In The News

Late Alarm  – Pending Hospice Aggregate Cut?

As Congress prepares its end-of-year omnibus package, HHAU has learned that a cut to the hospice aggregate cap is being considered in a list of possible “pay-for” items for year-end policies that they would like to enact.

NHPCO, NAHC and LeadingAge sent a letter to Congress last week, outlining issues that will occur if a cut is approved. Despite efforts, the National Partnership for Healthcare and Hospice Innovation (NPHI) told the group that they could not sign onto a letter opposing a cap cut.

A key part of the join letter states:

“While over 50 percent of beneficiaries have hospice stays that are a total of 18 days or less, the number of patients with much longer lengths of stay has increased in recent years. This is in part a result of the changing nature of the population choosing hospice, many more people with non-cancer diagnoses are choosing to utilize the MHB. To this end, MedPAC in 2020 first put forward their recommendation to wage-adjust and reduce the hospice aggregate payment cap by 20 percent across-the-board. However, enacting this change now will have the impact of pushing patients with long length of stay, especially patients with Alzheimer’s Disease and related dementias, out of the hospice care they need.

“On top of this most recent threat to the hospice benefit, Congress has also taken action in recent years to reduce hospice spending through policy that lowers the aggregate cap. In the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), Congress changed the methodology for how the aggregate cap is calculated each year. That methodology change has been extended twice now and accrued savings. Should this change be extended, we would ask that the savings it generates be used to fund additional targeted hospice program integrity efforts that will hone in on truly abusive behavior while not punishing the vast majority of high-quality providers.”

Even More Stormy Seas for Hospice

A few weeks ago, NAHC and NHPCO became aware of a ProPublica reporter who is working with the New Yorker on an article about fraud in hospice that is expected to be published in the near-term. The story was initially believed to focus on known issues in California, Texas, Nevada, and Arizona. However, it now appears that the scope of the story will be much wider than previously thought, and may also address hospice margins, dynamics between for-profits and non-profits, long lengths of stay, provision of insufficient care, false claims act suits, the hospice cap and more. With a potential cap cut pending, the timing of this story couldn’t be worse.

The four national hospice associations have written a letter to CMS Administrator Brooks-LaSure requesting a meeting and urging that the agency take action to address the proliferation of hospice agencies in a handful of states through the imposition of targeted moratoria and other actions rather than a blanket response across the nation.

See NHPCO’s Hospice Action Network Action alert and share with our representatives. Agencies may also consider responding to any misrepresentations in the pending news article with letters to the Editor. While cap cuts have successfully been averted in the past, the effort is becoming more difficult each year.

 

Healthcare Workers Recruitment and Re-engagement Fund

A Request for Applications (RFA) is used to award grants to promote specific program goals. An organization (in this case, the Colorado Department of Public Health and Environment) announces that grant funding is available, and eligible organizations may apply for it. The purpose of this CDPHE RFA is to incentivize and assist employers in the recruitment of different licensed healthcare professionals to employment in long-term care facilities (LTCF), facilities with a Healthcare Professional Shortage Area Designation, and pediatric-serving hospitals. If a facility successfully recruits a licensed professional who has left the healthcare industry and will work 20 hours per week or more on average for a minimum of six months, the facility is eligible to receive a one-time payment of $20,000 per professional re-engaged.

Eligibility

Organizations that may apply for funding must meet the following criteria:

Operate as a long-term care facility, meaning it is a nursing home, nursing facility, skilled nursing facility, intermediate care facility, or a health facility that is planned, organized, operated, and maintained to provide supportive, restorative, and preventative services to persons who, due to physical and/or mental disability, require continuous or regular inpatient care.

Hold an official federal designation as a Health Professional Shortage Area (HPSAs) may also apply. 

Hospitals that serve the pediatric population.

In order to receive grant funding, a facility that is eligible based on the above criteria must hire a healthcare professional who is not currently working, but has an active license or reinstates their license and will work for the facility an average of 20 hours per week. The healthcare professional must attest that they will work for the facility a minimum of six months and that they have previously left the healthcare industry for a minimum of six months.

The Healthcare Workforce Recruitment and Re-engagement Fund incentivizes creative retention ideas. These may include signing bonuses, child care and transportation stipends, tuition reimbursements, and employee health and wellness programs. A full list of suggestions can be found in our Allowables Roadmap

This program has $10,000,000 available for this RFA, and CDPHE anticipates awarding grants until the funds are exhausted. No facility will be eligible to receive more than $240,000 in total. Each contract will be effective upon approval by the State Controller through June 30, 2025. All aspects of the project are dependent upon funding availability.

Learn more at https://cdphe.colorado.gov/healthcare-workers-recruitment-reengagement-fund

 

Tracking the Public Health Emergency - When Will it Ever End?

The Biden-Harris administration has indicated that it will not issue a 60-day notice to end the COVID-19 public health emergency (PHE) on January 11, 2023, meaning that we can now expect the PHE to be extended for another 90 days through April 11, 2023.

Energy and Commerce Republican Leader Cathy McMorris Rodgers (R-WA) and Health Subcommittee Republican Leader Brett Guthrie (R-KY) have repeatedly called on the Biden Administration to provide a detailed plan to unwind the COVID-19 emergency. Additionally, The National Association of Medicaid Directors (NAMD) sent a letter to Senate Majority Leader Chuck Schumer (D-NY), Senate Minority Leader Mitch McConnell (R-KY), Speaker Nancy Pelosi (D-CA), and House Minority Leader Kevin McCarthy (R-CA) urging Congress to provide states with certainty around the end of the Medicaid continuous enrollment requirement. Specifically, NAMD asked lawmakers to:

Provide certainty on when Medicaid coverage redeterminations will begin, with at least 120 days’ advance notice.

Provide certainty that existing federal guidance on the redetermination period will not change.

Provide certainty on available financial resources during the redetermination period, specifically by maintaining the current 6.2 percentage point FMAP enhancement through the first quarter of redeterminations and phasing the enhancement down over 12 months after this quarter.

Provide certainty that underlying Medicaid eligibility will not change during the redetermination period.

The Senate passed a resolution to end the national emergency declaration, which has been renewed annually since former President Trump issued the declaration pursuant to the National Emergencies Act and is different than the COVID-19 PHE.  The resolution was advanced by a bipartisan vote of 62-36.  In response, the White House Office of Management and Budget (OMB) issued a statement affirming that President Biden would veto efforts to end the national emergency. The current national emergency declaration is set to expire on March 1, 2023. Until it’s conclusion, the declaration allows the President to waive various federal regulatory requirements and activate a variety of statutory emergency authorities.  ‘

 

New Boosters Add Limited Protection Against Covid-19 Illness, First Real-World Study Shows

By Brenda Goodman, CNN

Updated Covid-19 boosters that carry instructions to arm the body against currently circulating Omicron subvariants offer some protection against infections, according to the first study to look at how the boosters are performing in the real world. However, the protection is not as high as that provided by the original vaccine against earlier coronavirus variants, the researchers say.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the new data “really quite good.”

“Please, for your own safety, for that of your family, get your updated Covid-19 shot as soon as you’re eligible to protect yourself, your family and your community,” Fauci said at a White House briefing Tuesday.

Uptake of the bivalent boosters, which protect against the BA.4/5 subvariants as well as the original virus strain, has been remarkably slow. Only 11% of eligible Americans have gotten them since they became available in early September.

The new study found that the updated boosters work about like the original boosters. They protect against symptomatic infection in the range of 40% to 60%, meaning that even when vaccine protection is its most potent, about a month after getting the shot, people may still be vulnerable to breakthrough infections.

That’s in about the same range as typical efficacy for flu vaccines. Over the past 10 years, CDC data shows, the effectiveness of the seasonal flu vaccines has ranged from a low of 19% to a high of around 52% against needing to see a doctor because of the flu. The effectiveness varies depending on how similar the strains in the vaccine are to the strains that end up making people sick.

The authors of the new study say people should realize that the Covid-19 vaccines are no longer more than 90% protective against symptomatic infections, as they were when they were first introduced in 2020.

“Unfortunately, the 90% to 100% protection was what we saw during like pre-Delta time. And so with Delta, we saw it drop into the 70% range, and then for Omicron, we saw it drop even lower, to the 50% range. And so I think what we’re seeing here is that the bivalent vaccine really brings you back to that sort of effectiveness that we would have seen immediately after past boosters, which is great. That’s where we want it to get,” said Dr. Ruth Link-Gelles, an epidemiologist at the US Centers for Disease Control and Prevention.

Read Full Article

 

CMS Updates Medicare Enrollment Instructions

The Health Group

Effective December 5, 2022, certain modifications have been made to Chapter 10 of the Medicare Program Integrity Manual dealing primarily with “Ownership Disclosures”, “Electronic Funds Transfers”, and “Special Payment Addresses”. MM12880 - Provider Enrollment Instructions: Seventh General Update (cms.gov).

Ownership Disclosures:

The provider or supplier must disclose ALL persons and entities that meet the definition of “owner”.

Providers must show the applicable ownership percentage for each owner if required by the specific provider enrollment application being completed.

There cannot be indirect owners without direct owners.

The combined disclosed ownership percentages for the provider or supplier’s organizational and individual owners cannot be greater than 100%.

 
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