It is important that home health and hospice providers monitor legislative and regulatory initiatives that have the potential to impact their operations. There are numerous such legislative and regulatory initiatives. Home health and hospice providers are encouraged to address their concerns and desires to their legislators in addition to the ongoing monitoring of the legislative and regulatory process.
Home Health
The Centers for Medicare & Medicaid Services (CMS) has proposed regulatory reimbursement cuts that focus on what CMS has termed "case mix creep." These cuts, as presented by CMS, were not based on obtaining and analyzing quantitative data. As a result a Senate bill has been introduced that would require CMS to develop and use an organized and rational approach to the evaluation of home health case mix adjustments. This bill proposes to determine if there is any foundation for the proposed CMS cuts as they now exist.
The key unanswered question, from which it appears these proposed cuts stem, is why patient severity scores have increased. CMS contends it is an effort by home health providers to obtain higher reimbursement, while home health providers point to several factors for these increased severity scores. Among these factors are the increased acuity of patients discharged from hospitals, a shift of patients from rehabilitation facilities and nursing homes to home health, and the increased age and frailty of patients admitted for care.
In the Collins-Feingold Senate bill, it is proposed that an objective process be established for the evaluation of case mix weights that includes the establishment of a technical advisory group. This technical advisory group would be made up of home health representatives, beneficiary representatives, and health policy experts and would be charged with the responsibility for the development of specific measurable criteria that would be used for analysis of case mix weights. In addition, CMS would be required to address any payment rate adjustments that are based on case mix weight changes in a transparent manner using the public notice and rulemaking process for developing these standards. CMS would be required to fully disclose any studies on the subject and data used in analysis before any adjustment could take effect. In selecting data to use for the evaluation, an actual claims review would be conducted to form the foundation for the service’s evaluation rather than using a simple regression analysis of statistical data.
Providers are asked to contact their legislators in support of this legislation. The bill, Senate Bill3315, the Home Health Care Access Protection Act, is available for full review at http://www.govtrack.us/congress/bill.xpd?bill=s111-3315. Providers can sign up for email notifications regarding the progress of this bill at goes forward through the legislative process.
Hospice
Contained within the Patient Protection and Affordable Care Act (Public Law 111-148) is a requirement that either a hospice physician or nurse practitioner (NP) have a face-to-face encounter with an individual receiving hospice care prior to the 180th day recertification and for each subsequent recertification. Along with conducting the face-to-face encounter, with the 180th day recertification and each subsequent recertification, either the physician or NP will have to attest that the face-to-face encounter did take place. Along with this requirement, there is an additional provision requiring that a medical review be conducted on all cases of more than 180 days for hospices with high average lengths of stay (based upon the Secretary of Health and Human Services’ determination). This face-to-face recertification requirement is an important hospice initiative that hospice providers need to understand and to be actively involved in during its actual interpretation and implementation. It is anticipated that CMS will soon be issuing regulations governing this new requirement and it is essential that hospice providers’ voices be heard prior to this release.
Home Health and Hospice
Recently in a Federal Register notice, the Health Information Technology for Economic and Clinical Health (HITECH) Act was issued. This notice included a request for input and comments. This Act expands an individual's right under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to receive an accounting of protected health information (PHI) disclosures made by HIPAA-covered entities and their business associates. The HITECH Act was part of the economic stimulus package passed last year, i.e., the American Recovery and Reinvestment Act of 2009. As the current disclosure language exists in the HIPAA Privacy Rule, providers are asked to make available to an individual upon request, an accounting of certain disclosures of the individual's protected health information, extending back over a six-year time frame. At this time information disclosures needed to carry out treatment, payment, and health care operations are exempt from this disclosure. However, the HITECH Act would not allow this exemption to apply to such disclosures, if they are made through an electronic health record. The complete Federal Register release is available at http://edocket.access.gpo.gov/2010/pdf/2010-10054.pdf.
It is important that providers monitor and stay abreast of these and other legislative and regulatory activities that impact their operations and that they take an active role in addressing these activities so that their voices can be heard.
Resources:
http://edocket.access.gpo.gov/2010/pdf/2010-10054.pdf
http://www.govtrack.us/congress/bill.xpd?bill=s111-3315 |
