the same period in 2002, says the M&A firm based in the Pittsburgh area.

    Six HHA deals occurred during the quarter, down from 12 the directly previous quarter and 11 during the same period of 2002, Braff notes. "With Congress debating Medicare reform legislation that could significantly impact reimbursement in several key home care sectors, we would anticipate at least some market hesitation until the dust settles," says Dexter Braff, president of the Braff Group.

    Three hospice deals took place in the quarter, up one from the directly previous quarter but down two from the year-ago quarter. Fourteen home medical equipment transactions occurred, down from 24 in the first quarter of 2003 but up one from the previous year's quarter.

    Only infusion and pharmacy deals increased. The quarter's eight deals were up from four transactions in the directly previous quarter and five in the year-ago quarter, Braff reports.

  • The investigation against home care consolidator Med Diversified Inc. is moving forward.

    The SEC has served Andover, MA-based Med with a subpoena requesting "documents and materials, from 1997 to the present, relating to the Company's accounting and auditing matters; relationships with current and former financing sources and analysts; records of current and former directors and officers; various litigation matters; records of stock option and incentive plans; various press releases; various personnel records; and minutes from board of directors meetings," Med says.

    The SEC announced its inquiry a year ago, the company adds.

  • A class action lawsuit on behalf of shareholders has been filed against Matria Healthcare Inc., two law firms have announced. The suit filed in U.S. District Court for the Northern District of Georgia accuses Matria of issuing false and misleading statements between October 2001 and June 2002, when the company's stock fell from $12 to $7 per share, say The Law Offices of Marc S. Henzel in Bala Cynwd, PA and Lasky & Rifkind in New York City.

  • Providers no longer have to fill out separate forms for ownership and control disclosures or financial solvency, CMS says in an Aug. 14 letter to state survey agencies (S&C-03-29). Information on forms HCFA-1513 (Ownership and Control Interest and Disclosure Statement) and HCFA-2572 (Statement of Financial Solvency) now is collected on Medicare's general application forms, CMS-855A and CMS-855B.

    CMS is pulling the forms as recommended by the Department of Health and Human Services Regulatory Reform Task Force, but states may continue to use the forms for their Medicaid programs. If so, all references to CMS and HCFA must be removed, CMS says in the letter.

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