Summary of the CMS Open Door Forum on June 29

From NAHC (Redacted by HHAC)

The Centers for Medicare and Medicaid Services (CMS) held a Home Health, Hospice, and DME Open Door Forum on June 29, 2022. The summary of the Forum applicable to home health and hospice providers is below.

Home Health

CMS provided a high-level summary of the CY 2023 Home Health PPS Rule.  (See the NAHC Report article here for a detailed summary and here for a link to the recording of the webinar conducted by NAHC’s Bill Dombi and Mary Carr where the proposals are discussed.)

The draft OASIS-E Guidance Manual was released in May as were OASIS-E Q&As.

Also recently posted was the June Expanded Home Health Value Based Purchasing Model newsletter and FAQs. CMS indicated they intend to have a sample interim report and sample performance report  for the expanded model available in iQIES soon, and there will be a webinar in August that walks through these sample reports.

Those providers that believe they are exempt from the home health CAHPS because they have had 59 or fewer patients from the period of April 2021 through March 2022, need to complete the Participation Exemption Request Form for the annual payment update for calendar year 2024. Additional exemption information is found here.

Hospice

CMS reminded hospices that the August refresh of Care Compare will include the two new claims-based measures – Hospice Visits in Last Days of Life and Hospice Care Index.  These measures were slated to be publicly reported with the May refresh of Care Compare but this was pushed back to August due to errors in the Provider Preview Reports for these measures issued in March. Therefore, hospices are to disregard the preview reports for March.  Corrected preview reports are available now.

The reconsideration period for the FY2023 annual payment update (APU) hospice quality reporting program (HQRP) requirements is coming up.  Hospice providers will receive notification from their Medicare Administrative Contractor (MAC) if they are subject to the APU penalty, and they will also receive notification in their CASPER folder.

There was some concern expressed by hospice participants in the ODF that the Care Compare website currently reflects that data for the HCI and HVLDL is suppressed upon request from the agency. This is not accurate as CMS suppressed the data due to an error in the preview reports, as stated above. CMS indicated that there is an additional update to the footnotes that will be pushed out soon and should provide some additional clarity on this situation for the public.

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Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements

This is an update to a NAHC Report article published on June 15, 2022.

Previously, NAHC reported that the Centers for Medicare & Medicaid Services (CMS) posted memo QSO-22-17-ALL containing new instructions for surveys for compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements. CMS previously issued guidance and survey procedures to survey entities for assessing and maintaining compliance with the regulatory requirements for vaccination.

Under the previous guidance, federal, state and Accreditation Organization (AO) surveyors were to assess for compliance with the vaccination requirements at surveys for initial certification, standard recertification or reaccreditation, and complaint surveys.

Effective immediately, surveyors will continue to survey for compliance with the vaccination requirements during initial and recertification surveys, but will now only survey for compliance in response to complaints alleging non-compliance with this requirement (not all complaint surveys). NAHC received clarification from CMS that any complaint survey addressing infection control and not just the COVID-19 vaccination requirements specifically, will include a review of the provider’s compliance with the vaccination requirements.  Since these requirements became effective earlier this year, 95% of the nearly 12,000 providers that have been surveyed by states are in compliance with the requirements.

This most recent memo also instructs state survey agencies to reach out to their CMS Location if they are considering citing vaccine requirements at immediate jeopardy, Condition or actual harm levels. CMS is reviewing its previous interpretive guidance describing Immediate Jeopardy, Condition-level and actual harm determinations to ensure that deficiency citations recognize good faith efforts by providers/suppliers and to more fully evaluate harm or potential harm to patients/residents by considering trends in COVID-19 rates in the community.  Stay tuned to NAHC Report for more information on these updates as they become available.

House Lawmakers Call Out ‘Bad Actors’ Within Medicare Advantage

Home Health Care News | By Joyce Famakinwa
 
House lawmakers are pushing for more oversight of Medicare Advantage (MA) plans in light of concerns over higher spending, improper claim denials and access to treatment.
 
A number of lawmakers on the House Energy and Commerce Committee’s oversight subcommittee examined the issue during a hearing that centered around the MA program on Tuesday.
 
“I am deeply concerned with recent reports that seniors in private sector Medicare Advantage plans are facing unwarranted barriers to accessing timely, medically necessary care,” Energy and Commerce Chairman Frank Pallone, Jr. (D-N.J.) said during the hearing. “Several studies have raised concerns that insurance companies are denying beneficiaries’ access to treatment and imposing burdensome requirements that delay care. Improper claim denials and increased use of prior authorizations are preventing beneficiaries from receiving the care they need.”
 
Pallone noted that while many Medicare Advantage plans seemed to be acting responsibly, “bad actors” were endangering the health of seniors and increasing costs for taxpayers.
 
Though several officials from federal agencies testified, including the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), the Medicare Payment Advisory Commission (MedPAC) and the Government Accountability Office. The U.S. Centers for Medicare & Medicaid Services (CMS) was not represented at the hearing.
 
“It’s a shame CMS did not agree to testify at this hearing to speak to the work the agency is doing to improve this program,” Rep. Morgan Griffith (R-Va.), a ranking member of the subcommittee, said.
 
Additionally, no MA plans spoke at the hearing.
 
During the hearing, Erin Bliss, the assistant HHS inspector general, pointed to OIG findings that plans were using chart reviews or in-home health risk assessments to diagnose patients. Oftentimes, there would be no follow-up.
 
In total, these diagnoses resulted in an estimated $2.6 billion in risk-adjustment payments for 2017.
 
Bliss also expressed that plans sometimes delayed or denied beneficiaries’ access to medical care, despite the requested care being medically necessary and meeting Medicare coverage rules.
 
“In other words, these Medicare Advantage beneficiaries were denied access to needed services that likely would have been approved if the beneficiary had been enrolled in original Medicare,” she said. “These denials likely prevented or delayed needed care for beneficiaries.”

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FDA Advisers Recommend Updating COVID Booster Shots for Fall

Associated Press | By Lauran Neergaard and Matthew Perrone

At least some U.S. adults may get updated COVID-19 shots this fall, as government advisers voted Tuesday that it's time to tweak booster doses to better match the most recent virus variants.

Advisers to the Food and Drug Administration wrestled with how to modify doses now when there's no way to know how the rapidly mutating virus will evolve by fall — especially since people who get today's recommended boosters remain strongly protected against COVID-19's worst outcomes.

Ultimately the FDA panel voted 19-2 that COVID-19 boosters should contain some version of the super-contagious omicron variant, to be ready for an anticipated fall booster campaign.

"We are going to be behind the eight-ball if we wait longer," said one adviser, Dr. Mark Sawyer of the University of California, San Diego.

The FDA will have to decide the exact recipe, but expect a combination shot that adds protection against either omicron or some of its newer relatives to the original vaccine

"None of us has a crystal ball" to know the next threatening variant, said FDA vaccine chief Dr. Peter Marks. But "we may at least bring the immune system closer to being able to respond to what's circulating" now rather than far older virus strains.

It's not clear who would be offered a tweaked booster — they might be urged only for older adults or those at high risk from the virus. But the FDA is expected to decide on the recipe change within days and then Pfizer and Moderna will have to seek authorization for the appropriately updated doses, time for health authorities to settle on a fall strategy.

Current COVID-19 vaccines have saved millions of lives globally. With a booster dose, those used in the U.S. retain strong protection against hospitalization and death but their ability to block infection dropped markedly when omicron appeared. And the omicron mutant that caused the winter surge has been replaced by its genetically distinct relatives. The two newest omicron cousins, called BA.4 and BA.5, together now make up half of U.S. cases, according to the Centers for Disease Control and Prevention.

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