NAHC Details Medicare Home Health Priorities at March on Washington
April 7, 2016 11:20 AM
At the National Association for Home Care & Hospice’s (NAHC) 2016 March on Washington Conference, NAHC’s team of policy experts detailed the current legislative and regulatory priorities pertaining to Medicare home health. Subsequent NAHC Report articles will provide coverage regarding the sessions pertaining to Medicare hospice, as well as Medicaid home care, and private duty home care.
“People have asked us to get into a little bit more detail about some of the subjects that we have as our priority issues to address before Congress and before the administrative agencies,” William A. Dombi, Vice President for Law at NAHC said. “What we want to do is delve a lot deeper into the issues related to Medicare home health.”
Oppose a “Sick Tax”—Block Efforts to Impose a Fee Paid by Patients to Access Medicare Home Health Services. Dombi said that NAHC remains committed to preventing ongoing threats to impose a home health copay, or “sick tax,” on Medicare beneficiaries. “The reality being that last year at this time, the Speaker of the House, then John Boehner, had a list of things that were going to help finance the physician SGR fix, and on that list was a Medicare home health copay,” Dombi said. “If you think the issue has gone away, even though it was only 12 months ago, it is once again on the list of recommendations from the Medicare Payment Advisory Commission and on President Obama’s final budget.”
Background: The imposition of a home health copay would a) be a “sick tax” on some of the oldest, poorest, sickest Medicare beneficiaries; b) shift seniors to more costly hospital or nursing home settings; and c) increase Medicare and Medicaid costs. A home health copay was repealed in 1972 because of the burden it placed on seniors, collection costs, and the services it shifted to more costly settings. Home health patients and their families and friends already pay a huge copayment by providing an estimated $470 billion a year in unpaid care at home, costs that would be incurred by Medicare if these patients were in a hospital or nursing home.
Repeal or Reform the Face-to-Face Physician Encounter Documentation Requirement. “The face-to-face encounter requirement is still a significant issue for home health, as you well know,” said Mary K. Carr, Vice President for Regulatory Affairs at NAHC. “Even with what CMS perceives as a fix with the elimination of the narrative, we are finding that it’s actually getting worse. With the probe end educate, we have 85-90 percent denial rates.”
“It has reached a point of helplessness at CMS for remedying this problem,” Dombi added. “CMS has had multiple opportunities to make this work. They took what we thought was a very positive step and now have turned that same positive step into a negative relative to what standards are necessary to comply with the documentation requirement.”
Background: CMS issued a rule that requires an in-person consultation between a physician and a patient no more that 90 days before the first home health services or no later than 30 days after admission to home health. CMS imposed burdensome, duplicative, costly and confusing documentation requirements that exceed the intent of the law passed by Congress. The increased paperwork burden has created a disincentive for physicians to recommend home health care. Congress should enact legislation repealing or reforming this rule.
Ban the Use of Prior Authorization in Medicare Home Health Services. “Prior authorization is something that is an extraordinary measure for CMS to use,” Dombi said. “It should only be used in a highly targeted fashion and in limited circumstances because prior authorization has been well known to be a roadblock, a barrier, to access to care for people who are duly entitled to care, and we do not want to have innocent victims of that.”
Background: CMS has proposed a prior authorization demonstration program in five states: Florida, Illinois, Massachusetts, Michigan, and Texas. With an estimated cost of nearly $250 million a year for CMS to administer and likely multiples of that cost for home health agencies to process nearly one million claims through that system each year, prior authorization comes at an extreme cost with no justification for its imposition on all home health agencies in the targeted states. Overall, prior authorization is ineffective in identifying the very small number of providers that are fraudulent. Finally, prior authorization will create significant barriers to access to home health care for beneficiaries and hospitals that are trying to transfer patients to their homes.
Allow Nurse Practitioners and Physician Assistants to Sign Home Health Plans of Care.“We just want parity with these transitions of care from the hospital to the community,” said Richard Brennan, VP for Government Affairs at NAHC.
Background: Congress should enact the bipartisan Home Health Care Planning Improvement Act (S.578; H.R.1342) that would allow Nurse Practitioners (NP) and Physician Assistants (PA) to certify and make changes to home health plans of treatment. NPs and PAs are playing an increasing role in the delivery of our nation’s health care, especially in rural and other underserved areas. Medicare reimburses NPs and PAs for providing physician services to Medicare patients. NPs and PAs can certify Medicare eligibility for skilled nursing facility services, but not more cost effective care in the home.
Following are other top Medicare home health priorities detailed at the March on Washington:
Ensure Appropriate and Adequate Reimbursement for Medicare Home Health Services
Background: Under the CMS rate rebasing rule, CMS concedes that at least forty-three percent of home health agencies will be paid less than their costs by 2017. Using more realistic numbers, the industry projects that about fifty-six percent of home health agencies will be paid less than costs by 2017. Congress should a) postpone implementation of the rule and require CMS to reevaluate the rule including consideration of all usual and customary business costs consistent with standards under the Internal Revenue Code, telehealth services, all disciplines of caregivers, and usual business operating expenses along with needs for operating capital and operating margins; b) establish transparent and accurate processes for modification of PPS payment rates and case-mix adjustmentsas set forth in the Home Health Care Access Protection Act; and c) ensure full market basket updates to Medicare home health payments.
Make Permanent the Add-On for Services to Rural Patients; Ensure Home Care Access for Rural and Underserved Patients
Background: Congress should extend the payment differential(“add-on”)forcaredeliveredin ruralareas by enacting the Preserve Access to Medicare Rural Home Health Services Act (S.2389). Congressmustalsoclosely monitor the homehealth prospective payment system to ensure thatindividual case payments are sufficient to maintain access to care. Finally, Congress should monitor adequacy of payments so thatagenciesinunderservedareas(rural,innercity,medicalshortageareas)cancontinue to provide care to Medicare beneficiaries.
Ensure Appropriate Development of Performance-Based Payment for Medicare Home Health Services
Background: Congress should monitor the progress of the ongoing value-based purchasing demonstrations or proposals and use the findings to guide its consideration of value-based payment for Medicare home health services. Any action in this area must: 1) be developed in conjunction with provider stakeholders; 2) be tested as a pilot program prior to full-fledged implementation; 3) be fair in its assessment of the quality of care provided to home health patients and incorporate pending OASIS changes, as well as a mix of multiple process and outcome measures; 4) refrain from negatively affecting patient access to care; 5) be consistent with the home health PPS and appropriately risk-adjusted; 6) limit any expansion of data collection requirements and fully reimburse agencies for the costs of any additional data collection requirements that are imposed; 7) only reward or penalize agencies for care elements over which they have some control; 8) reward high scoring agencies as well as those that demonstrate improvement for the dynamic value of home health services to the entire Medicare program; 9) not pose cash flow difficulties for agencies, with the incentive pool not to exceed 2 percent of home health payments; and 10) allow the Secretary of Health & Human Services sufficient discretion to delay application of value-based purchasing if implementation concerns arise.
Stay tuned to NAHC Report for further coverage of the 2016 March on Washington.