Month: August 2009

Providers to Receive Letters for TPL Claims Beginning September 8, 2009

Providers should expect to see letters from “Commonwealth Medicine” representing the MassHealth TPL (Third Party Liability)  Unit on or about September 8, 2009. The letter, which will take the form of an “Initial Overpayment Notice,” will list those claims for dually-eligible beneficiaries that MassHealth has identified as requiring a Medicare determination of coverage. MassHealth is the payer of last resort and as the subrogee for these beneficiaries is requesting that you begin the demand bill process to determine if Medicare should have been billed for these services.    The claims in dispute are for Federal Fiscal Year 2008 or dates of service October 1, 2007 through September 30, 2008.

In preparation for this initiative, the Alliance in cooperation with MassHealth held 2 workshops for providers in July and August.  The process and expectations were discusses by representatives of the TPL Unit and the Provider Outreach and Education department of National Government Services reviewed the “demand bill” process.

For a copy of the TPL Powerpoint which includes an excellent timeline,  click here. For a copy of the NGS presentation discussing the demand billing process, click here

Health Care Reform Update: End-of-Life Provision Cut from Senate Proposal

Although a provision allowing Medicare to reimburse doctors who voluntarily counsel patients and their families on end-of-life issues and care was dropped from a Senate version of a health care reform proposal, a separate House version has kept it intact.

The Senate Finance Committee’s ranking Republican member, Senator Charles Grassley of Iowa, said the provision could be “misinterpreted” and would not be included in the committee’s proposal.

According to the Boston Globe, the end-of life provision, written by Oregon Democratic Congressman Earl Blumenauer, would cover counseling sessions for end-of-life issues like “living wills, making a close relative or friend a health care proxy, hospice care, and information about medications for chronic pain.” The counseling sessions, the Globe reports, “would be covered by insurance every five years, and more frequently for the seriously ill.”

Thanks in part to former Alaska Governor Sarah Palin, the provision was “misinterpreted” by many as Senator Grassley feared and subsequently spun into what has become known as the “death panels” proposal, where, Palin and others allege, the government would decide who is treated.

In the Globe article, Congressman Blumenauer dubbed references to the so-called death panels or euthanasia as “mind numbing” since “the bill would block funds for counseling that presents suicide or assisted suicide as an option.”

Click here to read the Boston Globe article on the end-of-life provision.

A Los Angeles television news station highlighted hospice care as a cost-saving alternative to expensive and extraneous treatment in their report on the end-of-life provision, which can be viewed by clicking here.

Return to www.thinkhomecare.org.

CMS Publishes HHPPS Updates for CY 2010

The August 6, 2009 Federal Register sets forth an update to the home health prospective payment system for calendar year 2010.  In addition, CMS proposes changes to the outlier policy and a submission of OASIS data as a condition of payment.  This  rule also proposes changes to the language clarifying “skilled services” and seeks input on physician/patient interaction associated with the home health plan of care.

It is important that the industry comment on these proposed changes. Comments are due to CMS by September 28, 2009 at 5PM. Please send a copy of your comments to the Alliance: hsiegel@hcalliancema.org

For a copy of the complete document, click here (large file, please allow a few moments to load).

State Steps Up Defense Against Flu

State public health officials have adopted emergency regulations to allow dentists, pharmacists and paramedics to provide the H1N1 flu vaccine for the upcoming fall flu season.

As reported on State House News and in the Boston Globe, the Public Health Council made the decision in light of budget resrictions and the need to protect millions of state residents against the H1N1 virus. According to State House News, the Springtime wave resulted in 1,383 confirmed cases and 10 deaths in Massachusetts.

The emergency regulations go into effect on September 14 and accompany an additional 75,000 doses of  the vaccine purchased by the Department of Public Health. The 885,000 doses this year are up from 810,000 doses a year ago. State House News reports that “Another 2.2 million doses are expected to come from the private sector, including commercial vaccinators, health care providers and health care facilities.”

For more information, click here to read the story from Boston.com on the new precautions.

Return to www.thinkhomecare.org.

New Issues of Update Available

The July 31 and August 7 issues of Update are now available for download on our newsletter archive.

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CNN Story Highlights Impact of Possible Home Health Cuts

A proposal in the US House of Representatives, known as the “Tri-Committee” Health Reform Bill, would take $56.8 billion over ten years from the Medicare home health payment, according to the Congressional Budget Office (CBO) and the National Association for Home Care & Hospice (NAHC).

CNN reported on a 12 year old California girl getting care from a team of home health professionals. The story highlights how that care is threatened by potential cuts in the Tri-Committee bill.

Click here to read the CNN story and please visit our “contact your legislator” page to send a message to your federal representatives in an effort to oppose cuts to home health. Just fill in your contact information and click “send” to deliver the message.

Return to www.thinkhomecare.org.

Send a Message to Legislators on CORI Delays

A new message is available on the Legislative Action Center of our advocacy page relating to the delay in CORI processing for potential employees that agencies are experiencing.

Please take the time to read the brief email message and send it to your local legislators, as well as the House and Senate Chairs of the Joint Committee on the Judiciary, by clicking here. All you have to do is fill in your contact information, click send, and our website will take care of the rest.

Learn more about the Alliance’s efforts surrounding the CORI processing issue by clicking here.

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Alliance Members Receive Discount at Partners Symposium

Up from Crisis: Overhauling Healthcare Information, Payment and Delivery in Extraordinary Times

With more than 1,000 healthcare and technology leaders world-wide, from hospitals, clinics, home health agencies, large employers and health plans attendees will  exchange ideas with tech entrepreneurs, business execs, investors, government officials and patient organization representatives.

Partners is extending a special opportunity to to all Home Care Alliance members, friends, and colleagues to register for October’s Symposium for $795; that is $100 off the regular rate.  To obtain the discount, register as “general public” at on the event’s website and type in “HCAlliance” in the invitation code box.

Return to www.thinkhomecare.org.

New Medicare Website Launched to Help Caregivers

A new website called “Ask Medicare” was recently launched as a resource and navigation tool for the millions of caregivers so that answers and information can be readily obtained for those who give much of their time caring for others.

Many features are available on the site, including help with billing, comparing drug plans, locating care, and even a chat room for caregivers to exchange their stories and experiences.

CNN did a report on the new website, which you can see by clicking here. The article focuses on Kim Mickens, a Baltimore woman who spends 40 hours per week caring for her mother Delphine who lives with Alzheimer’s disease.  Below a a brief clip from the CNN story:

Today, Mickens and her mother are a loving twosome. When Mickens is at work, she leaves Delphine with an in-home nurse and relies on her son to help out when he gets home from school. Mickens finally feels content about the quality of care her mother is getting, and she says it would have never happened so quickly had she not found the Ask Medicare Web site.

“I have no problems with it: Once I punch it in, it comes up and takes me out to all the different Web sites,” say Mickens. “It’s very helpful. I am glad they came up with it.”

Click here to visit the newly-launched “Ask Medicare” web tool for caregivers.

Return to www.thinkhomecare.org.