A national trade association of health insurers, America’s Health Insurance Plans, is strongly protesting a new round of proposed cuts to 2015 Medicare Advantage payment rates. Preliminary estimate of the combined effect of the Medicare Advantage growth percentage and the fee-for-service growth percentage is estimated to be -1.9 percent,” CMS said Friday in releasing their proposed rule.
“The new proposed Medicare Advantage cuts would cause seniors in the program to lose benefits and choices on which they depend. Last year’s six percent cut to Medicare Advantage rates resulted in higher premiums, reduced benefits, fewer coverage options, and loss of provider choices for seniors. Another round of payment cuts would be devastating to the more than 15 million seniors and people with disabilities that have chosen to enroll in Medicare Advantage for the better benefits and higher quality coverage these plans provide.
The Bundled Payments for Care Improvement initiative, developed by the Center for Medicare and Medicaid Innovation, has been reopened for additional models focusing on post-acute.
Through the initiative, organizations partner together and enter into payment arrangements that include financial and performance accountability for episodes of care. There four models of bundled payment being tested, but models 2 and 3 are areas where home health agencies can play a central role.
Model 2 is titled Retrospective Acute Care Hospital Stay plus Post-Acute Care, where the episode of care includes the inpatient stay in the acute care hospital and all related services during the episode.
Model 3 is Retrospective Post-Acute Care Only, where the episode of care is triggered by an acute care hospital stay and begins at initiation of post-acute care services with a participating home health agency, skilled nursing facility, inpatient rehabilitation facility, long-term care hospital.
More information on the program and the “open period” where new proposals can be submitted is available here. In order to be considered for participation in the Bundled Payments for Care Improvement initiative, all open period submissions must be submitted by April 18, 2014.
Once again, the Alliance is planning a special afternoon to honor and showcase the best people and programs in our industry today. This celebration of innovation and excellence will take place on April 29th at the historic John F. Kennedy Library. Invitations to attend will be sent to a broad health care audience.
This event offers member agencies two opportunities to shine:
Nominate a program, product, or operational change that has either a) enhanced the well-being of patients, clients, or the community, b) driven efficiency in operations or the health care system, or c) enhanced the productivity or satisfaction of agency staff.
Nominate an employee or homecare supporter for a STAR Award. These awards celebrate the exceptional accomplishments of the everyday heroes in our midst who make incredible differences in the lives of their patients/clients and their families. Though there are too few opportunities to recognize all who deserve one, a STAR award brings with it some well-deserved recognition for both the agency and the individual.
Nominations may be made by Alliance agencies, their patients, or their partner organizations. Download & complete the nomination form to let the world know about your best & brightest. Nominations are due by March 7, 2014.
The Alliance is pleased to announce the publication of the 2014 edition of the Guide to Private Home Care Services, which will begin shipping next week.
New this year, the Guide has been split into three regional editions:
Boston & Northeastern Massachusetts (covering Essex, Middlesex, and Suffolks, as well as the city of Brookline);
South-of-Boston, Cape, and Islands (covering Norfolk, Bristol, Plymouth, Barnstable, Dukes, and Nantucket counties); and
Central & Western Massachusetts (covering Worcester, Franklin, Hampshire, and Berkshire counties);
The new system greatly streamlines the user experience, showing customers and families agencies who provide service where it’s needed without overwhelming them with information. The county-by-county cross-references have also been revamped, and our popular “The Agency Advantage” essay (explaining the benefits of working with an agency instead of a direct hire) is now prominently featured on the rear cover.
Copies will begin shipping next week. Additional copies will be available for order on our website shortly.
CMS has delayed enforcement and penalties related to its new and controversial “two midnight rule. ” The deadline to begin enforcement of the rule had already been delayed from Oct. 1, 2013, to March 31, 2014 and is now being pushed back to September 30, 2014.
The final hospital rule, published last August, modifies and clarifies CMS’s longstanding admissions policy for payment purposes. The 2-midnight benchmark states that if the admitting practitioner admits a Medicare beneficiary as an inpatient with the reasonable expectation that the beneficiary will require care that “crosses 2 midnights,” Medicare Part A payment is “generally appropriate,” assuming medical record documentation justifies the admission.
The attempt to clarify admission rules was in part driven by beneficiary complaints about increased use, and length of, observation stays, which left some patients who went to nursing homes subject to surprise 20% copayments.
The AHA and the AMA have been lobbying strongly for a repeal or delay of the the new rule. AHA questions CMS’s assertion that the new rule will bring in more revenue as hospitals will be able to bill full inpatient rates on cases that may have been outpatient in the past.