Literature Review

‘Lot of work to be done’: What home health leaders expect from payment rulemaking in 2024Home Health Care News; by Joyce Famakinwa; 6/24/24 In recent years, home health care has faced relentless cuts from the Centers for Medicare & Medicaid Services (CMS). It has plagued the industry, but providers and advocates alike are still hopeful a light at the end of the tunnel is ahead. ... Home Health Care News recently caught up with PQHH CEO Joanne Cunningham and David Totaro, the president and executive director of Hearts for Home Care. ... [Cunningham said,] "I anticipate that what we will see, given CMS’s posture and prior rulemaking cycles, is the continuation of the policy that will put in place permanent cuts to the Medicare home health program. We’re bracing ourselves for an additional sizable permanent cut. We don’t know exactly what CMS has planned for the temporary cuts, otherwise known as the clawback cuts. We will certainly see, at a minimum, CMS identify what their new projected value of the temporary cuts are. ...

ASTHO and NAMD call on Congress to fully fund Medicaid and CHIP in U.S. territories ASTHO - Association of State and Territorial Health Officials; by Jane Esworthy and Stephanie Rhodes; 6/20/24 In a joint letter to Congress, the Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD) urged Congress to fully fund Medicaid and Children's Health Insurance Programs (CHIP) in the U.S. territories. ASTHO and NAMD request that Congress lift the annual Section 1108(g) allotment cap for all territories and authorize a permanent 83% Federal Medical Assistance Percentage (FMAP) for Puerto Rico. ... “ASTHO recognizes the importance of permanent, sustainable, and equitable Medicaid financing for all U.S. territories,” says Joseph Kanter, MD, MPH, ASTHO CEO. ... “Unlike the states, the U.S. territories face an annual cap on their Medicaid funding,” says Kate McEvoy, Executive Director of NAMD. “This has impaired the territories’ capacity to provide needed health care to Medicaid-eligible U.S. citizens and nationals. It has also held the territories back from making the structural investments in care delivery and value-based payment reform, workforce, IT systems, and program integrity that are crucial to high performing and innovative Medicaid programs.”

Tapestry Hospice settles healthcare kickback claims for $1.4 million United States Attorney's Office - Northern District of Georgia; Press Release; 6/20/24 Tapestry Hospice of Northwest Georgia, LLC, and its owners and managers, David Lovell, MD, Stephanie Harbour, Ben Harbour, and Andrew Nall (collectively “Tapestry”), agreed to pay $1.4 million to resolve allegations that they violated the False Claims Act by entering into kickback arrangements with medical directors in exchange for referrals of hospice patients to Tapestry. “By entering into kickback arrangements, health care providers can cause doctors to make medical decisions that are motivated by financial gain, rather than the patient’s best interest,” said U.S. Attorney Ryan K. Buchanan. “Our office is committed to ensuring the accountability of health care providers who put their own financial needs ahead of their patients.” “The False Claims Act settlement in this case will hopefully be a deterrent to those who selfishly evade our federal healthcare programs for their own benefit,” said Keri Farley, Special Agent in Charge of FBI Atlanta. “The message is clear, the FBI will not tolerate companies operating corporate-wide schemes to illegally line their pockets.” 

Compliance landmines in the hospice regulatory landscape Hospice News; by Holly Vossel; 6/14/24 Hospice providers are navigating a minefield in today’s regulatory environment to avoid getting caught up in the mix of fraudulent activity in the space. The current state of hospice regulations has providers walking compliance tightropes, according to Patrick Harrison, senior director of regulatory and compliance at the National Hospice and Palliative Care Organization (NHPCO). Fraud, waste and abuse exist in several different industries and health care is no exception. But the majority of hospices are striving to provide quality end-of-life experiences to terminally ill patients and their families, Harrison said at the Hospice News Elevate conference in Washington D.C. 

Red River Valley expands services for dual-eligible populationsHospice News; by Holly Vossel; 6/11/24North Dakota-based Hospice of the Red River Valley is focused on expanding its home- and community-based services among dual-eligible Medicare and Medicaid populations in need of greater support. Serious and terminally ill patients in lower socioeconomic and underserved regions face several competing challenges in accessing health care, according to Tracee Capron, executive director at Hospice of the Red River Valley. Developing a sustainable care delivery model that better addresses unmet needs among patients and their families requires significant investment, Capron said. 

To guard themselves from sanctions, home health agencies need to invest in QAPI programs, NAHC experts say McKnights Home Care; by Adam Healy; 5/22/24 To protect themselves against the Centers for Medicare & Medicaid Services’ compliance enforcement mechanisms, home care providers must focus on quality assessment and performance improvement (QAPI) programs, experts at the National Association for Home Care & Hospice said during a webinar. ... Earlier this month, the Centers for Medicare & Medicaid Services released updates to its enforcement remedies and alternative sanctions for home health and hospice agencies. These remedies and sanctions may be imposed in lieu of termination for providers with condition-level deficiencies. They include civil money penalties, payment suspensions, temporarily-appointed management, directed plans of correction or in-service training.

Hospice of the Red River Valley awarded $2 million grantNewsDakota; by Steve Urness; 5/25/24The North Dakota Department of Health and Human Services, Medical Services Division, has awarded a substantial grant of up to $2 million to Hospice of the Red River Valley. This grant is designated for the expansion of home and community-based services to Medicaid members residing in under served regions of North Dakota.

CMS extends Medicaid waivers to 2025 Becker's Payer Issues; by Rylee Wilson; 5/13/24 CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. The waivers, previously set to expire at the end of 2024, will be extended for six more months, Daniel Tsai, deputy CMS administrator and director of the Center for Medicaid and CHIP services, wrote in a May 9 memo to states. Nearly all states were expected to complete the unwinding process by June 2024, Mr. Tsai wrote, but because several states took extension waivers from CMS, several states will continue renewals past June. 

New DOJ task force to tackle competition-related concerns in healthcare McKnights Senior Living; by Kathleen Steele Gaivin; 5/13/24 The Justice Department said its Antitrust Division’s new Task Force on Health Care Monopolies and Collusion will consider “widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, healthcare IT services, access to and misuse of healthcare data and more.” The group’s mandate is to facilitate policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.

Health Equity Data Definitions, Standards, and Stratification: New resource available Centers for Medicare and Medicaid Services; by CMS; May 2024Resource of health equity-related data definitions, standards, and stratification practices ... This document serves as a technical resource that can be used by organizations and entities, such as providers, states, community organizations, and others, that wish to harmonize with CMS when collecting, stratifying, and/or analyzing health equity-related data. It may also clarify differences in results that may arise when different data standards and definitions are used. This document includes suggested definitions, standards, and stratification practices for the following sociodemographic elements:

Medicaid disenrollments higher than expected: Report Becker's Payer Issues; by Rylee Wilson; 5/2/24 The number of people disenrolled from Medicaid through the redeterminations process has surpassed original estimates from the Urban Institute and Robert Wood Johnson Foundation. According to a May 2 report, as of November 2023, nearly 9 million people had been disenrolled from Medicaid. The figure came out to 60.5% of the foundation's original estimate of 14.8 million people losing coverage, with several months remaining in the redetermination process. 

Star ratings of Leapfrog's 25 straight-'A' and 'F' hospitals Becker's Hospital Review; by Mackenzie Bean; updated 5/3/24 A comparison of data from CMS and The Leapfrog Group suggests that a hospital's strong performance in one national quality rating system does not necessarily mean it will be a top performer in another. Leapfrog updated its spring safety grades May 1, recognizing 15 hospitals that have received an "A" grade in every consecutive update since 2012. Of these hospitals, only eight received a five-star rating from CMS. Similar discrepancies are seen across Leapfrog's "F" hospitals. While two did receive one star — the lowest possible rating — another five received two stars, and one hospital earned four stars. [Click on the title's link for the list.]