In The News

Elara Caring Agrees to Pay $4.2 Million to Settle False Claims Act Allegations That It Billed Medicare for Ineligible Hospice Patients

U.S. Department of Justice

Elara Caring, and its wholly owned subsidiaries JHH/CIMA Holdings Inc., CIMA Healthcare Management Inc., CIMA Hospice of Texarkana L.L.C., CIMA Hospice of East Texas L.L.C. and CIMA Hospice of El Paso L.P., have agreed to pay $4.2 million to resolve allegations that they violated the False Claims Act by knowingly submitting false claims and knowingly retaining overpayments for the care of hospice patients in Texas who were ineligible for the Medicare hospice benefit because they were not terminally ill. 

“The hospice benefit under Medicare provides critical services to vulnerable patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will continue to ensure that this benefit is used to assist those who need it, and not to line the pockets of those who seek to abuse it.”

The settlement resolves allegations that Elara Caring’s Texarkana, Texas, location, which previously operated as CIMA Hospice, knowingly submitted false claims for hospice services provided to patients who were ineligible for the hospice benefit because they were not terminally ill.  The patients at issue in the settlement were at the Texarkana location between 2014 and 2019 and in 2020. The settlement also resolves allegations regarding two patients at other Texas locations between 2015 and 2021. The settlement further resolves allegations that Elara Caring knowingly and improperly concealed or avoided obligations to repay overpayments for these patients…

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CMS’ Daniel Tsai Stands Behind ‘80-20’ Provision, Medicaid Access Rule In Congressional Hearing

Home Health Care News / By Joyce Famakinwa
A senior Centers for Medicare & Medicaid Services (CMS) official stood behind the “80-20 rule” — which has drawn major pushback from the home-based care industry — during a congressional hearing Tuesday.
Last week, the “Ensuring Access to Medicaid Services” rule was finalized. The impetus behind the rule is to strengthen access to home- and community-based services (HCBS) for Medicaid beneficiaries.
The provision that has grabbed the most attention is the one that would require 80% of Medicaid payments for HCBS to be reserved for direct care workers’ wages.
During the hearing, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-Wash.) was critical of the 80-20 rule.
“The Medicaid access rule’s so-called 80-20 policy will lead to home care agencies reducing the amount of care that they can provide,” she said. 
Daniel Tsai – the deputy administrator and director of Center for Medicaid and CHIP services at CMS – defended the 80-20 provision, pointing to low wages in HCBS and the correlation to care quality, as he also did last week
“Data shows that direct care workers typically earn low wages and receive limited benefits, contributing to a shortage of direct care workers and high rates of turnover in this workforce, which can limit access to and impact the quality of HCBS,” he wrote in his witness testimony. “By supporting and stabilizing the direct care workforce, this provision will result in better qualified employees, lower turnover, and a higher quality of care, improving access to quality care for Medicaid beneficiaries.”
CMS wants to ensure that this percentage of Medicaid payments are going to direct care workers instead of things like administrative overhead or profit…

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2024 Pediatric Palliative and Hospice Needs Assessment


The National Hospice and Palliative Care Organization (NHPCO) has released the 2024 Pediatric Palliative and Hospice Care Needs Assessment. If your organization has cared for at least one pediatric patient during the last four years, please complete the survey. The Needs Assessment is a product of the NHPCO’s Pediatric Advisory Council with the goal to gain a better understanding of the organizations and providers caring for pediatric patients with serious illnesses throughout the United States. The needs assessment helps create resources and support advocacy. You do not need to be an NHPCO member to complete the survey. Any questions can be directed to the Pediatric Advisory Council at [email protected].

Over the next month, NHPCO will be sharing the Needs Assessment on social media, feel free to share the posts or create your own.

Facebook           Twitter                 LinkedIn              Instagram

Any questions can be directed to Alix Ware at [email protected]


Expanded HHVBP Model Performance Feedback Reports

April 2024 Interim Performance Reports (IPRs) are Available on iQIES   

The Preliminary April 2024 Interim Performance Reports (IPRs) for the expanded HHVBP Model have been published on the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide HHAs with the cohort assignment, performance year measure data for the 12 most recent months, and interim Total Performance Score (TPS). Using the IPR, an HHA can assess and track their performance relative to peers in their respective cohort throughout the expanded Model performance year.   

An HHA will receive an IPR for the calendar year (CY) 2023 performance year if the HHA:  

  • Was Medicare-certified prior to January 1, 2022, and  
  • Meets the minimum threshold of data for at least one (1) quality measure in the quarterly reporting period for the performance year.

IPRs are available via iQIES in the “HHA Provider Preview Reports” folder, by the CMS Certification number (CCN) assigned to the HHA. If your organization has more than one (1) CCN, then a report will be available for each CCN. Only iQIES users authorized to view an HHA’s reports can access expanded HHVBP Model reports. For assistance with downloading your HHA’s IPR, please contact the iQIES Service Center at 1-800-339-9313, Monday through Friday, 8:00 AM-8:00 PM ET, or by email ([email protected]). To create a ticket online or track an existing ticket, please go to CCSQ Support Central.   

Locating the IPR in iQIES  

  1. Log into iQIES at  
  2. Select the My Reports option from the Reports menu. 
  3. From the My Reports page, select HHA Provider Preview Reports. 
  4. Select the HHVBP file to view the desired report. To quickly locate the most recently published report, select the down arrow adjacent to the Created Date label at the top of the table. This will order the reports in the folder from newest to oldest.  
  5. Select the file name link and the contents of the file will display.  

Instructions on how to access the IPRs are also available on the Expanded HHVBP Model webpage, under “Model Reports.”  

Submitting an IPR Recalculation Request   

There are two (2) versions of the quarterly IPRs: a Preliminary IPR and a Final IPR. The Preliminary IPR provides an HHA with an opportunity to submit a recalculation request for applicable measures and interim performance scores if the agency believes there is evidence of a discrepancy in the calculation. Please note, the recalculation request does not apply to errors in data submission since submission requirements for the expanded Model align with current Code of Federal Regulations (CFRs).   

To dispute the calculation of the performance scores in the Preliminary IPR, an HHA must submit a recalculation request within 15 calendar days after publication of the Preliminary IPR. For the April 2024 IPR, HHAs must submit a recalculation request by May 15, 2024.

The Final IPR will reflect any changes resulting from any approved recalculation request.  

HHAs may submit requests for recalculation by emailing [email protected]. Recalculation requests must contain the following information, as cited in the CY 2022 HH PPS final rule (p. 62331) and CFR §484.375:   

  • The provider’s name, address associated with the services delivered, and CCN.   
  • The basis for requesting recalculation to include the specific data that the HHA believes is inaccurate or the calculation the HHA believes is incorrect.   
  • Contact information for a person at the HHA with whom CMS or its agent can communicate about this request, including name, email address, telephone number, and mailing address (must include physical address, not just a post office box).   
  • A copy of any supporting documentation, not containing PHI, the HHA wishes to submit in electronic form.  

These instructions are also available on the Expanded HHVBP Model webpage, under “Model Reports.”


Relief Provisions Not Enough to Mitigate Damage of 80/20 Policy, Providers Say

 McKnight’s Home Care / By Adam Healy

Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate.

“Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,”  the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published. 

Among the mitigating factors in the final rule: CMS extended the time frame for when the 80/20 provision will take effect to six years from four years. The agency also is requiring states to review their Medicaid rates to ensure access. And it is mandating that states report how long it takes beneficiaries to access home- and community-based services, Dan Tsai, deputy administrator and director of Center for Medicaid and CHIP services at CMS, said in a question-and-answer session at a press conference Tuesday. 

“We ensured that there is a period of reporting for every state and provider so that there’s transparency around where every provider is, and there are a whole suite of provisions in the rule that also get at whether the actual rates that the state Medicaid agency is paying for the service is sufficient,” Tsai said in response to a question by a staff writer at McKnight’s Home Care Daily Pulse. “We do that both by requiring a set of … processes in which the states need to review their rates with a whole group of individuals, and whether those rates are sufficient to ensure access.”

Taken together, all of these changes are “very important in making sure the rate itself is sufficient” to support home care agencies and their workers, Tsai said.

CMS also is offering providers relief from the 80/20 provision by modifying the calculation by which certain expenses are factored into the 80% threshold, expanding the types of services that fit under the 80%, and including optional “hardship exemptions” for smaller providers, the NAHC report said. 

Still, these changes will likely not be enough to mitigate the damage that the 80/20 provision is expected to cause, according to NAHC and other providers.

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