Home Care Unlimited of El Paso

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Tel. 915.757.1373

1160 Airway Blvd., Ste. B6 El Paso, Texas 79925

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By Home Care Unlimited of El Paso, Mar 3 2014 06:02PM

Medicare Home Health Payments Slashed

An Unprecedented Medicare Cut that Will Endanger Millions of Vulnerable Seniors

CMS Acknowledges “43 Percent” of all Medicare Providers Will Face

Below-Cost Payment Rates by CY 2017


• The Centers for Medicare and Medicaid Services (CMS) released the Home Health Prospective Payment System (HHPPS) Final Rule on Friday, November 22nd. The rule is effective beginning January 1, 2014.

• The Final Rule unnecessarily rebases payment rates at the maximum cut permitted under the Affordable Care Act: a cut of -3.5% per year over each of the next 4 years, totaling an unprecedented cut to Medicare home health funding of 14% by 2017.

• This rule disregards appeals made by hundreds of lawmakers, dozens of stakeholders among beneficiary advocacy organizations (including AARP), and tens of thousands of seniors and caregivers.


• CMS’s rebasing cut directly affects the 3.5 million homebound seniors and persons with permanent disabilities who use home health care annually. These vulnerable citizens are older, sicker, poorer and more likely to be a minority than the typical Medicare beneficiary.

• CMS acknowledges that “approximately 43 percent” of all Medicare home health providers will be paid less than the cost of care by CY 2017.2 No previous Medicare rule has ever had such an impact on nearly half of a health care sector.

• In reality, CMS is actually underestimating the devastating impact of these cuts on providers over the next 4 years. Based on recent cost and revenue trends, it is more realistic to expect that 72.9% of providers will be paid less than their costs by 2017. To reach its projection, CMS must assume that providers can completely absorb the 14% rate cut without any financial consequences, an assumption that is in conflict with actual experience in 2011, 2012, and 2013 when rate cuts significantly reduced Medicare margins.

• Below-cost Medicare payment typically leads to home health agency closure because – unlike other sectors – Medicare Advantage and Medicaid pay even less than Medicare and do not offset Medicare losses.


• The Secretary has the authority1 to revise the rebasing cut to protect seniors’ access to home health:

o Section 1895 of the Social Security Act allows the Secretary to implement a less aggressive approach to rebasing, providing HHS significant discretion and flexibility to consider all relevant factors to ensure continued access to care. The law does not require a 14% cut.

o Section 1871(b)(1) of the Social Security Act empowers the Secretary to dispense with notice and comment rulemaking and modify the HHPPS rebasing adjustment before or after it goes into effect on January 1 in order to serve the public interest.


• CMS did not evaluate or consider the impact on access to care for the over 47 million Medicare beneficiaries who may need home health care.

• CMS did not consider any of the available alternative methods of rate rebasing that would have ensured continued access to care while conforming to its legal obligations.

• CMS disregarded its own current data that shows that as many as 73% of home health agencies cannot withstand rate cuts at the level set in the rule.

• Finally, CMS ignored lawmakers’ request that the impact of rebasing on beneficiaries and small business be fully assessed for the entire 4 years (2014-2017) in which it is to take effect. Specifically, CMS said that a 4-year impact analysis was “neither practicable nor appropriate.”5 And yet, CMS conducted a 4-year impact analysis in the Physician Fee Schedule for CY 20106 – suggesting that such analyses are practicable and appropriate.


Congress must act now to stop this unsustainable payment cut from taking effect on January 1. Congress should:

• Postpone implementation of the rate change to no earlier than January 1, 2015

• Require a re-evaluation of the CMS methodology for rate rebasing taking into consideration all factors relevant to maintaining access to care

• Require a report to Congress on the re-evaluation and any needs for a revised rate rebasing methodology by June 30, 2014.

By Home Care Unlimited of El Paso, Feb 24 2014 05:23PM

Home Health Not Subject to RAC Prepayment Demonstration Edits

February 21, 2014 03:18 PM

The Centers for Medicare and Medicaid Service (CMS) has confirmed that home health agencies will not be subject to the current Recovery Audit Contractor (RAC) prepayment demonstration project. CMS stated the reason there is no prepayment review for home health agencies is “because of our current procurement process for new Recovery Auditor contracts, we have decided to “pause” our Prepayment Review Demonstration. And, because of the timing of the pause, along with the fact that there will be a nationwide Recovery Auditor for home health claim reviews, we decided to remove the edits for home health claims at this time.”

CMS announced a RAC prepayment review demonstration project to begin in September 2012. The prepayment review demonstration was to include all provider types, but initially limited it to hospitals in seven states with high incidences of improper payments and fraud: Florida, California, Michigan, Texas, New York, Louisiana and Illinois and four with high claims volumes of short inpatient hospital stays: Pennsylvania, Ohio, North Carolina, and Missouri.

From what NAHC has gathered, there is no set planfor when other providers would be added.In January, however, CMS posted additional review topics and provider types that would be part of the prepayment review demonstration project in 2014.

Two home health issues were included:

Blepharoplasty - (Inpatient Hospitals, Professional Services & Outpatient Hospitals)

Skilled Nursing Facility and Coding Validation - (Skilled Nursing Facilities)

Trastuzumab (Herceptin), multi-dose vial waste – (Outpatient Hospitals, Professional Services)

Home Health – Medical Necessity & Conditions to Qualify for Services – (Home Health Agencies)

J9310 Rituximab Dose vs. Units Billed – (Outpatient Hospital)

Skilled Nurse Length of Stay – (Home Health Agencies)

National Government Services recently announced that home health would not be subject to the prepayment reviews under the demonstration. Since there had not been an announcement or information shared with the provide community, except a list of addition topics posted on the CMS web site, NAHC sought clarification regarding CMS’ plans to include home health in the RAC prepayment demonstration project.

In addition, the current post-payment RAC activity will soon slow down as CMS proceeds with its procurement process for the next round of Recovery Audit Program contracts.

The following is posted on the CMS RAC website:

“…. It is important that CMS transition down the current contracts so that the Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts. In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program. Several years ago, CMS made substantial changes to improve the Medicare Recovery Audit program. CMS will continue to review and refine the process as necessary. For example, CMS is reviewing the Additional Documentation Request (ADR) limits, timeframes for review and communications between Recovery Auditors and providers. CMS has proven it is committed to constantly improving the program and listening to feedback from providers and other stakeholders. Providers should note the important dates below:

• February 21 is the last day a Recovery Auditor may send a postpayment Additional Documentation Request (ADR)

• February 28 is the last day a MAC may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration

• June 1 is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment.”

By Home Care Unlimited of El Paso, Feb 23 2014 10:17PM

NAHC’s Efforts to Postpone the Employer Mandate Results in More Progress

February 12, 2014 03:09 PM

The Obama administration recently issued an IRS Final Rule that further delays parts of the Affordable Care Act requiring employers to provide health insurance for their workers. Employers that have fewer than 100 full-time workers will have one extra year - until 2016 - before the employer mandate takes effect. Companies that have fewer than 50 workers are already exempt from the requirement to cover their employees.

In response to the most recent delay to the Employer Mandate, NAHC President Val J. Halamandaris commended the Obama Administration for "listening to the pleas of the American public - including the home care and hospice community - who very much want to see all American’s with access to health care."

Under the rule, employers of more than 100 full-time employees will need to cover 70 percent of their full-time employees in 2015 and 95 percent in 2016 or later or face a penalty. Obama administration officials said the change was a response to complaints about the law’s definition of a full-time worker as one who works 30 hours per week, rather than the conventional definition of a 40-hour work week.

NAHC has long endorsed changing the definition of “full-time worker” from 30 hours a week to 40 hours. Legislation to change that definition is pending in both the House and Senate.

For more on NAHC’s position on the full-time definition, please see NAHC Report, October 16, 2013.

NAHC's leadership led efforts to educate lawmakers on the consequences that the Employer Mandate would have on access to home health and hospice services, which helped to lead to an earlier decision in July to delay enforcement of the Employer Mandate and influenced the additional delay set out in this latest rule.

For more on NAHC’s position on the previous delay to the Employer Mandate, please see NAHC Report, July 3,


Analysis by NAHC staff found that the following changes will apply under the new ruling:

Employers with 50-99 full time employees (including FTEs) in 2014 will not be subject to the health insurance obligations or the penalty for failing to offer qualified health insurance in 2015. The penalty will start in 2016.

Employers with 100 or more full-time employees (including FTEs) in 2014 will need to offer 70% of full-time employees a qualified health insurance or face a penalty. The original requirement was set at 95% of the full-time employees. The offer must extend to 95% beginning in 2016.

Employers with 100 or more full time employees (including FTEs) in 2014 are subject to the mandate in 2015. However, the 2015 penalty calculation is based on accepting the first 80 full-time employees instead of the statutory 30 full-time employee exception. The exception will drop to 30 in 2016 unless there is a further change in the law.

In addition to allowing companies with 50 to 100 workers another year to start providing coverage or face a penalty, the administration is allowing companies that have close to 100 workers some discretion in whether they have to comply. Employers can decide whether they had at least 100 full-time employees in the previous year by picking a period of at least six consecutive months, instead of a full year. If companies lay off workers during the year so that they fall below the 100-worker threshold, they are supposed to sign a form saying that the layoffs were not done to avoid offering health coverage to their workers. Otherwise they will face a fine.

The administration has come under some criticism for not waiving the requirements for individuals as they have for companies. The law says that most people have to buy coverage starting this year. However, the administration is not expected to aggressively enforce the individual mandate to buy insurance in the first year.

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