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NAHC Report: Issue# 2481, 8/4/2014
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Proposed Medicare Home Health Payment Rule: Impact on Rural Providers
Senate Finance Committee Holds Hearing on the ABLE Act
For Your Information: FREE Hospice Teleconference on CMS’ Final Hospice Payment Regulations
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Proposed Medicare Home Health Payment Rule: Impact on Rural Providers

The proposed rule regarding home health prospective payment for 2015 issued by CMS on July 2, 2014 will have a unique impact on some rural providers. The cause of the impact centers on the rate adjustment that is made to reflect differences in wages among geographic areas and the application of a 3% rural add-on to the payments when the patient resides in an area designated as rural.

If finalized, CMS will apply a wage index adjustment that uses a 50/50 blend of 2014 and 2015 geographic area designations, otherwise known a Core Based Statistical Areas (CBSA). The reason for the blend is to provide a smoother transition to the new CBSAs that were approved in 2013 by the Office of Management and Budget (OMB) that are based on 2010 census data. In the 2006 Medicare payment rates, CMS also used a 50/50 transitional blend when OMB devised the CBSAs to replace the previous Metropolitan Statistical Areas (MSAs).

The switch to the new CBSAs means that 105 counties currently designated as rural would change to urban status. In addition, 37 urban counties would change to rural status. That means that HHAs serving the formerly rural counties will lose the 3% rural add-on with episodes that end January 1, 2015 and later. CMS confirmed that it intends to apply the rural add-on based on the 2015 CBSA designation even though it will use a 50/50 blend of 2014 and 2015 wage indexes.

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Senate Finance Committee Holds Hearing on the ABLE Act
Bill would establish tax-exempt ABLE accounts to assist individuals with a disabilities in building tax-exempt savings accounts to pay for qualified disability expenses

Prior to adjourning for its five-week August recess, the Senate Finance Committee Subcommittee on Taxation and IRS Oversight held a hearing on the Achieving a Better Life Experience (ABLE) Act. The measure, if enacted, would allow individuals with disabilities to set up tax-exempt savings accounts to pay for qualified disability expenses. The bill, S. 313, was introduced by Senator Robert Casey (D-PA) and has significant bipartisan support with 74 additional senators signed-on as sponsors.

The identical bill in the House also has strong bipartisan support with 380 Representatives signed-on as sponsors. The House bill was introduced by Rep. Ander Crenshaw (R-FL).

The bill specifies what services are considered, “qualified disability expenses,” including health and wellness services such as habilitation and rehabilitation services, therapy, respite care and long-term services and supports. Additionally, the ABLE Act stipulates that the amount a person has saved in an ABLE account will not be factored into Medicare or other means-tested federal programs.

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FREE Hospice Teleconference on CMS’ Final Hospice Payment Regulations
Teleconference held on August 13 at 1.00pm EST. First 300 registrants can participate

The National Association for Home Care & Hospice and the Hospice Association of America invite you to a FREE Hospice Teleconference on CMS’ Final Hospice Payment Regulations titled "What Do the CMS’ Final Hospice Payment Regulations for FY 2015 and Revised Hospice/Part D Guidance Mean to You?"

On May 2, CMS issued proposed regulations to govern hospice payment for Fiscal Year (FY) 2015; these proposed regulations included numerous policy changes that would affect hospice organizations. It is anticipated that CMS will issue final rules at any time and this teleconference provides an opportunity for hospice stakeholders to learn CMS’ final decisions on these pending policy changes. Additionally, on July 18, in response to significant pressure from hospice organizations, beneficiary advocates, and Medicare Part D plans, CMS issued revised guidance related to its prior authorization policy for processing of drug coverage under Part D for hospice patients. This teleconference will cover key issues related to CMS’ revised guidance. Faculty will include: Val J. Halamandaris, NAHC President; Theresa M. Forster, NAHC Vice President for Hospice Policy & Programs and Katie Wehri, Hospice Operations.

Date: Wednesday, August 13, 2014 at 1:00 p.m. Eastern

To Register: Please send an email to Cheryl Lee ( ). The first 300 to email will participate, members will be given priority. The call-in number is 1-888-637-7740; the conference code will be emailed prior to the call.

Questions: We encourage advance submission of questions from participants or submission while the teleconference is live on the date of the broadcast. Should your question(s) not be addressed in the call due to time constraints, we will highlight in NAHC Report. Send questions to Barbara Woolley, at

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