Medicare Compliance & Reimbursement

Tab for transport, care must be paid by participating HHA.

Details about the medical adult day care demonstration project have emerged, and they're making some home care providers think twice about getting involved.

The Centers for Medicare and Medicaid Services is soliciting applications for the demonstration, in which Medicare home health patients could receive a portion of their plan of care services in an adult day care facility.

Unwelcome surprise: CMS took many home care providers unawares in the July 18 special Open Door Forum on the demo. Under the project, HHAs must pay day care facilities for the entire day of day care when a patient receives a plan-of-care-covered service that day, explained Armen Thoumaian, CMS project officer for the demo. That includes transportation to and from the facility, Thoumaian said.

CMS won't allow the day care facility to bill either the patient or any other third party for that day of service. The same goes for transportation services.

CMS' "interpretation that [the] HHA is responsible for purchasing the entire day of services runs counter to my impression of the statute," Bob Wardwell of the Visiting Nurse Associations of America said in the forum.

The Medicare Modernization Act is clear that day care facilities can't receive duplicate payments for services rendered as part of the home health plan of care.

But nowhere does the law indicate that the HHA must pay for the entire day of care, including many services not on the POC, said Wardwell, a former CMS top official.