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NY, PA Home Care Associations and State Colleagues Gather in D.C. Targeting Medicare Home Health Cuts, Onerous Mandates

Gathering is part of the first-ever state home care association-led Public Policy Summit and Capitol Hill Advocacy Day on July 12-13

For immediate release: July 12, 2016


HCA Communications Director Roger Noyes: (518) 275-6961 (cell); (518) 810-0665 (office)

PHA Chief Operating Officer Jennifer Haggerty: (570) 510-5731 (cell); (717) 975-9448, ext. 22 (office) 

WASHINGTON, D.C. – State home care associations from around the nation, including New York and Pennsylvania, are converging on Washington, D.C. this week (July 12 and 13) for the first-ever Public Policy Summit and Capitol Hill Advocacy Day.

The program is sponsored by the Council of State Home Care Associations. It includes policy discussions, presentations from federal bureaus on regulatory and payment issues, insights from D.C. political insiders, and advocacy visits with lawmakers.

The home care associations representing New York State and Pennsylvania are among the leading participants. Executives from the associations have outlined a robust federal advocacy agenda for the Council, its member associations, and individual home care agencies attending.

“July is a perfect time for state home care associations and their members to get the attention of lawmakers and federal officials on core payment and regulatory issues,” said Vicki Hoak, Chief Executive Officer of the Pennsylvania Homecare Association (PHA) and chair of the Council of State Home Care Associations, which collectively includes 37 constituent state associations representing home health care providers in their regions. “This first-ever summit brings hundreds of provider representatives to Washington, along with the leadership of their state home care associations, for a collective voice and problem-solving.”

In visits with lawmakers, the Council and member associations will be focusing on top-tier Medicare home health issues. This includes: relief from Medicare home health “rebasing” cuts; the onerous physician face-to-face mandate for authorization of home care services; other payment issues, like the recently proposed pre-claim review rule; and the need for Congress to continue opposing copayments for home health beneficiaries. (A series of briefing papers on these issues are available on the New York and Pennsylvania home care associations’ websites. Click here for NY. Click here for PA.)

“New York’s home care system is in a uniquely precarious state,” said Home Care Association of New York State (HCA) President Joanne Cunningham. “While the federal government seeks to normalize Medicare margins through a series of rebasing cuts, we have legitimate objections to the methods and data samples used to justify such deep payment reductions.”

As part of its proposed Home Health Prospective Payment System (HHPPS) rule, the U.S. Centers for Medicare and Medicaid Services (CMS) is calling for another round of so-called “rebasing” cuts: $180 million in 2017. This follows $700 million in total cuts since 2014.

“Rebasing” is a process of resetting the home care rates. In theory, it is designed to normalize Medicare home health margins, so that reimbursement – on average nationwide – is substantially devoted to services and other costs directed to beneficiaries, meaning that operating margins are kept close to zero. However, HCA, PHA and other associations contend that CMS has used outdated and selective data to justify implementing the largest “rebasing” cuts allowed by law in each of the past three years (3.5 percent), with the fourth round of 3.5-percent rebasing cuts proposed for 2017.

“In New York State, 70 percent of Medicare-certified home health agencies are operating in the red according to our own data analysis,” Cunningham said. “For Medicare payments exclusively, New York agencies are shouldering double-digit losses, including an average negative operating margin of 16 percent.”

Hoak added: “CMS aims to normalize the financial profile of home care, but its data assumptions are fundamentally flawed, and its approach to rate rebasing overlooks the fact that states like Pennsylvania and New York are disproportionately impacted.”

She added: “CMS applies its cuts across the board nationally, with some minimal recognition of unique regional circumstances. But when rebasing cuts result in sizable losses for New York and Pennsylvania providers, there’s something fundamentally flawed with CMS’s calculations. This is why we are calling on Congress to mitigate these disastrous cuts.”

Another target of PHA, HCA and home care association advocacy is the disastrous Medicare face-to-face rule. Under this rule, home care providers must obtain excessive paperwork (within strict timelines) from physicians or other defined non-physician practitioners (NPP) documenting that the physician/NPP has met “face-to-face” with the home health patient or else home health services are not allowed.

Ms. Cunningham said: “Repeatedly, we’ve called on CMS to overturn or amend this onerous and duplicative requirement. Federal rules have long required home care providers to obtain a physician order and documentation supporting a patient’s need for home care services. While the face-to-face requirement seeks even greater physician involvement, the arcane, duplicative and unnecessarily complex compliance rules are virtually designed for home care provider error. The effect is disastrous: claims are denied on the basis of technicalities, administrative costs have exploded for providers having to chase down paperwork, and home care agencies remain financially liable for documentation that is largely outside their control.”

Hoak said: “CMS has attempted to address home health provider concerns by making some changes to the face-to-face requirement in 2014. In many ways, however, the rule is even worse now.” She noted that 90 percent of claims which are deemed “improper” by Medicare Administrative Contractors are due to documentation issues, adding that “the blame for these errors falls substantially on one factor: the face-to-face requirement.”

Since the face-to-face rule was initiated in 2010, the associations have engaged Members of Congress to urge a CMS fix to its rule. The associations have additionally sought legislation to streamline the face-to-face process by allowing physicians to simply document their face-to-face encounter with patients on long-used physician-order forms, rather than through a separate documentation process.

“In the meantime, while CMS has declined to offer a sensible alternative to this rule, auditors have stepped up their activity reviewing claims for face-to-face compliance,” Hoak said, noting a new CMS campaign called “probe-and-educate” audits, in which the contractors are auditing claims, denying those claims that don’t meet the rigorous face-to-face standards, and conferencing with providers individually on the reasons why the claim was denied.

Cunningham added: “While we welcome additional training and education on federal requirements – and have even coordinated these training sessions with Medicare contractors, physicians and hospitals – the very fact that CMS needs to conduct probe-and-educate audits suggests that the rule is not practical or sensible in its current form. CMS and home care provider resources could be better put to use in other areas, including a more direct target on areas where risk of fraud is greatest, not all providers.”

The Council and its associations are also calling on Congress to continue opposing a copayment charged to Medicare home health beneficiaries. The copayment idea has been put on the table several times during recent deficit-reduction talks as a way to raise revenue. But copayments are an unjust cost imposed on beneficiaries who may choose to forgo home health services altogether rather than pay the cost, possibly ending up in the hospital or other costlier settings if their condition is not treated at home.

As HCA states in its briefing document on this issue: “Eighty-seven percent of home health users have three or more chronic conditions. Thirty-eight percent live alone. Many have disabilities that require routine care management. Others are at risk of falls. A loss of home care services is detrimental to their quality of life.”

Cunningham added: “home care patients include the elderly, chronically ill and persons with disabilities, many living on fixed incomes. Those served by Medicare have paid into the system, often over many decades, and it is unconscionable to think that federal program changes would require them to pay more. We ask Congress to stand firm on its stand against any copayment proposal affecting home health beneficiaries.”


About Home Care

Home care includes a range of medical, therapy, assistive and adaptive services provided to the elderly, chronically ill or persons with disabilities in their own homes. It is a cost-effective service, functioning for preventive care, post-acute care (following hospitalization to help patients recuperate and avoid rehospitalization), and as an alternative to costlier facility settings or premature institutionalization.

To learn more about the Home Care Association of New York State (HCA) and the Pennsylvania Homecare Association (PHA), please visit their websites at and