HHS: Burden Of Proof On Provider Relief Recipients When Reporting

Inside Health Policy/ By Dorothy Mills-Gregg
  
Provider relief recipients will not receive an extension beyond Sept. 30 to report use of their relief funds and the burden of proof is on them to show they used the money to prevent, prepare for and respond to the pandemic, HHS staff said Thursday (July 8) during the first COVID-19 relief reporting webinar. Those with provider relief not spent by June 30 will have until Oct. 30 to return the unspent funds to HHS.
 
Providers waited nearly six months before the provider relief reporting portal went live last week. HHS opened the complete portal and supporting documents after hospitals, providers and lawmakers spent weeks asking the department to extend the provider relief spending deadline, which is tied to the reporting requirements, beyond Wednesday (June 30). HHS stopped short of a complete extension in guidance released June 11 and tied spending and reporting deadlines to when providers received their relief.
 
Providers who received $10,000 or more in relief before June 30, 2020 will have a hard deadline of Sept. 30 to report how they used their relief over the past year, said staff from the agency in charge of distributing the funds, Health Resources and Services Administration.
 
“You may not receive an extension on the deadline to report. If you do not report by the deadline, you will be deemed out of compliance with the terms and conditions of the payments and may be subject to recoupment,” HRSA staff said during the webinar.
 
Meanwhile, it’s up to providers to explain why they used provider relief for certain expenses and to make up for lost revenue due to COVID-19. Providers will have 30 days to respond to HRSA if it determines the provider’s calculation is not reasonable.
 
“So the burden of proof is on the provider to ensure that documentation is maintained to show that expenses are in fact to prevent, prepare for and respond to coronavirus,” HRSA staff said.

 -- Dorothy Mills-Gregg ([email protected])

CMS proposes to expand the Home Health Value-Based Purchasing Model nationwide

Healthcare Finance News/ By Nathan Eddy
 
The Centers for Medicare and Medicaid Services has issued a proposed home health rule aimed at accelerating the shift to value by expanding the Home Health Value-Based Purchasing Model nationwide.
 
The CY2022 Home Health Prospective Payment System proposed rule provides payment updates that would increase Medicare payments to home health agencies by an aggregate of 1.7%, or $310 million.
 
This increase reflects the effects of the proposed 1.8 percent home health payment update percentage ($330 million increase) and a 0.1 percent decrease in payments due to reductions made in the rural add-on percentages mandated by the Bipartisan Budget Act of 2018.
 
Along with routine updates to the Home Health Prospective Payment System, CMS proposes home infusion therapy services payment rates for 2022, as well as making permanent changes to the home health conditions of participation implemented during the COVID-19 pandemic.
 
The proposed rule also seeks feedback on ways to attain health equity for all patients through policy solutions, including enhancing reports on Medicare/Medicaid dual eligible and disability status.
 
In addition, the proposal seeks ideas on providing care for people who live in rural areas, the LGBTQ+ population, religious minorities and groups who would otherwise be adversely affected by persistent poverty or inequality...

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Bill Would Create New Federal Long-Term Care Insurance Program

CMS PROPOSING SIGNIFICANT SURVEY REFORMS FOR HOSPICES

The Health Group 

In 2019, the OIG presented findings of significant deficiencies and/or complaints regarding hospice providers.  As a follow-up Congress enacted significant changes to the hospice survey process, including actions available to CMS to address seriously deficient hospices, including penalties.

On June 25, CMS issued, as part of the CY 2022 Home Health Prospective Payment System Rate Update, proposed rules intended to implement the legislative intent.

Some of the proposed regulations include submission of the Form CMS-2567 (Statement of Deficiencies and Plan of Correction) by the accrediting organizations as part of their contractual agreement with CMS and require public posting of State and Accrediting Organization findings.

The proposed rule makes permanent that hospices are required to be surveyed every 36 months; however, standard, or abbreviated surveys are required in response to complaint allegations.  It also requires that CMS develop a training and testing program for surveyors, thereby improving the consistent survey process among surveyors, which has been a concern for hospices in the past.  Other programs are to be put in place to better ensure consistency of the survey process and survey results.

The proposed rules provide significant attention to the surveyors, including the elimination of conflicts of interest (defined in the proposed rule), requirements for survey teams, creation of measures to determine survey accuracy, and required reporting by the accrediting organization based on pre-determined criteria.

The proposed rule establishes a Special Focus Program (SFP) to address issues that place beneficiaries at risk for poor care.  An SFP hospice is to be surveyed at least every six (6) months.  SFP hospices are determined in a cooperative effort between CMS and the applicable State Agency.  Non-compliant hospices can be exposed to significant remedies.

Expect significant education on these proposed rules by national and state associations, as well as other organization.  All hospices must get prepared to deal with the implications of the proposed rules.  Comments to the proposed rules must be received by CMS on or before August 27, 2021.