ast week, HCA submitted comments on the recently revised proposed rule by the state Department of Health (DOH) that establishes an Independent Assessor and other changes to Medicaid-covered personal care services (PCS) and consumer directed personal assistance services (CDPAS). Continue reading “HCA Comments on Independent Assessor Proposed Rule “
At the end of December, HCA submitted comments to the U.S. Department of Health and Human Services (HHS) on a Request for Information (RFI) about regulatory flexibility granted during the COVID-19 pandemic. Continue reading “HCA Submits Comments on Federal Regulatory Relief Measures “
HCA Vice President for Finance and Management Patrick Conole has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposed 2021 payment rule for home health. The comments can be downloaded here.
The proposed rule includes updates on a mix of longstanding payment-related programs and structures, but, due to the COVID-19 pandemic, left the existing 2020 Patient-Driven Groupings Model (PDGM) intact.
CMS is expected to finalize the rule, following the comment period, in late October, with the rule going into effect on January 1, 2021.
In comments to the U.S. Centers for Medicare and Medicaid Services (CMS), HCA focused on three principal areas of the proposed hospice rule for fiscal year (FY) 2021: hospice wage index updates and revisions based on new Core-Based Statistical Area (CBSA) designations published by the Office of Management and Budget (OMB) in 2018; CMS’s proposed elimination of the Service Intensity Add-on (SIA) budget neutrality factor; and upcoming changes to the hospice election statement, along with a new addendum requirement.
HCA Vice President for Finance and Management Patrick Conole submitted comments to the U.S. Centers for Medicare and Medicaid Service (CMS) on CMS’s interim rule regarding home care and hospice “regulatory revisions” that have been issued in response to the public health emergency.
In our comments, HCA recognized CMS’s efforts thus far on regulatory relief and waivers, including CMS’s responsive interpretation of the “homebound” status definition in light of COVID-19, new allowances for non-physician practitioners to order home health services, and the modest expansion of remote telecommunications services to help shield against exposure risk and to help augment care.
On this latter area, however, HCA made several recommendations. We noted the recently extended or expanded flexibilities, permissions and payments for telehealth by other practitioners that should be likewise provided broadly to home health and hospice providers whose patients and staff also face infection exposure risks.
Congress is debating another coronavirus aid package, and it is imperative that home care receives vital stabilization funds as part of it.
As reported last week, the U.S. House of Representatives passed a $3 trillion aid bill. It is opposed by U.S. Senate leaders, who are seeking an alternative approach. All forecasts suggest that a new package — however it may look — is not conceivable until sometime in June.
HCA President and CEO Al Cardillo this week wrote a letter to all members of New York’s Congressional Delegation appealing for funds to home care in this upcoming aid package, noting that prior relief measures have yielded billions in support for hospital needs while “home care’s fiscal chasm” in COVID-19 relief “has been substantially unaided by these measures.”
HCA has joined forces with four partner groups representing long term care and managed care organizations on a letter (see here) to the Cuomo Administration calling for Personal Protective Equipment (PPE) distribution and prioritization protocols inclusive of home care. We also sought approval of recommended measures to safely provide care where PPE or staffing are insufficient, such as the enlistment of alternate care providers, voluntary plan-of-care changes, and other flexibilities.
Last week, HCA submitted comments to the state Department of Health (DOH) on its proposed rule that would establish a per member per month (PMPM) payment for administrative services provided by Fiscal Intermediaries (FIs) under the Consumer Directed Personal Assistance Program (CDPAP).
Our comments are at https://hca-nys.org/wp-content/uploads/2020/03/FI-PMPM-Proposed-Rule_FINAL-Comments_022620.pdf. Continue reading “HCA Submits Comments on FI PMPM Proposed Rule”
HCA Vice President for Finance and Management Patrick Conole yesterday sent comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposed 2020 payment rule for home health.
The proposed rule includes updates on a mix of longstanding payment-related programs and structures, alongside the major structural overhaul known as the Patient-Driven Groupings Model (PDGM).
CMS is expected to finalize the rule, following the comment period, in November, with the rule going into effect on January 1, 2020.
Today, HCA and six other prominent health care associations wrote to the state’s Deputy Secretary for Health and Human Services Paul Francis with core recommendations and key amendments that the state should consider in its multi-billion-dollar 1115 Medicaid waiver renewal process. (See the letter here.)
Section 1115 of the Social Security Act gives the U.S. Secretary of Health and Human Services the authority to approve state-level experiments, pilots, or demonstration projects in Medicaid and the Children’s Health Insurance Program (CHIP) programs.
In response to an RFI soliciting public comments on regulatory relief, HCA on Monday provided the U.S. Centers for Medicare and Medicaid Services (CMS) with a set of recommendations to ease home care and hospice regulations.
Our recommendations include such areas as the retrieval of records, use of actual patients (versus pseudo-patients) in aide competency evaluations, coordination of documentation requirements with physicians, and a range of other proposals that, we believe, will align with CMS’s aim to make the health care system more effective, simple and accessible.
At today’s health and Medicaid budget hearing, HCA President Al Cardillo delivered testimony revealing the financing, workforce and overall support needs of the home care, hospice and Managed Long Term Care sector using data from our just-issued financial and trends report.
Rule would limit, deny immigration for those on public assistance, with implications for home care patients and the individuals who support them
HCA today commented on a new federal proposal that would limit or deny permanent legal status to immigrants if they rely on a wide range of government services, such as Medicaid, food assistance, and housing assistance. Our comments seek exemptions of individuals employed or seeking employment as home care or personal care aides. Continue reading “HCA Seeks Home Care Exemption in Federal “Public Charge” Rule Change”
HCA submitted comments last week on a state Department of Labor (DOL) proposed rule that would exclude sleep time and meal periods from compensable hours for an “employee” – not limited to a home care aide – who works on shifts of 24 hours or more.
This proposed rule is similar to a home care-specific emergency rule issued by DOL in October 2017 and renewed numerous times under which DOL codified “the Commissioner’s long-standing and consistent interpretation that compensable hours worked under the state Minimum Wage law do not include meal periods and sleep time of home care aides who work shifts of 24 hours or more.” Continue reading “HCA Submits Comments on State DOL 24-Hour Rule”
Yesterday, HCA submitted extensive written comments on the Fiscal Year (FY) 2019 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting. The proposed rule was posted in April by the U.S. Centers for Medicare and Medicaid Services (CMS) and previously summarized to the HCA membership in our newsletter.
HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) urging CMS to maintain its existing requirement for states, like New York, to submit an access monitoring review plan that holds states accountable on Medicaid access to care.
Under a rule known as the “equal access provision,” states are required to set Medicaid fee-for-service (FFS) rates to ensure access to services for Medicaid beneficiaries at a comparable level to non-Medicaid FFS-insured individuals. To hold states accountable for keeping competitive rates, CMS in 2015 began requiring states to submit an access monitoring review plan (or AMRP) every three years when rate changes occur (among other factors) to fee-for-service entities like Certified Home Health Agencies (CHHAs) and other FFS providers. Continue reading “In Letter to CMS, HCA Opposes Thresholds Exempting States from Having to Submit Monitoring Plans of Medicaid Access”
HCA members serving Buffalo, Rochester and surrounding counties sent a letter this week to Western New York Congressman Chris Collins bolstering his support for legislation (H.R. 1825) to allow non-physician-practitioners (NPPs) to order and refer for home health services.
Rep. Collins is sponsor of this priority bill and has indicated his support to move it forward this Congressional session. The bill has widespread bipartisan co-sponsorship, including from 11 members of the New York House Delegation. Please see the list of House cosponsors here. If Representatives serving your patients are not on this list, please contact their offices to urge their co-sponsorship of H.R. 1825 so that we can keep up momentum on this priority bill. If you need any assistance, please contact HCA’s Communications Director Roger Noyes at email@example.com. Continue reading “WNY HCA Members Write to Rep. Collins on NPP Authorization Bill”
HCA this week voiced support for a proposal to add non-skilled in-home supports as a supplemental benefit under Medicare Advantage (MA).
Our comments — to the U.S. Centers for Medicare and Medicaid Services (CMS) — also include recommendations for implementation of this potentially transformative change. HCA’s comments can be downloaded here.
CMS recently announced the proposal in a notice to MA plans on 2019 payment changes, saying that it intends to expand the scope of the “primarily health related supplemental benefit standard.” Such an expansion would cover services or items that “diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization.”
Yesterday, HCA submitted comments to the state Department of Labor (DOL) and testimony for a state Senate Hearing on DOL’s proposed scheduling/call-in pay rule, which would have major implications for health care providers, especially home care. Our comments are here and our testimony is here.
As described in numrous communications, the rule would impose the following requirements on employers (with certain exceptions):
An employee must be paid an additional two hours of call-in pay if reporting for a shift that was not scheduled 14 days in advance.
An employee whose shift is canceled within 72 hours of the scheduled start time must be paid at least four hours of call-in pay. Continue reading “HCA Submits Comments and Senate Testimony on Proposed Scheduling Rule”
HCA has sent comments to the U.S. Centers for Medicare and Medicaid Services (CMS) urging it to halt a new proposal that would fundamentally overhaul the Medicare home health reimbursement system to the tune of $1 billion in cuts, beginning January 2019, as part of the proposed 2018 Home Health Prospective Payment System Rule. (Our comments are available here.)
This payment system, (called the Home Health Groupings Model, or “HHGM”) is the most drastic reimbursement change affecting the home care sector in decades. Because it is not budget-neutral (which should be a fundamental requirement when modifying any payment system), CMS needs to rescind this policy change and put into place a stakeholder-involved process to make rational and methodical policy changes that will not have dire consequences on America’s home care agencies. Continue reading “HCA Comments on 2018 HHPPS, with Focus on HHGM Payment Cuts”
HCA has written comments in support of an April 3, 2017 proposed rule that would extend the deadline for implementation of the new home health conditions of participation (CoPs).
HCA was among the first associations to formally call for a delay in the new CoPs, which are slated for a July 13 start date. Notably, we gained strong support from New York Congressional Rep. John Faso who wrote to CMS calling for a six-month delay. Within days of Rep. Faso’s letter, CMS issued the April 3 proposed rule to implement the delay, triggering a public comment period to gain stakeholder responses about whether to suspend implementation until January 13, 2018.
The new CoPs are the most sweeping changes to federal home health regulations in 20 years, and HCA has recently held education programs to prepare providers for the rules, which touch on virtually all aspects of an agency’s operations. In seeking a delay, HCA and others stressed the incredibly short timeframe for providers to prepare and the fact that CMS, still, has yet to circulate Interpretive Guidelines that would further outline the enforcement process for these new regulations.
Read our letter of support here: https://hca-nys.org/wp-content/uploads/2017/05/Medicare-CoPs-proposed-rule-delay_comments_final_051117.pdf.
As Congress continues to deliberate on the Republican-led health care plan, HCA late last week sent a letter urging New York’s Congressional Delegation to oppose the bill’s current iteration, with its dramatic proposals to overhaul the Medicaid program.
Our letter joins the growing chorus of hospital and community health groups, insurance representatives, practitioner organizations and consumer groups “who recognize that this bill would deprive citizens of life-saving coverage, recklessly destabilize insurance markets, and create a fiscal crisis for states like New York,” writes HCA President Joanne Cunningham. Continue reading “HCA Calls on Congress to Oppose ACA Repeal and Replacement Bill, With Its Deep Cuts to Medicaid “
The Medicare Payment Advisory Commission (MedPAC) recently voted unanimously to recommend an additional five-percent Medicare payment cut in the next annual rates for home health agencies. The recommendations also call on the U.S. Centers for Medicare and Medicaid Services (CMS) to implement a two-year rebasing of the home health prospective payment system (HHPPS) beginning in 2019.
MedPAC intends to incorporate these recommendations in its Report to Congress in March.
Yesterday, HCA President Joanne Cunningham sent a letter (see here) to MedPAC’s Executive Director, Dr. Mark E. Miller, raising “grave concerns” about MedPAC’s recommendations and the data assumptions underlying them. In the letter, also cc’d to New York’s Members of Congress, she presented some New York-specific home health agency financial findings that vary substantially from MedPAC’s aggregate national data assumptions. Continue reading “HCA President Responds on MedPAC Recommendations to Cut, Rebase Medicare Home Health Rates”
HCA submitted extensive comments this week on the U.S. Centers for Medicare and Medicaid Services proposed rule for the 2017 Home Health Prospective Payment System (HHPPS). You can download the comments here.
The comments address such areas as the continued methodology flaws in CMS’s rebasing of Medicare home health rates, including the incorporation of a “case-mix-creep” adjustment that appears to adjust the rebasing cuts to a level beyond that authorized by Congress. We also seek CMS action to address the lack of a comprehensive impact analysis for rebasing and the failure of rebasing to incorporate all usual and necessary indirect and direct costs in CMS’s analysis. Continue reading “HCA Submits Comments on HHPPS Rule for Medicare Home Health”
While the U.S. Centers for Medicare and Medicaid Services (CMS) has revised the Medicare Prior Authorization of Home Health Services Demonstration to now become a Pre-Claim Review Demonstration, HCA believes the revised Demonstration would still create unnecessary obstacles to care, increase system wide costs, and jeopardize the quality of care that patients receive. Download our July 20, 2016 comments to CMS on the proposal.
This week, HCA submitted extensive written comments on the 2017 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting recently posted by the U.S. Centers for Medicare and Medicaid Services (CMS). You can download the comments here.
One concern addressed in our comments relates to CMS’s Medicare Choice Model (MCCM), where Medicare beneficiaries and dually eligible beneficiaries are able to receive hospice-like support services from certain hospice providers while concurrently receiving services provided by their curative care providers. Continue reading “HCA Comments on 2017 Hospice Proposed Rule”
HCA this week submitted comments in strong support of long-sought proposed changes to the state’s physician order and billing deadlines for home care. Our comments are at https://hca-nys.org/wp-content/uploads/2016/04/DOHsProposal_90DayPhysicianOrderFlexibilit-March28.pdf.
These proposed changes, initiated and drafted by HCA, have been a long time in the making, and HCA this year succeeded in getting the Department of Health to consider these vitally needed changes. The proposal would align the state’s deadlines with the broader timetables allowed under Medicare. The proposed changes were further recommended and advanced by the Home and Community-Base Care Workgroup. They would apply to CHHAs, LHCSAs and LTHHCPs.
As HCA President Joanne Cunningham said in a statement to Crain’s Health Pulse in February, when the proposed rule was posted, “We appreciate the state’s support for a sensible timeline that has worked under Medicare. This proposal ensures that providers and physicians can focus on the initiation or modification of the care itself.” Continue reading “HCA’s Comments Voice Strong Support for Physician Signature, Billing Flexibility Proposal”
HCA this week submitted a strongly worded comment letter opposing a prior authorization demo for Medicare home health services being floated by the U.S. Centers for Medicare and Medicaid Services (CMS).
We are also part of a nationwide effort, in collaboration with partner state associations throughout the country, weighing in jointly on the rule, all calling for the rule to be rescinded. Continue reading “HCA Opposes CMS Prior Authorization Proposal”
HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposal to modify the Medicare Conditions of Participation (CoPs) related to discharge planning requirements for hospitals, critical access hospitals and home health agencies. The proposal was first issued in October.
While HCA supports efforts to revise the CoPs in this area, we commented on several technical and substantive areas of concern, including: CMS’s cost estimates (which fall short of the real impact); implications and possible conflicts with managed care practices; flaws in the publicly reported quality data that hospitals would use for assisting patients in selecting a post-acute provider; the content requirements of discharge summaries; and other issues.
You can download the comments here.
HCA has submitted extensive comments (see here) on the U.S. Centers for Medicare and Medicaid Services (CMS) proposed rule for the 2016 Home Health Prospective Payment System (HHPPS). The comments address such areas as the continued methodology flaws in CMS’s rebasing of Medicare home health rates, including the incorporation of a “case-mix-creep” adjustment that appears to adjust the rebasing cuts to a level beyond that authorized by Congress. We also seek CMS action to address the lack of a comprehensive impact analysis for rebasing and the failure of rebasing to incorporate all usual and necessary indirect and direct costs in CMS’s analysis. The comments also address concerns with the Medicare face-to-face rule, CMS’s value-based payment proposal and several other detailed, technical aspects of the proposal.
HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on a proposed rule that would provide the most significant update to Medicaid managed care rules in more than a decade. The rule covers the delivery of managed long term services and supports (LTSS); quality improvement; program and fiscal integrity; state delivery system reforms; rates to plans; beneficiary experience; and other areas.
HCA’s comments address: the misalignment between federal and state regulations for home care; the need for actuarial soundness of rates by states to managed care plans and rates by plans to home care providers; disenrollment due to home care provider changes; transitions of care; state monitoring requirements; grievances and appeals and aid continuing; provider screening and enrollment; uniform billing; and plan contacts.
HCA has submitted our comments on the 2016 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting recently posted by the U.S. Centers for Medicare and Medicaid Services (CMS). Our comments can be read here.
On the payment side, our comments specifically address several items in the proposed rule, including: revisions to the routine home care rate, the service intensity add-on payment, the inpatient aggregate cap accounting year timeframe, and the wage index which is particularly problematic and in need of revision.
We also provide item-by-item comments on quality reporting elements of the proposed rule, such as the Hospice Quality Reporting Program (HQRP) data submission process and future quality measures; the impact of Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results on 2017 payments (an unfunded mandate in need of reimbursement support); and the reporting of diagnoses on hospice claims.
HCA writes a letter to the Cuomo Administration with comments on a new state budget proposal which seeks to move all health care payments from fee-for-service models to value-based models.
The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed the first new changes to the Medicare home health Conditions of Participation (CoPs) in years. The CoPs haven’t been changed since 1989, and this new set of changes includes sweeping new requirements related to patients rights, quality reporting and other areas affecting the operation of most home care agencies.
HCA comments on the proposed 2015 home health prospective payment system rule which establishes the Medicare home health payment and regulatory policy for 2015. The proposed rule extends the cuts previously enacted under the federal “rebasing” regimen and makes some changes to the Medicare home health physician face-to-face rule documentation requirements.
HCA requests an extended comment period that would provide more time for the industry to vet CMS’s proposed rule revising the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies. The current December 8, 2014 comment deadline does not offer adequate time to obtain crucial feedback from the home health agency members in the field, who have been operating under the existing home health CoPs since 1989.
HCA and LeadingAge New York write to the state’s Medicaid Director regarding Safety Net concerns in the Delivery Reform Incentive Payment (DSRIP) program, as well as some recommendations regarding the attribution methodology whereby patients are assigned to DSRIP networks.
HCA writes to the Governor in support of A.6530-B (Cusick)/S.4719-B (Lanza), which passed both houses of the Legislature. The legislation will help ensure vital access to care for home health and hospice patients during emergencies, as well as support the overall operation of the health system in responding to disasters.