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CMS bans surprise billing
Modern Healthcare
By Michael Brady
The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.
The interim final rule bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.
"No patient should forgo care for fear of surprise billing," HHS Secretary Xavier Becerra said in a statement. "Health insurance should offer patients peace of mind that they won't be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises."
While public health insurance programs like Medicare and Medicaid already prohibit balance billing, people with job-based coverage or individual health plans frequently and unknowingly accept care from an out-of-network provider before they are slapped with a surprise medical bill. The new rule aims to put a stop to that.
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CMS Releases Updated Emergency Preparedness Guidance
From the National Association for Home Care & Hospice (NAHC)
The Centers for Medicare & Medicaid Services (CMS) has released emergency preparedness (EP) guidance for surveyors, as well as providers and suppliers, with assessing a facility’s compliance with the EP requirements. Both home health agencies and hospice providers must conduct exercises to test the emergency plan at least annually, and both inpatient and outpatient providers that activate their emergency plans are exempt from the next required full-scale community-based or individual, facility-based functional exercise. This exemption is based on the facility’s 12-month exercise cycle. The cycle is determined by the facility (e.g. calendar, fiscal or another 12-month timeframe)...
HHAC Member Access to Full Article |
New Home Health Proposed Rule
The U.S. Centers for Medicare & Medicaid Services (CMS) released its 387 page new home health proposed payment rule last Monday, while also announcing plans for the nationwide expansion of the industry’s value-based purchasing demonstration beginning January 1, 2022.
The summary of the rule as stated in the Federal Register can be found below, however, an article by Joyce Famakinwa in Home Health Care News , which can be accessed through the following link, also does a great job of hitting the most important highlights of the proposed rule and presenting them with historical context: https://homehealthcarenews.com/2021/06/extensive-proposed-rule-sets-stage-for-value-based-purchasing-pdgm-adjustments/ . In addition to the highlighted changes, the rule establishes survey and enforcement requirements for hospice programs as set forth in Division CC, section 407, of the CAA 2021.
CMS-1747-P
On June 28, 2021, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1747-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2022. The proposed rule results in an estimated 1.7 percent increase ($310 million) in payments to HHAs in CY 2022.
Additionally, this rule provides monitoring and analysis of the Patient-Driven Groupings Model (PDGM); solicits comments on a methodology for determining the difference between assumed versus actual behavior change on estimated aggregate expenditures for home health payments as result of the change in the unit of payment to 30 days and the implementation of the PDGM case-mix adjustment methodology; proposes to maintain the CY 2021 low utilization payment adjustment (LUPA) thresholds; and proposes to recalibrate the PDGM case-mix weights, functional levels, and comorbidity adjustment subgroups for CY 2022. This rule also proposes to utilize the physical therapy LUPA add-on factor to establish the occupational therapy add-on factor for the LUPA add-on payment amounts; and make conforming regulations text changes to reflect that allowed practitioners are able to establish and review the plan of care. Finally, this rule includes updates to the home infusion therapy services payment rates for CY 2022, as required by section 1834(u) of the Act.
A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2022 HH PPS proposed rule. Please visit the Home Health Prospective Payment System (HH PPS) Limited Data Set (LDS) webpage for more information.
Proposed Rule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cms-proposes-calendar-year-2022-home-health-prospective-payment-system-rate-update
Proposed Rule: https://public-inspection.federalregister.gov/2021-13763.pdf |
CMS releases CY2022 Home Health Prospective Payment System Proposed Rule, Including Expansion of Home Health Value-Based Purchasing Program (HHVBP) Nationwide
From the Alliance for Home Health Quality and Innovation
Late this afternoon, the Centers for Medicare and Medicaid Services (CMS) released the CY 2022 Home Health Prospective Payment System Rate Update proposed rule.
The proposed rule seeks to expand HHVBP nationwide to all 50 states plus the District of Columbia beginning January 1, 2022. In 2018, the Alliance awarded a grant to Columbia University and the RAND Corporation to look at the impacts of policy changes, including those of the HHVBP program. Stay tuned for more information on the work produced by the grant upcoming shortly.
Additionally, the proposed rule updates payment rates and proposes to maintain the CY2021 LUPA thresholds for CY2022. Further updates to the HH Quality Reporting Program (QRP), Inpatient Rehabilitation Facility QRP, and Long-Term Care Hospital QRP are also included, along with making permanent selected regulatory blanket waivers for home health aide supervision that were made available to HH agencies during COVID-19.
A fact sheet on the proposed rule from CMS is available here.
The Alliance will once again be submitting comments to CMS on the proposed rule. We will be coordinating with our members over the next two months. If you are interested in discussing the proposed rule, members are encouraged to reach out to Alliance Executive Director Jennifer Schiller at [email protected]. |
Talking to Health Care Workers and Patients About the COVID-19 Vaccines
In accordance with President Joe Biden’s call for a National Month of Action to get as many Americans as possible vaccinated against the novel coronavirus COVID-19, the National Association for Home Care & Hospice (NAHC) has created a useful toolkit for talking to health care workers and patients about the COVID-19 vaccines, how they work, why they work, and why everyone who is eligible for the vaccine should take advantage of it.
The toolkit, COVID-19 Vaccine Communications Guide, is located on the Coronavirus Resources for Home Care & Hospice page on the NAHC website. It contains helpful tips and advice for talking to people about the vaccine, as well as informative articles, videos, and other resources. NAHC urges anyone working to vaccinate people against COVID-19 to look at the toolkit and see if it can be of help to them. |
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