In The News

File Self-Determined CAP Report by February 28, 2023

Hospices can complete and submit their self-determined CAP Report between now and February 28, 2023. Each Medicare Administrative Contractor (MAC) has specific instructions on the completion of the report. Hospices should obtain their Provider Statistical and Reimbursement (PS&R) summary and Hospice Cap reports from the CMS Website to complete the report. Begin this process early to better plan for any potential liabilities. For more information, review the Regulatory & Compliance Center Billing & Reimbursement page.


Provider Coalition Seeks Flexibility in Proposed DOL Contract Worker Rule

McKnight’s Home Care | By Diane Eastabrook
A coalition of 17 provider organizations is urging the Department of Labor to consider the needs of the healthcare industry under a proposed rule aimed at cracking down on the misclassification of contract workers.
In a letter sent last month to DOL Secretary Marty Walsh, the groups — including the American Medical Association, the National Rural Health Association and American Association of Nurse Practitioners — argued that the rule modifying the employee or independent contractor classification under the Fair Labor Standards Act could exacerbate the worker shortage in healthcare. 
The organizations said the COVID-19 pandemic had increased demand for physicians, nurses and nurse practitioners, requiring providers to rely more heavily on contract workers to fill care gaps. 
“It is critical that the proposed rule ensure appropriate flexibility within the health care workforce so providers can continue to meet the health care needs of their communities,” the letter stated. 
The proposed rule will focus on whether a worker is economically dependent upon the entity sourcing the client for work or if the worker is, in fact, in business for themselves, according to home care attorney Angelo Spinola from Polsinelli Law. Spinola told McKnight’s Home Care Daily Pulse the proposed rule will negatively affect many healthcare providers, including home care agencies.
“It is common for providers to utilize contract labor, and the DOL’s proposed modifications will make it more likely for these contractors to be deemed as misclassified,” Spinola said. “This impacts consumer-directed models, nurse registries, home health providers who supplement the workforce with contract labor, staffing arrangements and a variety of other healthcare models. We have seen an uptick in DOL investigations surrounding contract labor and anticipate this trend will continue and create more challenges for any business utilizing contract labor if the new standard is adopted.”
The DOL announced the proposed rule last October, saying it would provide providers better guidance and help them avoid misclassifying employees. The department singled out home care as one of a dozen industries in which worker misclassification has been a problem.
“Misclassification deprives workers of their federal labor protections, including their right to be paid their full, legally earned wages,” Walsh said at the time. “The Department of Labor remains committed to addressing the issue of misclassification.

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Rate of Beneficiaries Switching From Traditional Medicare to Medicare Advantage Is Growing 

MedCity News | Marissa Plescia
More beneficiaries are switching to Medicare Advantage plans from traditional Medicare plans, partially leading to higher enrollment in Medicare Advantage (MA), new research shows.
This is a reversal from several years ago, the study published in JAMA Health Forum found. From 2015 to 2016, the switching rate from MA to traditional Medicare was 4.6%, compared to 4.1% for traditional Medicare to MA. This shifted during the 2016 to 2017 period, when the switching rate from MA to traditional Medicare was 3.7%, and 5.3% for traditional Medicare to MA. The gap became wider as years went on: in the 2019 to 2020 period, the switching rate from MA to traditional Medicare was 2%, compared to 6.8% the other way around.
The researchers, from KNG Health Consulting, relied on the 2014 to 2020 Master Beneficiary Summary File Limited Data Sets from the Centers for Medicare & Medicaid Services to conduct the study. They examined switching by demographic groups, Medicare-Medicaid enrollment status and mortality status.
MA enrollment has grown drastically in the last several years, accounting for 46% of the overall Medicare population in 2021, compared to 19% in 2007. In 2023, it is expected to cross the 50% threshold, the report stated. This increase is both because of more traditional Medicare beneficiaries switching to MA plans and new enrollees choosing MA plans, according to the report.
“Medicare switching behavior has changed over time, with switching into MA accounting for a larger portion of MA enrollment growth,” the researchers wrote.
Differences in switching rates were higher when broken out by dual-eligibility status, the researchers found. In the 2019 to 2020 period, MA to traditional Medicare was 1.6%, compared to 6.1% the other way around. For Medicare-Medicaid beneficiaries, the switching rate was 4.5% for MA to traditional Medicare and 11.2% for traditional to MA.

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Home Health Providers Believe They Can Be The ‘Quarterback’ For Behavioral Health Needs

Home Health Care News | By Patrick Filbin
As in-home care providers look to use a more integrated approach to care, it’s critical to some that mental and behavioral health is part of the equation.
Despite the added costs that come with offering those services, the need to care for patients with those ailments is undeniable.
“Typically, these folks are 10 to 15 times more costly than a patient without behavioral health need experience,” Joe Cramer, president of hospice and behavioral health at Elara Caring, said during Aging Media Network’s Continuum event in December. “We’re looking at how to partner with primary care or psychiatric providers to do a total cost of care from either an episodic perspective, or a full total cost of care perspective, where we are essentially the quarterback of their care.”
Elara Caring is a Texas-based home health, hospice, personal care, palliative care and behavioral health provider. It has a 16-state footprint and does about 100,000 in-home visits for patients with serious mental illness or substance use disorder per year.
Prior to the pandemic, Elara Caring provided behavioral health services in two states. It now does so in nine states, and has been able to do so by training its psychiatric nurses on how to properly care for patients with specific needs.
Recently, Elara Caring developed a program called “Embrace,” which aims to help its members who have experienced loss. That loss could be of a loved one, their independence or their home, Cramer explained.
Patients can access the program at home, which could be a skilled nursing facility (SNF), senior living facility or a private residence.
“Roughly 50% of individuals going into senior living or a SNF have elevated anxiety or depression,” Cramer said. “Our nurses are really trained in supporting their behavioral health diagnosis.”
Senior care providers sometimes focus on the medical and think of behavioral treatment as secondary. However, Elara Caring’s approach is symbolic of a larger movement in senior care where the two kinds of care can be addressed under one umbrella.
“With Elara, we focus on the behavioral with the medical conditions there,” Cramer said. “We’re looking at what’s causing the anxiety or depression, if they have that, and what kind of loss they’re dealing with to really support them.”
Embrace, Cramer said, has reported a 78% reduction or stabilization of a patient’s anxiety or depression and 33% reduction in patients being admitted into facilities rather than the places they call home.
Payers and insurers are also involved heavily in this movement.

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Now Available: Telehealth Indicator for Doctors and Clinicians on Care Compare

The Centers for Medicare & Medicaid Services (CMS) added a new telehealth indicator on clinician profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC). The new indicator helps beneficiaries and caregivers more easily find clinicians who provide telehealth services.

Telemedicine services expanded in response to the COVID-19 public health emergency to improve patients’ access to care. Last year, CMS reported a 30-fold increase in telehealth services, with more than half of Medicare beneficiaries utilizing them between March 1, 2020 and February 28, 2021. The telehealth indicator is the latest example of CMS’s efforts to ensure Care Compare provides beneficiaries and caregivers meaningful information about services they value as they search for clinicians.

For more information, access the Telehealth Indicator on Medicare Care Compare fact sheet.

If you have any questions about the telehealth indicator or public reporting for doctors and clinicians on Care Compare, contact the QPP Service Center at 1-866-288-8292 (Monday-Friday 8 a.m. - 8 p.m. ET) or by e-mail at [email protected]. To receive assistance more quickly, consider calling during non-peak hours (before 10 a.m. and after 2 p.m. ET). Customers who are hard of hearing can dial 711 to be connected to a TRS Communications Assistant.  

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