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:: NAHC Report
NAHC Report: Issue# 2339, 12/20/2013
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
Senate Special Committee on Aging Holds a Hearing on Long-Term Care Policy
CMS Issues Policy for Recalcitrant Providers
For Your Information: 2013 NAHC Annual Meeting Certificates for Attendees are Now Available Online
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Senate Special Committee on Aging Holds a Hearing on Long-Term Care Policy

On December 18, 2013, the Senate Special Committee on Aging held a hearing entitled “The Future of Long-Term Care Policy: Continuing the Conversation.” Michelle Martin, the Policy Director for the National Council on Medicaid Home Care -  an affiliate of the National Association for Home Care and Hospice (NAHC) - attended the hearing.  The hearing was attended by a handful of Senators: Chairman Bill Nelson (D-FL), Ranking Member Susan Collins (R-ME), Sheldon Whitehouse (D-RI), Jon Manchin (D-WV), Tammy Baldwin (D-WI), Elizabeth Warren (D-MA), Kelly Ayotte (R-NH), and Tim Scott (R-SC). The four witnesses during the hearing were:

  • Judy Feder, Professor, Georgetown University McCourt School of Public Policy and Fellow, Urban Institute;
  • Mark J. Warshawsky, Visiting Adjunct Scholar, American Enterprise Institute (former Chair of LTC Commission);
  • Bruce Chernof, President and Chief Executive Officer, The SCAN Foundation (former Vice Chair of LTC Commission); and
  • Anne Tumlinson, Senior Vice President, Avalere Health.

The Senators and witnesses agreed that long-term care, whether received in an individual’s home or in a nursing home, is an area that is growing in terms of individuals needing care but remains sorely underfunded and misunderstood.  The general public is unaware of the lack of coverage for long-term care offered by health insurance, Medicare and Medicaid.  How to successfully address the funding issue is where the Senators and panelists differed in their views.  Senator Scott agreed with Mr. Warshawsky, opining that the private sector holds the answers and the possibility of market-based incentives would cause individuals to seek long-term care coverage.  Senators Baldwin, Warren, and Whitehouse took greater interest in the idea of a public social insurance mechanism put forth by Judy Feder. Anne Tumlinson made the point that, regardless of a public, private or hybrid financing model, there needs to be some type of mandate in order to create a risk pool large enough to be sustainable. While the Committee reached no conclusions on the topic of how to fund long term care needs, the importance of working to develop solutions was very clear to all of the Senators.

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2013 NAHC Annual Meeting Certificates for Attendees are Now Available Online

The 2013 NAHC Annual Meeting certificates are now available online and ready to download for participants and attendees to this year’s Annual Meeting.

Please click here to download your certificate.

Visit the CARING Store online for the latest Resources

CMS Issues Policy for Recalcitrant Providers

The Centers for Medicare & Medicaid Services (CMS) has issued manual updates to address providers termed as “recalcitrant.” CMS’ definition of “recalcitrant” providers are those who have a history of prolonged program abuses and refuse to comply with Medicare coverage rules. These providers have been on a pre-pay medical review for years and continue to show no improvement in inappropriate behavior. 

CMS will apply two sanction authorities that currently exist under the Social Security Act at 1128A(a)(1)(E) for civil money penalties and 1128(b)(6) for civil money penalties and/or exclusion from Medicare and State Health Care programs. Both of these sanctions are delegated to the Office of the Inspector General.

The contractors are instructed to consider the following criteria before referring a recalcitrant provider to CMS Region Office and The Program Integrity Fraud and Abuse Suspensions and Sanctions (FASS) Team for further action.

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