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Major Revisions Made to Home Office Cost Report
The Health Group
The U.S. Centers for Medicare & Medicaid Services has released Home Office Cost Statement, Form CMS-287-22 (“Home Office Cost Report”). R1P248i | CMS
The new Home Office Cost Report (CMS-287-22) is effective for cost reporting periods beginning on or after October 1, 2022, and implements an electronic reporting requirement, which was not previously required.
The Home Office Cost Report, as modified, renames many of the worksheets to be more consistent with other cost report types and incorporates new reporting data.
A home office is an entity that provides centralized management and administrative services to the individual members of a chain organization. A chain organization consists of two (2) or more Medicare-certified providers or at least one (1) provider and any other non-provider business. To the extent that a Home Office furnishes services to a provider, the reasonable costs of such services are included in the provider’s cost report, as determined by the Home Office Cost Report. Home office costs are assigned to all supported activities through direct assignment, functional allocations (based on established statistical basis), or pooled allocations.
The revised cost report, which will be required to be submitted electronically, incorporates Level 1 edits. Failure to correct a Level 1 edit will result in the inability to submit the Home Office Cost Report electronically. If claiming home office costs, a provider must ensure they are submitting an acceptable Home Office Cost Report to the Home Office’s Medicare Administrative Contractor (“MAC”). Also, a copy of the Home Office Cost Report must be sent to each of the MACs for the chain providers. If submitted electronically through the Medicare Cost Report e-Filing (“MCReF”) portal, we expect that all MACs are appropriately notified. If, however, the Home Office Cost Report is filed via CD or flash drive directly with the Home Office’s MAC, a copy of the Home Office Cost Report should be submitted to other provider servicing MACs as an attachment to the provider’s cost report submission and identified as a copy.
Effective for cost reporting periods beginning on or after 10/1/2018, for providers claiming costs on their cost report that are allocated from a home office or chain organization with the same fiscal year end, a cost report will be rejected for lack of supporting documentation if the home office or chain organization has not completed and submitted to the chain provider’s contractor a Home Office Cost Statement that corresponds to the amounts allocated from the home office or chain organization to the provider’s cost report.
We recommend that all providers who submit Home Office Cost Reports review the revised report to ensure that data currently being accumulated is sufficient to meet the future reporting needs. We will report additional information regarding the revised Home Office Cost Report as we further assess the details. |
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Criminal Conviction in “No Poach” Case
It may be tempting for providers to enter so-called “no poaching agreements” due to staffing shortages and a lack of capable managers, including marketing staff, which continue to plague the healthcare industry. These agreements often involve conspiring with rivals not to solicit or hire each other’s employees. Don’t do it!
According to the Department of Justice (DOJ), these agreements may produce artificial suppression of employees’ compensation and may violate the federal Sherman Act. Violations of the Sherman Act could result in criminal prosecution or civil enforcement actions. There has been a dramatic increase in both types of action under the Sherman Act based on “no-poach” agreements.
The Department of Justice (DOJ) has now succeeded in criminal prosecution of this type of arrangement in United States v. Hee et al [Case No. 2:21-cr-00098, D. Nev; (October 27, 2022)]. In this case, the DOJ charged VDA, a health staffing company, and Ryan Hee, a regional manager for VDA, with violation of Section 1 of the Sherman Act by conspiring with another company to refrain from poaching each other’s nurses and to fix their wages. As a result of a guilty plea, VDA was ordered to pay $139,000 as a criminal fine and restitution.
VDA was one of two primary providers of contract nursing services to the Clark County School District from October of 2016 until July of 2017. During this time, VDA participated in a conspiracy with another contract health care staffing company to allocate nurses and fix their wages. The agreement in question lasted for less than nine months, after which VDA was sold.
In addition, VDA has pointed out that the no poach agreement involved only a single telephone conversation and one email message between one of VDA’s employees and a competitor’s employee. This conversation and email message both occurred on the same day six years ago immediately after the Department of Justice (DOJ) published its Antitrust Guidance for HR Professionals.
Based upon the above, it clearly doesn’t take much to produce a criminal conviction in this area. Although this case involved a “no poach” agreement, it certainly signals that the DOJ is serious about antitrust enforcement in general. There are three other labor market criminal cases brought by the DOJ that are still pending. Stay tuned for more developments in this area.
©2022 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author. |
RSV Updates
Healthcare Ready
National pediatric bed capacity is the scarcest it has been in two years, with 71 percent of US pediatric hospital beds reported as filled. Since October 21, hospitals in the following states and localities have seen rising pediatric surge: Rhode Island, Washington, Colorado, Texas, Ohio, Louisiana, New Jersey, Massachusetts, Connecticut, Maryland, Virginia, and Washington, DC. The increase in pediatric hospital admissions is largely due to a rise in respiratory-related illnesses, such as respiratory syncytial virus (RSV), enterovirus, and rhinovirus (RSV being the most critical illness for which children are currently being admitted to the hospital).
We will be producing a respiratory syncytial virus (RSV) situation report weekly for the foreseeable future as RSV has been surging recently within the pediatric community.
Impact to Healthcare
The concurrence of rising RSV cases and preparation for the upcoming flu season is straining pediatric hospitals across the US. Connecticut Children’s Medical Center, Hartford, Connecticut, is working with FEMA to set up medical tents on the hospital lawn because of the increased need for beds.
Children’s hospitals in DC, Virginia, and Baltimore are reporting full capacity of available pediatric beds. Based on the experiences of states that are already impacted by the pediatric respiratory illness surges, current trends indicate a likelihood that more states will be impacted.
Vulnerable Populations
Infants younger than six months, especially those who are premature, are at and especially high risk for contracting RSV and are affected by typical symptoms of this illness. Excessive medical surge caused by RSV and other respiratory diseases may threaten the health outcomes of children, especially infants if the medical surge situation worsens and crisis standards of care are implemented.
Treatments for RSV
Prevention and preparedness will be essential to avoid worsening surge conditions for infants, children, and adolescents. Children and young adults – who are eligible – are encouraged to get flu shots prior to flu season, especially because there is no vaccine for RSV, yet. This will help prevent seasonal cases of the flu and lessen the risk of increased hospitalizations due to other respiratory illnesses. Fewer flu-related hospitalizations will ensure greater bed capacity in pediatric hospitals for the treatment of other illnesses.
A monoclonal antibody therapy called palivizumab is available to prevent severe RSV illness in certain infants and children who are at high risk for severe disease. It cannot cure or treat children who are already suffering from serious cases of RSV; it is a preventative treatment. |
Home Health, Hospice & DME Open Door Forum
Wednesday, November 9, 2022 PM at 12:00 PM-1:00 PM (MT)
Please call at least 15 minutes prior to the forum start time.
- Opening Remarks
- Announcements & Updates
- Update on the CY 2023 Home Health Prospective Payment Rate Update Final Rule
- Home Health QRP Topics
- Rulemaking
- Final OASIS-E Manual & Instrument
- Home Health Quarterly OASIS Q&As
- Public Reporting
- HH QRP
- Hospice QRP
- HQRP Requirements for CY 2023/FY 2025
- Public Reporting
- HOPE
- HQRP New Documents
- HHCAHPS Survey Updates
This call will be Conference Call Only. To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 5109694
Instant Replay: 1-800-396-1242; Conference Passcode: No Passcode Needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1- 800-396-1242, 1 hour after the call has ended. The recording expires November 11, 2022, 11:59 AM ET.
Were you unable to attend the recent Home Health, Hospice & DME ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Home Health, Hospice & DME ODF call. Both the audio and transcript will be posted to: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html. |
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."
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