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  NAHC Report: Issue# 2621, 3/12/2015
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
Permanent “Doc Fix” Sustainable Growth Rate Deal Possible As Deadline Looms
Latest Hospice PEPPER Report Set for April Release
For Your Information: Capitalizing on the Private Duty Revolution
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Permanent “Doc Fix” Sustainable Growth Rate Deal Possible As Deadline Looms

The Centers for Medicare & Medicaid Services (CMS) on March 6, 2015, released change request (CR) 9091, which addresses payment to hospice agencies that do not submit required quality data and outlines the penalties for failure to report.

For fiscal year 2014, and each subsequent year, if a hospice agency does not submit required quality data, their payment rates for the year will be reduced by 2% for that fiscal year. Application of the 2% reduction may result in an update that is less than 0.0 for a fiscal year and in payment rates for a fiscal year being less than such payment rates for the preceding fiscal year. In addition, reporting-based reductions to the market basket increase factor will not be cumulative; they will only apply for the fiscal year involved.

For calendar year 2014, CMS considers Hospice Item Set data submitted by the hospices to CMS for reporting periods beginning on or after July 1, 2014, through December 31, 2014, as meeting the reporting requirements. For calendar year 2015 and subsequent years, CMS considers Hospice Item Set data submitted by the hospices to CMS for reporting periods beginning on or after January 1 through December 31 as meeting the reporting requirements for that year. Hospices that receive notification of Medicare certification on or after November 1 of the preceding year involved are excluded from any payment penalty for quality reporting purposes for the following fiscal year.

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Latest Hospice PEPPER Report Set for April Release
New “Target Areas” Include Days of CHC, RHC in Assisted Living and Nursing Facilities

In 2012, the Centers for Medicare & Medicaid Services (CMS) began development and release of Program for Evaluating Payment Patterns (PEPPER) reports for Medicare-certified hospices through its PEPPER contractor, TMF Health Quality Institute.  As part of the PEPPER process, specific “target areas” within the Medicare hospice benefit that could be at risk for improper payment are identified, and data related to those target areas are analyzed.  The PEPPER reports supply an individual hospice’s data over three years’ time and also provide, for comparison, the same data for hospices nationally, within the same Medicare Administrative Contractor (MAC) jurisdiction, and within the same state as the subject hospice.  This data allows a hospice to assess how its performance (and potential risk) in the target areas compares with others.  Initial hospice PEPPER reports were hard copy, but beginning in April 2014 hospice PEPPERs became available to the hospice CEO, president or administrator by way of an electronic PEPPER Resources Portal.

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Capitalizing on the Private Duty Revolution

Demography will determine the destiny of private duty home care in the next three decades. As the 78 million baby boomers reach their retirement years, most of them will want to age at home — and there will be a booming market for both the medical and nonmedical support private pay home care provides. How can private pay agencies meet the enormous demand in store? And how can they work together to ensure the future of their field? Get the answers from our experts as they show how the graying of our country can be a golden opportunity for you. A revolution in home care is brewing that could mean more revenues for private pay.

Conference Program
You may view the conference program here.

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