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:: NAHC Report
 
NAHC Report: Issue# 2461, 7/2/2014
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
Recent Advocacy Efforts on Part D Prior Authorization for Hospice Patient Medications
Authorities Indict Fourteen for Personal Care Assistant Fraud in Illinois
For Your Information: Open Forum, and Medicare Advantage and Managed Care Cost Analysis Discussion
NAHC/Home Care & Hospice Events
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Recent Advocacy Efforts on Part D Prior Authorization for Hospice Patient Medications
NAHC’s Forum of State Associations; 75 U.S. Senators Send Letters to CMS Opposing Part D Prior Authorization Requirements

Earlier this week, the Forum of State Associations, a NAHC affiliate that is comprised of state-based home care and hospice associations from across the nation, sent a letter to CMS Administrator Marilyn Tavenner expressing, “concerns related to the negative beneficiary consequences that are resulting from the Centers for Medicare & Medicaid Services’ (CMS) imposition of a beneficiary-level prior authorization (PA) requirement for all drugs processed by Part D plans for patients who are enrolled in the Medicare hospice program.”

The letter was endorsed by all state members of the Forum of State Associations, and also offered support of the letter that was recently sent by 45 national advocacy organizations to CMS that also expressed concerns about the PA requirements. NAHC was a signatory to the latter letter.

The letter sent by the Forum of State Associations states that:

“[H]ospice providers report that the new PA process is creating significant delays in the dispensing of vitally important medications, is increasing out-of-pocket costs for hospice beneficiaries and is creating massive confusion for Medicare hospice beneficiaries and their families. Further, efforts by hospice providers to address questions of coverage responsibility at the front end or to communicate patient status information directly to plans (as advised by CMS’ guidance and FAQs on this issue) are in large part being rebuffed.”

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Authorities Indict Fourteen for Personal Care Assistant Fraud in Illinois

On June 5, federal and state officials announced the indictment of fourteen independent personal care assistants and Medicaid beneficiaries for home care fraud in the third wave of “Operation Home Alone” in Illinois. The first and second rounds, in May 2012 and July 2013, respectively, indicted a total of 29 people. Operation Home Alone was established to crack down on individuals defrauding Illinois’ Home Services Program.

The types of fraud involved, as well as the number of individuals charged for each, include:

  • Services billed while the personal care assistant or the beneficiary was in the hospital (6)
  • Services billed while the personal care assistant or the beneficiary was in prison (4)
  • Services billed while the personal care assistant or the beneficiary was working (3)
  • Services billed while the beneficiary was dead (1)

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Open Forum, and Medicare Advantage and Managed Care Cost Analysis Discussion
Closing General Session at the Financial Management Conference

This year, NAHC and its affiliate Home Care & Hospice Financial Managers’ Association (HHFMA) Financial Management Conference & Exposition is being held July 13 – 15 in Chicago, IL. Once again, the Closing General Session will present its open, no holds-barred forum meeting to conclude the annual conference. The session addresses any and all issues of interest to the conference faculty and attendees. 

A special feature at this year's Closing General Session is a program focused on Medicare Advantage and managed care cost analysis.

The Managed Care Task Force Committee of HHFMA has developed an analytical tool that assists providers with the essential task of costing and pricing Medicare Advantage Plan services to assist all providers with network contract negotiations. The tool is based on the nationwide Managed care Survey conducted by HHFMA.

The seminar will include a discussion of the survey results and the use of the MA plan Costing and Pricing Tool. Be sure to plan you time at the Financial Management Conference to include this crucial program at the closing session of the conference.

Moderator: William A. Dombi, Esq., Vice President for Law, National Association for Home Care & Hospice; Executive Director, Home Care & Hospice Financial Managers Association, Executive Director, National Council on Medicaid Home Care, Washington, DC

Panelists: Pat Laff, CPA, Managing Principal, Laff Associates, Hilton Head Island, SC; Paul Giles, BS, Director of Home Health Finance, Dignity Health Care, Yorba Linda, CA ; Christopher Attaya, MBA, FHFMA, VP, Business Intelligence, Strategic Healthcare Programs, Santa Barbara, CA; Dawn Michelizzi, BS.  Controller, VNA of Greater Philadelphia, Philadelphia, PA

To register to attend this year’s Financial Management Conference & Exposition, please click here.

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