NAHC Submits Comments on CMS’ Proposed Rule on Accountable Care Organizations
February 11, 2015 01:05 PM
Earlier this month, the National Association for Home Care and Hospice (NAHC) submitted formal comments to CMS on their proposed rule on Accountable Care Organizations (ACOs) within the Medicare Shared Savings Program. NAHC’s comments focused on three main areas:
1. Waivers for telehealth services;
2. Waiver of the homebound requirement and other payment waivers, and;
3. Waivers for referrals to post-acute care settings
NAHC states in its comments that:
“NAHC recommends that any waiver should apply to beneficiaries in Track 2 in addition to Track 3 ACO MSSPs. Limiting to waivers to Track 3 may discourage ACOs that are currently in Track 1 from participating in a Medicare Shared Savings Program for fear of taking on too much risk unless if wavers are also applied to Track 2 ACO agreements. Any ACO that assumes some level of risk should have the flexibility to provide care that achieves the dual goals of positive patient outcomes and Medicare savings.”
With respect to waivers for telehealth services, NAHC’s comments state that:
“NAHC supports CMS’ proposal to waive certain telehealth requirements for beneficiaries in a Medicare Shared Savings Program (MSSP). Expanding the geographic area and the originating sites for telehealth services will greatly enhance the Accountable Care Organization’s (ACOs) ability to coordinate care and improve accessibility and timeliness of needed care. The increased flexibility in the use of telehealth will also create better efficiencies in providing care to individuals with chronic diseases and the vulnerable elderly.
NAHC urges that CMS permit the beneficiary’s home to be an approved originating on site for the telehealth waiver. Permitting payments to ACOs for telehealth services in beneficiaries’ homes would provide the ACO with a mechanism to readily address the needs of high risk patients, who are often confined to the home. Practitioners could intervene at critical points, thus avoiding more costly interventions. In addition, providing telehealth services in the home would go a long way in maintaining the beneficiary’s health status and prevent unnecessary hospitalizations.
Homebound patients cannot readily avail themselves of useful telehealth services under the current originating site restrictions. Today’s portable telehealth equipment performs the same functions as equipment stationed in a hospital or nursing home. As such, the originating site restrictions unnecessarily limit access to telehealth services and the resulting improvements in care quality and efficiency.”
NAHC’s comments relative to waiving the homebound requirement once again raise the organization’s concerns with CMS’ proposed start rating system, stating that:
“NAHC applauds CMS’ proposal to waive the homebound requirement for certain beneficiaries in MSSPs. NAHC also appreciates that CMS recognizes that the homebound requirement could impede the ACO’s ability to effectively care for high risk patients. Home health agencies have been at the forefront of innovation in caring for patients with multiple chronic conditions with the explicit goal of preventing re-hospitalizations. We believe the ACOs, as well as the beneficiaries will benefit tremendously if home health care can be provided before a patient’s condition deteriorates to the point of rendering a patient homebound.
CMS proposes to only permit waiver of the homebound requirement for those home health agencies that have a quality rating of 3 or more stars.
NAHC recommends that CMS not apply a star rating system as a quality metric for home health care for the MSSP. NAHC has concerns with CMS’ proposed star rating system, particularly, the measure selection and the rating calculation methodology. In addition, a star rating for home health care has yet to be fully developed and tested. More importantly, the star rating on an HHA is not a measure of its ability to achieve Medicare program savings.”
In its comments, NAHC also recommends how CMS could more properly provide waivers for referrals to post-acute settings, stating that:
“CMS proposes to waive the requirement thatthe hospital may“not specify or otherwise limit the qualified provider which may provide post-hospital home services’’when providing the beneficiary with a list of qualified post-acute care providers. The ACO would be permitted to recommend preferred providers. However, the beneficiary’s freedom of choice would be maintained when selecting a post-acute provider.
Recommendations: NAHC supports the waiver to permit the ACO to list and recommend preferred providers on the hospital post-acute care provider list under certain conditions:
First, patients in the ACO realm should be notified in advance that participation in the ACO may mean that the ACO directs patients to certain pre-identified post-acute care providers.
Second, hospitals participating in the ACOs should be required to provide written and verbal notice to the individuals in need of post-acute care of their right to choose any qualified provider in advance of making a recommendation. Along with the notice, the hospital should provide detailed information about any qualified provider that the patient wishes to consider and arrange for an in-hospital visit with the patient for that post-acute provider.
Third, the hospital must disclose to patients and providers the criteria applied in making provider-specific recommendations.”
To read NAHC’s full comments, please click here.