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NAHC Report: Issue# 2369, 2/10/2014
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CMS Enforces Hospice Respite Level of Care Requirements
Plaintiffs Sue New Mexico over Loss of Services Following DD Waiver Overhaul
For Your Information: Join the American Health Lawyers Association and NAHC at the Upcoming Long Term Care and the Law Conference
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CMS Enforces Hospice Respite Level of Care Requirements

Late last week, CMS released Change Request (CR) 8569  - Enforcement of the 5 day Payment Limit for Respite Care Under the Hospice Medicare Benefit.  New edits are being implemented to prevent payment of respite care for more than 5 days at a time for any hospice claim submitted on or after July 1, 2014.  CMS will Return to Provider (RTP) any claim received after this date that has more than 5 units per episode of respite care.  This does not mean that hospices cannot provide and bill for this level of care more than once per month or benefit period.  It means the hospice cannot submit a claim for respite care that exceeds 5 days per occurrence.  The CR revises Section 30.3 of the Medicare Claims Processing Manual, Chapter 11 to reflect this requirement. 

CMS adds the following to this Section:

Respite care is payable only for periods of respite up to 5 consecutive days. Claims reporting respite periods greater than 5 consecutive days will be returned to the provider. Days of respite care beyond 5 days must be billed at the appropriate home care rate for payment consideration.

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Plaintiffs Sue New Mexico over Loss of Services Following DD Waiver Overhaul

On January 15, in Waldrop, et al v. New Mexico Human Services Department et al, seven adult plaintiffs and their legal guardians, along with Disability Rights New Mexico and the Arc of New Mexico, filed a lawsuit against the state of New Mexico (the State). Specifically, this lawsuit accuses the State of violating the rights of the beneficiaries of the State’s Home and Community Based Waiver program for people with developmental disabilities (the DD Waiver) following the State’s overhaul of the DD Waiver.


According to the Complaint, New Mexico submitted its original application for the DD Waiver to the United States Department of Health and Human Services (HHS) in 1983. HHS approved the application, and authorized 200 “slots” for the DD Waiver in the first three years. The number of participants in the DD Waiver reached almost 3,800 by 2008, and remained constant since then.

As a result of its rebalancing policies, in the 1990s, the State was able to close “two large segregated institutions” that served the disabled, resulting in many moving into the community and receiving Medicaid services there. New Mexico spends more on average for those in its DD waiver as compared to the national average, as the DD waiver is now able to serve most of its high need population.

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Join the American Health Lawyers Association and NAHC at the Upcoming Long Term Care and the Law Conference

The National Association for Home Care & Hospice is a co-sponsor of the upcoming American Health Lawyers Association (AHLA) Long Term Care and the Law conference. The conference will be held in Las Vegas, NV at The Cosmopolitan Hotel, from Wednesday, February 19 to Friday, February 21, 2014.

The 2014 conference promises to be an exciting and informative meeting where some of the leading long term care lawyers in the nation will be presenting on topics ranging from fraud and abuse to how the post-acute market is changing. NAHC’s Bill Dombi will provide an update on the “Legislative and Regulatory Issues for Home Health and Hospice.”

For the first time, the conference will have an education track with a focus on “Home Health and Hospice.” Some of the program topics include Government Fraud Concerns in Hospice and Home Health; Home Health Transactions: Clinical and Legal Aspects of the Diligence; Compassionate and Compliant End of Life Care in SNFs; and Hone in on Home Health and Hospice Compliance and Quality: The Government is Watching. The conference will also have an Interactive Session and Roundtable dedicated to home health and hospice.

This year’s plenary session is titled, Acute and Post-Acute Integration: Insights from Both Outside and Inside the Long-term Care Spectrum. The Plenary Session Panel will discuss these trends with an outstanding panel of diverse experts who will provide perspectives from outside as well as inside the post-acute spectrum. Two moderated panels will delve deeply into not only what appears to be happening with post-acute integration, but also what is really happening with actual provider experiences. The first part of the panel will include leaders who are outside of long-term care – from the acute care, managed care, and health care financing arenas. They will provide their perspective on how they see forces outside of long-term care affecting and shaping this integration trend. A second expert panel of individuals from inside the post-acute care spectrum, who are deeply involved in developing these integration transitions within their organizations, will then discuss and give examples of what the post-acute organizations who are leading this movement are doing.

As a co-sponsor to the conference, NAHC non-attorney members and NAHC In-House Counsel members will receive a special discounted rate. To view rates, click here.

For detailed information on the brochure, program, education sessions, and the speakers, please click here.

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