Home Health Final Rule Creates Cloud Over NAHC Annual Conference

HomeCare News

ST. LOUIS (October 25, 2022)—As the National Association for Home Care & Hospice’s (NAHC) Annual Convention and Expo concluded today in St. Louis, Missouri, one issue loomed over the attendees: What will happen with the federal government's home health final payment rule, which must be released no later than Nov. 2? 

“We have people checking the Federal Register every day at 4:15 Eastern,” said NAHC President Bill Dombi in his address to the conference, which was attended by almost 3,000 people in the home health, personal care and hospice  industry.

“You have a range of action,” Dombi told HomeCare, “from where the rule doesn’t change, and you have the 7.69% cut and whatever inflation adjustments … The other extreme is where [CMS] begs forgiveness for the big mistake they made.” 

Find a summary of the proposed rule here.

NAHC holds the position that home health providers have been chronically underpaid; however, CMS applied the payment adjustment in the proposed rule because it believes providers have been overpaid due to behavioral changes under the Patient Driven Groupings Model.

Dombi said he expects to see some cuts, but providers could also see a higher inflation adjustment, which would result in a flat payment rate. CMS has also floated the idea of phasing in the payment cut, Dombi said, but the association and industry rejected that proposal, citing that even phased in cuts would harm patient care.

“Do you want to die now or die next year?” he said. 

A NAHC study of the industry found that 44% to 51% of home health business would operate in the red in 2023 if the cuts go through as proposed.

On the positive side, Dombi said that advocacy surrounding the rule is the most intense he’s seen in his lifetime. Industry allies in Congress have stepped up, as well, he said. 

"In four months, NAHC members have sent 60,000 emails, tweets, phone calls, etc.," Summer Napier, NAHC director of grassroots advocacy, said in a separate address. "This is more than double the next highest action alert. We've also gained 16,000 additional advocates" from across the spectrum of care—including patients and family members of NAHC members.

"We don't know what the final rule will hold," Napier added. "But, we want you to know your efforts have not been in vain."

Read Full Article

Temporary Administrative Approvals for PDN PARs Through Dec. 31, 2022

This message is for members who receive Private Duty Nursing (PDN) benefits, and their families. The Department heard concerns regarding the PDN Prior Authorization Request (PAR) process. Our shared goal is to ensure Colorado has programs that provide people with access to the services they need, which is especially important for those with complex healthcare needs. We continuously evaluate how to best balance our responsibility to ensure our members have timely access to care and our federal responsibility to demonstrate all authorized services are medically necessary at the level approved. We take your feedback seriously.

We are reaching out to you to let you know the Department is initiating a Temporary Administrative Approval Process (through Dec. 31, 2022) on all PDN PARs. This means that if you received a full or partial denial for Private Duty Nursing services it will be approved as requested until Dec. 31, 2022. Any new PARs will also be approved through Dec. 31, 2022. This will give us time to work with your providers so they can submit all the needed documentation to ensure the right level of care is approved in a timely manner. You do not need to take any action; however, during this time your provider will be required to submit PARs and all supporting documentation. Your provider may reach out to you for additional information or documentation from your physician. We will be sending formal notices with this information over the coming weeks.

We also heard feedback that our notices can be confusing. In response, we will be working to improve those notices over the coming months. We will also be working on additional educational materials to help you understand what to expect in the prior authorization process, your appeal rights, the option to continue services during an appeal, and what benefits may be available.

This Temporary Administrative Approval process will allow us time to conduct outreach to families, work with our providers to ensure they understand prior authorization, documentation, as well as continuation of benefits requirements, and update our notices to ensure greater clarity.
If you have questions about the PDN benefit or the prior authorization process, you may reach out to the Department at [email protected].

Medicaid Denials for Colorado Children with Severe Disabilities Set Off “Sheer Panic” Among Parents 

The Colorado Sun | By Jennifer Brown

Parents of children with medical needs so severe they need round-the-clock nursing care at home are in “sheer panic” as the state Medicaid program notified them this fall that their services have been denied or reduced. 

At least 20 families have hired legal counsel to fight the denials and about 150 people attended a Medicaid children with disabilities meeting to discuss the denial letters, which were received during the past few weeks. 

Two days before a planned family news conference at the state Capitol, officials from the state Medicaid division Wednesday offered a temporary fix. The Colorado Department of Health Care Policy and Financing — which includes the Medicaid program for people with low incomes or disabilities — announced a 60-day reprieve on pending denials. 

But for families, it’s not enough. They want a permanent solution to an injustice they say the state should have fixed months ago. 

Family has 7 medically fragile children

Several parents gave emotional testimony this month during a medical services board meeting, a governor-appointed, rule-making group for the state department. Board members, after hearing parents speak, strongly urged the department to remedy the issue immediately. 

Katerina and Brad Evers, both nurses, have seven adopted children, all with severe medical needs — feeding tubes, oxygen machines, wheelchairs and 150 prescription medicines among them. The kids, ages 2-16, were all living at Children’s Hospital Colorado with no family capable of taking care of them. 

All have had 24/7 nursing services approved by Medicaid, a requirement of the hospital when each was discharged. But in the past few weeks, the Everses were notified that three of the children’s Medicaid services were cut in half, to 10 or 12 hours per day. They are expecting a similar reduction in services for two other kids with similar medical issues. 

“We are scared to death No. 1 because we don’t know what is going to happen to these children,” Brad Evers told the medical services board. “This is barbaric. This can’t happen this way. They were in the hospital and they didn’t have a mom or a dad.

“They were born broken, and now you are going to break them more because you want to stop some services? They get to call somebody a mom and a dad, and you want to cut hours?”

The family is able to function because the kids’ Medicaid services have paid four daytime nurses and Katerina and Brad to care for them at night, Katerina told The Colorado Sun. The children go to various schools, and some need a nurse with them at school all day. Katerina and Brad try to sleep some during the day, but also take children to doctor’s appointments. 

Read Full Article 

Fixing the ‘Toxic’ Home Health-Medicare Advantage Relationship

Home Health Care News | By Andrew Donlan

The home health industry’s battle with Medicare Advantage (MA) plans for fair rates has gone from a few stakeholders saying “the quiet part out loud” earlier this year to nearly every major provider in the country talking about the issue with regularity.

My colleagues and I have covered the topic extensively. But we’ve moved beyond the question of how providers feel about MA rates for home health and moved onto the next: How can the problem be solved?

Taking a step back, here are a few of the certainties we know:

• All signs point to MA being the dominant insurer type among Medicare beneficiaries by the end of the decade.
• MA pays far lower rates for home health services compared to fee for service (FFS). Encompass Health Corporation (NYSE: EHC) said this week that MA rates are at a 40% “discount” compared to FFS. Intrepid USA Healthcare Services confirmed that number was about in line with its experience – and even suggested the rates were sometimes lower than that.
• Two companies with significant market share in MA – Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH) – have already – or are in the process of – acquiring two of the largest home health providers in the country in Kindred at Home and LHC Group Inc. (Nasdaq: LHCG), respectively.
• Some have described MA as the federal government’s “darling.” But the Office of Inspector General (OIG) recently published a report condemning MA organizations for limiting beneficiaries’ access to necessary care and denying payments to providers for services that are covered under Medicare and MA billing rules.

“It’s been a challenge because, not only is the rate lower, but the processing of the claims is 6 to 8 times harder for your back office revenue cycle,” Intrepid USA CEO John Kunysz told me. “They just put in so many hurdles.”

Based in Texas, Intrepid USA providers home health and hospice services, with over 60 locations spanning across 17 states.

In this week’s exclusive, members-only HHCN+ Update, I explore the tumultuous relationship between the home health industry and MA, and also try to highlight some potential solutions for the road ahead.