The Senate Finance Committeeâ€™s bipartisan Chronic Care Working Group unveiled its latest draft proposal to improve care for Americans living with chronic conditions â€“ the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2016 â€“ at a stakeholder meeting Thursday, October 27.
On Friday, October 14th, the Centers for Medicaid and Medicare (CMS) released the highly anticipated final rule for the Medicare Access & CHIP Reauthorization Act of 2105 (MACRA). MACRA is the repeals the sustainable growth rate (SGR) formula that determined Medicare Part B reimbursement rates for physicians and replaces it with new ways for paying for care. Further, this also ended the need for reoccurring legislative adjustments every year for the payment rates, often called â€œdoc fixes.â€ Under MACRA, participating providers will be paid based on the quality and effectiveness of care â€“ moving payment from value, not volume. These will be done through two value-based payment programs; Merit Based Incentive Payments System (MIPS) and Advanced Alternative Payment Models (APM).
On Dec. 23, 2015, CMS issued its draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces (FFM). This draft letter outlines the rules that will govern the health plans in the FFMs. This includes rate reviews, plan quality improvement standards, benefit discriminatory design and other key oversight functions.
CMS has announced a five-year pilot program, called the Accountable Health Community Model that will support organizations to do comprehensive screening assessment for health-related social needs among Medicare and Medicaid beneficiaries, and to connect patients with needed social services.
Last week, the Senate voted 52-47 in support of the Restoring Americans' Healthcare Freedom Reconciliation Act (H.R. 3762). Only 51 votes were required for passage under the budget reconciliation process. The legislation would repeal key provisions of the Affordable Care Act including the individual and employer mandates, the Cadillac tax and the Prevention and Public Health Fund. In addition, the legislation includes a repeal of the Medicaid expansion provisions.
MedPAC convened for its final meeting of the year Dec. 10-11, 2015 in Washington, D.C. The Commissioners reviewed the latest data (2014) related to utilization, access to care, margins, and other information on the home health and hospice benefits.
Last week CMS released its "Fiscal Year 2015 Agency Financial Report." In the report, CMS notes that for FY 2015, the improper payment rate for home health claims was more than 58 percent. The FY 2015 rate is developed using claims from July 2013 Ã¢â‚¬â€œ June 2014. The improper payment rate for home health claims in FY2014 was 51.4 percent. Both years represented the highest improper payment rate for home health services ever and, according to CMS, are Ã¢â‚¬Å“due to the documentation requirements to support the medical necessity of the services.Ã¢â‚¬Â CMS identified three actions it is taking to reduce the improper payment rate for these services.
At last weekâ€™s MedPAC meeting, staff and commissioners discussed the continued development of a unified post-acute care payment model as required by the IMPACT Act. Under a unified payment model, there would be a single payment model for the different post-acute care providers, including skilled nursing facilities, inpatient rehab facilities, long term care hospitals, and home health agencies. Payments under the model would vary based on patient characteristics, not the setting or amount of care provided.
House Energy and Commerce Committee (E&C) Chairman Fred Upton (R-Mich.) appointed a new task force designed to examine and promote legislative efforts to reform Medicaid. The E&C Committee has recently held several hearings and mark ups on Medicaid policy, and this task force will continue their work
Last week, CMS issued a final rule with comment that requires states to develop and implement a plan to measure access to specific fee-for-service services, including home health services. If access is found to be lacking, states must develop a correction plan. In a separate but related Request for Information, CMS seeks input on what the framework could be for metrics that would capture access regardless of state or delivery system type (FFS or managed care).
Last Friday, Oct. 30, CMS finalized its proposal to reimburse physicians and other eligible providers for providing advance care planning services to Medicare beneficiaries. VNAA has long-supported Medicare coverage for this important service. We believe this policy will assist many individuals receive the care they want when experiencing advanced illness, including but not exclusively at the end of life. VNAA is reviewing the final rule and will provide a more detailed analysis to our members shortly.
Last Thursday, Oct. 29, 2015, CMS issued proposed discharge planning requirements for home health agencies to enhance transitions of care, patient-engagement, and care coordination across the healthcare system. CMS estimates that the proposed provisions will cost HHAs approximately $300 million to implement. Read VNAAÃ¢â‚¬â„¢s summary of the rule. We encourage you to join us for a special Public Policy Town Hall to discuss this rule Thursday, Nov. 5 at 10 a.m. ET.
President Obama signed a two-year budget agreement on Monday that averts a potential government shutdown and increases the debt limit. The deal sets budget levels for two years, lifts the debt ceiling until March 2017, removed the threat of a government shutdown until Oct. 2017 and addressed the Medicare Part B premium spikes for some of the affected beneficiaries. The pay-fors included extending the Medicare sequester for another year (through 2025), repealing the Affordable Care Act requirement that large employers (employers with more than 200 employees) automatically enroll employees in their health plans, and establishing new payment rules for hospital outpatient department services, among other items.
Last Thursday, Oct. 29, the Centers for Medicare and Medicaid Services (CMS) issued the CY 2016 final payment rule. In the rule, CMS updates the Medicare Home Health Prospective Payment System Rate for CY 2016 and implements a Home Health Value-based Purchasing model. While CMS slightly reduced the case mix adjustment cut from the proposed rule, the rate update will still result in an overall -1.4 percent payment cut to home health agencies in 2016. Read VNAA's summary of the rule here. VNAA encourages you to join us for a special Public Policy Town Hall to focus on the final rule Thursday, Nov. 5 at 10 a.m. ET. All affiliate members are welcome to participate.
On Monday, Oct. 26, 2015, more than a thousand healthcare stakeholders came together to discuss the advancement of alternative payment and delivery models at the Health Care Payment Learning and Action Network Summit. The Network is a public-private partnership to advance the adoption of alternative payment models. At the Summit, attendees engaged in discussions around different payment initiatives being led by providers, health plans, and employers.
CMS is required to publish the final home health payment rule prior to Nov. 1 each year. VNAA anticipates that the rule will be released the afternoon of Friday, Oct. 30. We are closely watching to see whether CMS moves forward with the case mix adjustment and the home health value-based purchasing program as proposed. VNAA will alert members as soon as the rule is released.
The Senate Committee on Finance held a hearing last week on "Improper Payments in Federal Programs." Committee members reviewed the Government Accountability Office's (GAO) report "Improper Payments: Government-Wide Estimates and Use of Death Data to Help Prevent Payments to Deceased Individuals." The GAO found that "Government-wide, improper payment estimates totaled $124.7 billion in fiscal year 2014, a significant increase of approximately $19 billion from the prior year's estimate of $105.8 billion. The estimated improper payments for fiscal year 2014 were attributable to 124 programs spread among 22 agencies." The programs with the largest amount of improper payments were Medicare (approx. $60B), Medicaid (approx. $17B), and the Earned Income Tax Credit (EITC) (approx. $17B).
The House Committee on Energy and Commerce Subcommittee on Health will hold a hearing on Thursday, October 1, 2015, at 10:00 a.m. The hearing is entitled " Examining Potential Ways to Improve the Medicare Program. " The Subcommittee Members will review three Medicare bills, including a draft bill that would make changes to the face-to-face Medicare documentation requirements.
VNAA has been working in concert with other stakeholders to finalize the House bill language and we expect the draft bill to include additional changes before introduction. The draft legislation that will be discussed used the Home Health Documentation and Program Improvement Act of 2015 (S. 1650) as the framework.
The White House recently released the latest report from the Broadband Opportunity Council. The Council is part of the Administrationâ€™s effort to increase access to broadband across all communities in the U.S. The report outlines a number of actions federal agencies will take over the next 18 months.
The U.S. Department of Health and Human Services' Office of Inspector General (OIG) plans to review compliance with the home health prospective payment system to determine whether home health agency (HHA) claims were paid in accordance with federal laws and regulations. A prior OIG report found that one in four HHAs had questionable billing. Since 2010, nearly $1 billion in improper Medicare payments and fraud has been identified relating to the home health benefit.
Thanks to the efforts of VNAA members and the wider home health community, a total of 133 Members of Congress recently signed on to a letter asking the Centers for Medicaid and Medicare Services (CMS) to reconsider the cuts it included in its proposed home health payment rule for 2016.
Last week, VNAA submitted comments to CMS on the proposed 2016 home health payment rule. If finalized, the rule would cut Medicare payments to home health agencies by $350 million in 2016 and implement a value-based purchasing program. VNAA strongly urged CMS to rescind the proposed case-mix adjustment payment cut and, while supportive of value-based purchasing, recommended that CMS make a number of substantial modifications to the program. Read VNAA's full comments here.
Reps. Greg Walden (R-OR), Tom Price, M.D. (R-GA), James McGovern (D-MA) and Earl Blumenauer (D-OR), are leading a sign-on letter that is being circulated in the House expressing Congress' concern with the home health case mix cut and the Value Based Purchasing penalty percentage proposed by the Centers for Medicaid and Medicare Services (CMS). VNAA urges its members to contact their Members of Congress to ask them to sign on to this letter.
VNAA strongly supports the proposal put forth in July by the Centers for Medicare and Medicaid Services (CMS) that would reimburse providers for advanced care planning (ACP) and some additional telehealth services. VNAA encourages CMS to strengthen their ACP proposal by ensuring that all Medicare providers are eligible for reimbursement for providing ACP services, encouraging ACP at the annual Medicare wellness exam, ensuring that the ACP codes are location-agnostic, allowing for multiple counseling services, and allowing for stand-alone ACP visits. VNAA also asks that CMS modify its telehealth proposal to allow a patients home to be considered an originating site for the purposes of telehealth and to include home health providers on the list of eligible providers for reimbursement for telehealth services that are provided in the home.
Yesterday, CMS announced participants in its new Medicare Care Choices Model. This model seeks to answer two questions: Whether eligible beneficiaries would elect to receive supportive care services typically provided by hospice if they could also continue to receive curative services; and whether providing both palliative and curative care concurrently impacts quality of care, as well as patient and family satisfaction.
Last week, Reps. Walden, Price, McGovern and Blumenauer released an important letter to express Congress' concern with CMS' proposed home health case mix cut and the proposed Value Based Purchasing penalty percentage. This letter is now being circulated across the House of Representatives, and a similar letter is expected to be released in the Senate soon, too. These letters can be very helpful in securing CMS' reconsideration of its proposed cut and penalty, so it's critical that our community do everything it can to urge lawmakers to add their names to this letter.
On Wednesday, July 29, House Ways and Means Subcommittee Chairman Kevin Brady, R-TX, and Health Subcommittee Member Ron Kind, D-WI, introduced the Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298). This legislation would establish a value-based purchasing program across four settings in MedicareÃ¢â‚¬â€home health agencies, skilled-nursing facilities, inpatient-rehabilitation facilities and long-term-care hospitals.
In July, House Budget Committee Member Marsha Blackburn, R-TN, and House Budget Committee Chairman Tom Price, MD, R-GA, introduced the Coding Flexibility in Healthcare Act (Code-FLEX) (H.R. 3018). This legislation would institute a six-month transition period after the implementation of ICD-10 during which providers may submit claims with either ICD-9 or ICD-10 codes. The bill also requires CMS to report on the impact of ICD-10 on providers and beneficiaries within 90 days of the billâ€™s enactment. Three other bills have been introduced this year in the House that would delay or eliminate ICD-10.
Yesterday, CMS submitted comments to CMS on the Medicaid managed care proposed rule. In summary, VNAA commended CMSâ€™ efforts to update these regulations and better incorporate issues related to long term services and supports (LTSS). VNAA provided recommendations on how to strengthen the proposal to protect beneficiariesâ€™ access to home-based care.
On Wednesday, July 15, the House of Representatives passed the Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (S.971) by voice vote. The legislation continues the Medicare Independence at Home Medical Practice Demonstration Program for two more years. The bill was approved by the Senate on April 22. The measure now goes to the President.
The Palliative Care and Hospice Education and Training Act (PCHETA) is expected to be introduced today by Reps. Eliot Engel (D-NY-16) and Tom Reed (R-NY-23). PCHETA would establish education centers and career incentive awards to improve the training of doctors, nurses, physician assistants, social workers and other health professionals in palliative care.
House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) announced last week that the subcommittee will hold a hearing with the Medicare Payment Advisory Commission (MedPAC) to discuss hospital payment issues, rural health issues, and beneficiary access to care.
Last week, the CMS issued the 2016 proposed physician fee schedule. The rule proposes Medicare coverage for two advanced care planning service codes to reimburse physicians and other eligible providers for discussions with Medicare beneficiaries about advanced illness and end of life care.
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would mandate participation in the "Comprehensive Care for Joint ReplacementÃ¢â‚¬Â bundled payment initiative for hospitals in 75 regions. Nearly 800 hospitals would be impacted by the initiative if finalized. The proposal would establish 90-day acute/post-acute care bundles for hip and knee replacements.
On Monday, July 13, President Obama hosted the White House Conference on Aging (WHCOA), an important conversation about issues Americans face as they age. The Conference was timely as this is the 50th anniversary of Medicare and Medicaid.
On Friday, the US House of Representatives overwhelmingly passed The 21st Century Cures Act (H.R. 6), with a bipartisan vote of 344-77. The sweeping legislation is intended to modernize and fund the National Institutes of Health (NIH) and the Food and Drug Administration (FDA).
The Medicare Telehealth Parity Act is expected to be introduced today in the House of Representatives by Reps. Mike Thompson, D-CA-5, Gregg Harper, R-MS-3, Diane Black, R-TN-6, Peter Welch, D-VT- At Large. The Medicare Telehealth Parity Act would expand specific telehealth services under Medicare through a phased in approach that would include adding home health services among other provisions.
Later this week the House of Representatives is likely to vote on the 21st Century Cures Act (H.R. 6), which will modernize the Food and Drug Administration and the National Institutes of Health funding and processes. In addition, the proposed legislation includes provisions on telehealth and interoperability.
On July 8 at 3:30 p.m., CMS will host an Open Door Forum on home health and hospice issues, including the recently released home health payment rule. An agenda for the call can be accessed here. Participants may access the call by dialing 1-800-837-1935 and referencing Conference ID: 21624265.
On Thursday, June 25, the Supreme Court of the United States upheld financial subsidies for individuals enrolling in healthcare coverage through the federal exchange. In the 6-3 ruling, the justices cited the overall context for the law, indicating that despite "inartful" wording in the law, Congress clearly intended to make the subsidies available in both state-based and the federal exchanges.
On Friday, June 26, the Supreme Court legalized same sex marriage in its ruling on Obergefell v. Hodges. This decision may have implications for who is eligible for spousal benefits under employer-sponsored health plans and state Medicaid programs.
VNAA submitted comments to CMS on the FY 2016 hospice payment rule. This rule proposed a number of changes to the way in which hospice payment rates are calculated and updated. The most significant change is to propose two routine home care day rates to account for more costly days at the beginning of a hospice stay and a supplemental payment to account for patient needs in the last seven days of life.
On July 8 at 3:30 p.m., CMS will host an Open Door Forum to review the details of the home health payment rule.
Last week, CMS announced two modifications to the ACO Investment Model to assist providers in rural areas and small group practices participate in ACOs. The ACO Investment Model provides upfront assistance in the form of "prepaid savings" to groups of providers to develop the infrastructure necessary to manage populations.
Yesterday, VNAA sent comments to the Senate Committee on Finance regarding policy suggestions to improve care for Medicare beneficiaries with chronic conditions.
The Centers for Medicare and Medicaid Services (CMS) intends to add star ratings for patient experience of care to the Home Health Compare tool in Jan. 2016. This week, VNAA submitted comments to CMS and its contractor, RTI, on the methodology for calculating these ratings. VNAA commended CMS for a number of aspects of its approach, including the use of existing measures, that the measures will be risk adjusted to address some socio-economic and demographic factors, and that the majority of agencies will receive 4 or 5 stars. We also expressed concerns regarding how beneficiaries will interpret and use the star ratings. We are concerned that beneficiaries will be confused by (1) the multiple star ratings that will be displayed on the Compare website, (2) the difference between an agency's quality of care and patient experience scores, and (3) stars that are not uniformly risk adjusted.
On Wednesday, June 24, at 10:00 a.m. the Senate Committee on Finance will markup 12 health related bills. Of particular interest to VNAAâ€™s members is the Community Based Independence for Seniors Act (S. 704) which would create a Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program and help low-income, chronically ill Medicare beneficiaries remain in the community while potentially saving Medicare and Medicaid millions of dollars.
CMS has announced that it will conduct pre-payment "probe and educate" reviews on a small sample of claims from each home health agency. The purpose of these reviews is to ensure that home health agencies understand the patient eligibility criteria and have sufficient documentation to demonstrate that the patient meets the criteria. The criteria include that the individual is homebound, is in need of skilled services, and has had a face-to-face visit with an appropriate provider. While the intent of these pre-payment audits is education, CMS retains the right to withhold payment for any claims for which the documentation does not provide sufficient evidence that the patient is eligible for home health services.
CMS will host the final call on the Home Health Electronic Clinical Template and Home Health Paper Clinical Template tomorrow, Wednesday, May 20, 2015 from 2:30-3:30 p.m. ET. The templates were designed to assist physicians and practitioners in documenting patient eligibility for the Medicare home health benefit. The templates have been in the development process for the past year. This is the third and final call to obtain stakeholder input on the templates prior to submitting them to the Paperwork Reduction Act (PRA) clearance process.
Kathy Duckett, Director of Population Health at VNA Care Network Foundation & Subsidiaries in Massachusetts, was selected to participate in an HHS listening session "Accelerating Use of e-Care Plans for Delivery System Reform." HHS and the Office of the National Coordinator (ONC) sought input on the needs and issues of various stakeholders regarding e-Care Plans across the continuum of care. Their goal is to accelerate the expectation for comprehensive e-Care Plan usage across care delivery systems within the next few years and they sought input on how to make this reform occur more rapidly. They were particularly interested in understanding what role the government should play.
During the week of July 20 through 24, 2015, a final sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. CMS is accepting additional July volunteers from May 11 through 22, 2015. Don't miss your chance to participate in end-to-end testing with Medicare prior to the Oct. 1, 2015, implementation date.
VNAA is undertaking an initiative to highlight patient stories to help illustrate the care that our members provide. We are looking for stories of 75-250 words each that help tell the story of home health and hospice from every state. We will use the stories in our advocacy materials and our website.
The next release of the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER), scheduled for April 13, will include four new target areas, added in response to the recently-released Office of Inspector General (OIG) report identifying concerns with hospice services provided to beneficiaries residing in an assisted living facility (ALF). The OIG found "Medicare payments for hospice care in ALFs more than doubled in five years, totaling $2.1 billion in 2012. Hospices provided care much longer and received much higher Medicare payments for beneficiaries in ALFs than for beneficiaries in other settingsÃ¢â‚¬Â¦. This report raises concerns about the financial incentives created by the current payment system and the potential for hospices to target beneficiaries in ALFs because they may offer the hospices the greatest financial gain."
April 16 is National Healthcare Decisions Day or a great day to have conversations with your loved ones about how you want to live if you're experiencing serious illness or nearing the end of life. We know that these conversations don't happen often enough, which can leave patients and families with great uncertainty and stress at a point when they want to focus on quality time with each other. Patients without a plan are also more likely to experience the default "do everything" approach of modern medicine. This can mean receiving treatments that cause more pain and shorten life, rather than receiving care that provides more meaningful time with the people they love.
Beginning July 2015, Home Health Agencies (HHAs) will have a free new tool available to help them assess their risk for improper Medicare payments. TMFÃ‚Â® Health Quality Institute is developing a new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for HHAs under contract with the Centers for Medicare and Medicaid Services (CMS).
Last week, the Centers for Medicare and Medicaid Services (CMS) hosted a stakeholder call to discuss the timeline and process for HHAs to receive preview reports of their "5-Star" rating. Read on for a summary of the information the preview reports will include.
The House voted 392 - 37 to pass the Medicare Access and CHIP Reauthorization Act (H.R. 2) to permanently replace Medicare's Sustainable Growth Rate (SGR). This article highlights the key elements of the reform of interest to VNAA Members.
On Friday, March 13, MedPAC released its latest report and recommendations for changes to Medicare payment policy. While the recommendations for home health and hospice remain the same as previous years, MedPAC reported new data for both industries that is worth noting.
The Office of the National Coordinator on Health IT (ONC), the federal agency that coordinates and promotes the federal government's efforts on health IT, seeks new members for their Standards Federal Advisory Committee. The Standards Committee provides guidance and recommendations on a wide range of technical issues and brings on-the-ground expertise to the federal level.
The Visiting Nurse Associations of America joins with other national organizations to support the National Nurse Act of 2015 (H.R. 379). Introduced by Representatives Eddie Bernice Johnson (D-TX) and Peter King (R-NY), this legislation would designate the Chief Nurse Officer of the U.S. Public Health Service as the "National Nurse for Public Health" to elevate the authority and visibility of this position.
The Visiting Nurse Associations of America submitted comments to the Office of the National Coordinator for Health Information Technology last week on the Draft National Health IT Strategic Plan. VNAA encouraged ONC to support the development of EHRs and other IT tools specifically designed for PAC providers and emphasized the need for interoperability to support new care delivery models.
Last week CMS issued the following guidance with respect to Recovery Auditor Contractors' review of "$3700 Therapy Threshold" claims on a post-payment basis. Approval includes both complex medical necessity reviews and complex coding reviews.
VNAA recently submitted comments to CMS on the proposed five-star performance-rating system for home health agencies. CMS intends to create a consistent rating system in all sectors of the healthcare market to assist beneficiaries in making informed choices about where to obtain care. The star ratings will be in addition to the Home Health Compare measures currently available. Patients and their caregivers can use the star rating to search providers by performance criteria that matter most to them.
A federal judge has delayed until Jan. 15 the effective date of part of a new Labor Department rule that could mean higher wages for many home healthcare workers.
Home healthcare companions who provided "fellowship, care and protection" to the elderly or disabled have been exempt from minimum wage and overtime pay protection. A new Labor Department rule, however, significantly narrows the definition of companions to those who spend no more than 20 percent of their time providing actual care. The full rule was set to take effect Jan. 1.
The Center for Medicare Advocacy and Vermont Legal Aid filed a class action lawsuit against Sylvia Mathews Burwell, the Secretary of Health and Human Services, to stop Medicare's practice of repeatedly denying coverage for home health services for beneficiaries on the basis that they are allegedly not homebound, when Medicare has previously determined them to be homebound. (Ryan v. Burwell). The lawsuit was filed on Dec. 19 in the United States District Court in Burlington, Vt. on behalf of two Vermont residents, Marcy Ryan and John Herbert, as a regional class action lawsuit covering New England and New York.