Presentation Transcript

1. Ohio Council State of the Union Federal Round Up

   Deborah Randall, JD law@deborahrandallconsulting.com www.deborahrandallconsulting.com
2. Home Health Reimbursement Affordable Care Act calls for re-basing in 2014 CMS still in internal discussions On-going national audit of cost reports [200+] Problems of costs not included in 2010 cost reports, for example Face to Face [F2F] Because of wide range in the margins of average cost or average cost plus, ? 50% HHAs at risk
3. Home Health Reimbursement New Case-Mix Adjustment: MedPac approach. Contracted to Urban Institute but ?? Stalled The Talk: Therapy utilization no longer in the mix; Service utilization domain taken out? If dropped to an averaging, would nearly 65% of providers be below margin Responding to Proposed Rule:Full case-mix adjustment delayed due to “burdens” on HHA
4. HHA Survey Changes & Sanctions Contained in Home Health Final Rule on July 13, 2012 as a Proposed New Rule Long-discussed but now once again proposed intermediate sanctions, as exist for nursing homes under their COPs. Fines, temporary stewardship of the provider agency and other penalties Unannounced standard and extended surveys
5. Hospice Reimbursement Developments MEDPAC & CMS – the work is on-going ADR probes from all but NGS? The PEPPER Reports have just come out and indicate to hospices how they compare in state, regionally and nationally www.PEPPERresources.org
6. Wage Index NHPCO is analyzing how raw data from hospital cost reports gets to hospice annual wage index Important as it relates to rate cuts for which lobbyists are working hard on
7. Hospice ADRs 100 ADRs across the universe; random selection from CGS Provider to receive a letter – but some have not 20-30+ records >100 in Colorado; primarily technical denials Questions of how MAC can actually do these reviews “We commit” Palmetto took 9mos
8. ADRs “We are recommending legal counsel. Do not talk to us” – Scary Contracting is NOT allowed on a routine basis for after hours core services for crisis care. Continuous care and “crisis care” are not the same. Telephone answering service versus counseling on care. CMS has had a nation-wide telephone call with enforcement agencies on this subject.
9. Adding All Diagnoses to Claim Regulation added requirement to the hospice COPs plan of Care in 2006. CMS Manual requires on the Medicare Claim. Secondary v. Co-morbid CMS is looking at U shaped curve but.....case-mixed also? So these data are important OIG Report on Medicare Part D error in paying for drugs which are related to terminal illness [and hospice is/should be paying for]
10. Hospitals Need Home Care [Again] Centers for Medicare & Medicaid Services data: >2,000 hospitals will be penalized October 1 2012 for readmissions of 2 million Medicare beneficiaries within 30 days of discharge >$17.5 billion in hospital costs/yr. 278 (8.3 percent) hospitals forfeiting 1 % max of base Medicare reimbursements 1,933 (57 percent) hospitals to receive <1% penalty of their Medicare base reimbursements.
11. Expanding Care to the Home Behavioral Health Work of the Veterans’ Administration Medicaid reimbursement for telehealth Independence at Home projects underway Telehealth Telemonitoring reimbursement by private 3d pty Telerehabilitation Hospitals: Avoiding the 30 day rehospitalization
12. Other Models Beacon Grant programs beginning to report out on managing chronic illness. Findings in Indiana based on telehealth remote monitoring without traditional home health Independence at Home Entities have been selected. 16 enterprises will be the initial programs. Community Care Transitions Programs CCTP
13. Health Reform Programs Southwest Ohio Community Care Transitions Collaborative w Ky and Ind http://www.innovations.cms.gov/initiatives/Partnership-for-Patients/CCTP/CCTP-Round-3.htmlServing the Cincinnati Metropolitan Statistical Area and surrounding counties in Kentucky, Indiana, and Ohio, including the Council on Aging of Southwestern Ohio, the Greater Cincinnati Health Council, HealthBridge, Health Care Access Now, Healthcare Improvement Collaborative, Hamilton County Mental Health and Recovery Services Board, Clinton Memorial Hospital, Jewish Hospital, Mercy Hospital Fairfield, The Christ Hospital, and UC Health University Hospital.
14. Regulatory Sparring Aftermath of Face to Face for both home health and hospice Documentation concerns Multiple physicians or NPs Insufficient narratives Gaps before the 3d certification period F2F
15. Intensifying Fraud Reviews ZPIC Cases Hospice United States v. Goldman, E.D. Pa., No. 12-cr-305-ER, indictment unsealed 8/2/12). Eugene (Yevgeniy) Goldman, the medical director for Home Care Hospice Inc. Paid $100/hr, masking over $250,000 paid to him for referrals. Odyssey – continuous care cases Kolodesh and AsaraCare–alleged improper marketing US v Hospice of the Comforter- Non-terminal admissions; “Friends of Bob” allegedly were admitted without need
16. Intensifying Fraud Reviews Home Care Dual Eligibles Personal Care Broker Relationships
17. Looking at Nursing Facilities For failure to collect Medicaid spend-down For billing when a patient is already on hospice services For errors in Part D billing of drugs apparently related to the terminal illness But Not: for limiting patient right of choice by limiting number of hospices permitted to serve on the premises
18. Telehealth & Palliative Care Vision of patient-centered chronic disease Improved confidence, decreased isolation and depression, averting ER and hospitalization runs, using modern technology to expand access, IDT integration and care planning Partnering with palliation specialists Quality of end of life, reduction in suffering Meeting our new generation of patients
19. Contact Information Deborah Randall JD www.deborahrandallconsulting.com 202-257-7073 law@deborahrandallconsulting.com