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NAHC Report: Issue# 2463, 7/9/2014
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CMS Hosts Home Health, Hospice and DME Open Door Forum
Michigan Audit Uncovers $160 Million in Improper Home Care Payments
For Your Information: CMS Announces its Next Open Door Forum for Home Health, Hospice and DME
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CMS Hosts Home Health, Hospice and DME Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) held its most recent Home Health, Hospice, and Durable Medical Equipment (DME) Open Door Forum (ODF) on July 9, 2014.  CMS officials discussed the 2015 proposed rule for the home health prospective payment system (HHPPS), hospice reporting of DME items and the hospice CAHPS survey. Access to the recorded Forum is available through CMS’ Encore system by dialing 1-855-859-2056 and using conference ID code 44430036 beginning at 5 p.m. Eastern on July 9; the recording expires after 2 business days.

The proposed rule for the HHPPS rate update for 2015 went on display June 2, 2014 and includes both payment and non-payment related changes.

CMS proposes the following changes and clarifications to the Face to Face requirement:

  • Eliminate the narrative requirement
  • Only consider medical records from the patient’s certifying physician or discharging facility in determining initial eligibility for the Medicare home health benefit.
  • Claims for physician certification/re-certification for home health services be considered a non-covered service if the HHA claim was non-covered because the patient was ineligible for the home health benefit.
  • The proposed rule also clarifies that a new F2F encounter document must be completed when ever a start of care OASIS assessment is required, even if there has not been more than 60 days between episodes.

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Michigan Audit Uncovers $160 Million in Improper Home Care Payments

A state audit released this month found that Michigan improperly spent over 18 percent of total federal and state expenditures on the state’s Medicaid Home Help Program - $160 million out of $894 million in total expenditures from October 2010 through August 2013. Michigan may be required to pay almost $97 million back to the federal government.

Improper payments included:

  • $6.8 million in overpayments to 80 agencies that did not provide adequate documentation to secure higher fees compared to individual aides;
  • $2.6 million in payments for home services while the alleged beneficiaries were hospitalized;  
  • $3.3 million in payments to clients not deemed eligible for receipt of services; and $0.9 million in payments for home services while the alleged beneficiaries were in nursing homes

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NAHC and HHNA Invite Participation in a Free Teleconference
on July 11, 2014

Subject: What Do the Proposed Changes in the Face to Face Rule Means to You and Where Do We Go From Here?

Presented by: National Association for Home Care and Hospice (NAHC) and the Home Health Nurses Association (HHNA). Faculty: Val J. Halamandaris, President; Elaine Stephens, Executive Vice President; Jeff Kincheloe, Vice President for Government Affairs; Bill Dombi, Vice President for Law; and Mary Carr, Vice President for Regulatory Affairs.

Who may participate: All home care providers who register in advance with NAHC members and members of HHNA being given priority.

To reserve your place in line: Please send an email to Cheryl Lee  (  The first 500 people who send in an e-mail will participate.

Time of the conference:  Friday, July 11 at 2 pm EST.  The call in number is 1-800-289-0459.  The conference code will be emailed Friday morning prior to the call.

What other topics will be discussed? The names of the top ten nurses from whom which the Nurse of the Year will be selected; Details of the Preconference Being Offered at the NAHC Annual Meeting (October 19-22, 2014 in Phoenix, AZ): How to Give Referral Sources  the Service for which they are looking. An Overview of the 116 Educational Session being offered at the NAHC Annual meeting. New Benefits specifically for home health nurses being offered to NAHC and HHNA members.

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