Federal Lawsuit on Face-to-Face Rule Moving Forward

In a major win for home health agencies across the country, a federal district court determined that they will hear a legal challenge presented by the National Association for Home Care & Hospice (NAHC) to the validity of the physician narrative portion of the face-to-face requirement.

According to NAHC, the court issued an order denying Medicare’s effort to have the lawsuit dismissed by the court. The face-to-face requirement (F2F) was troublesome and frustrating from the outset as CMS released no standardized form for providers to follow and provider education was insufficient at best. It took constant advocacy and education on the state and local levels and strong lobbying on the federal level from state and national home care associations and agencies to even call attention to the problem.

The physician narrative where physicians must write a detailed account of patient eligibility for home health care services proved to be the paramount concern. Although the new final rule effective 1/1/2015 removes the narrative piece of the requirement, NAHC will continue to litigate the dispute to address the past claim denials and those denials that may still come involving home health services provided prior to January 1, 2015. If the lawsuit is successful, Medicare would be required to reopen and pay any claim previously denied for an insufficient narrative and stop any further claim reviews related to the narrative requirement.

NAHC and the Home Care Alliance continue to advise home health agencies to consider appealing any narrative-related claim denials while the lawsuit is progressing. Such action will preserve the opportunity to have the claims reviewed by Administrative Law Judges and also allow for easy identification of claims that may be subject to reopening if the lawsuit is successful.

The Alliance will also continue to provide education and updates on the new rule, including an upcoming webinar in early February. The Alliance helped lead the effort on a letter from New England Senators to CMS on F2F reviews and is out front with notices to physicians and hospitals on the recent rule changes.

Return to www.thinkhomecare.org.

Money Follows the Person Project Team Hosting Technical Assistance Sessions

University of Massachusetts Medical School, the Department of Developmental Services, and Home and Community Based Services (HCBS) Provider Network Administration Unit is recruiting service providers to serve people with disabilities and/or elders who live in the community and eligible for services under the Money Follows the Person Demonstration project (MFP).

The Provider Network Administration Unit is hosting Waiver Service Provider Technical Assistance Sessions. The sessions will give providers an overview of the HCBS Waivers and services offered, as well as an in-depth review of the application forms and submission requirements/process.

The MFP sessions will be held as follows:







Conference Room

8/19/14 2:00-4:00 PM Tuesday Forbes Library 20 West St. Northampton Community Room
8/28/14 2:00-4:00 PM Thursday UMASS Medical School 333 South St. Shrewsbury USA
9/16/14 1:00-3:00 PM Tuesday Taunton Public Library 12 Pleasant St. Taunton See Reception Desk
9/18/14 1:30-3:30 PM Thursday Boston Lower Mills Library 27 Richmond St. Dorchester See Reception Desk
9/30/14 2:00-4:00 PM Tuesday UMASS Medical School 333 South St. Shrewsbury USA
10/7/14 1:00-3:00 PM Tuesday Lenox Library 18 Main St. Lenox Welles Gallery
10/23/14 2:00-4:00 PM Thursday UMASS Medical School 333 South St. Shrewsbury USA


Return to www.thinkhomecare.org.

CMS Reopens Bundled Payment Initative for Post-Acute Care

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.

Return to www.thinkhomecare.org.

Alliance Statement on CMS’ Final Rule Slashing Home Health Care Payments

The following is a statement from the Home Care Alliance regarding the CMS Final Rule on Home Health Rebasing. The Alliance invites its members and advocates to share this with their local media:

In a final rule released last Friday, the Centers for Medicare and Medicaid Services (CMS) have implemented a home health payment that will result in a 3.5 percent cut per year for the next four years.

It would be easy based on history to view the recent final rule from the Centers for Medicare and Medicaid Services (CMS) as “another year, another cut.” This year, however, is different.

The home health industry has absorbed $78 billion of cuts since 2009, which will be executed over the better part of the next decade. Those cuts come from the Affordable Care Act, other CMS final rules over recent years, and sequestration. The latest cuts amount to an additional and an untenable 14 percent – or $22 billion – reduction over the next four years.

These total reductions since 2009 and including the CMS final rule are comparable to the combined 2013 budgets of the federal departments of education and homeland security.

With an aging population and home health agencies caring for sicker patients that are released from the hospital at an earlier stage of recovery, the federal Medicare program is making it nearly impossible for quality providers to continue delivering effective services that end up saving taxpayers by preventing costlier facility-based health care under these circumstances.

The Home Care Alliance of Massachusetts joined providers and associations from across the country, as well as many members of Congress, in urging CMS to revisit what they had proposed back in July. Those calls and letters went disregarded and it is evident that CMS is trying to attain a numerical target in their budget ignoring logic at the expense of American seniors who benefit from care at home. CMS claims the cuts amount to a 1.05 percent reduction, which is a slight improvement over the proposed rule, but the cumulative impact of continued cuts scheduled for 2015, 2016, and 2017 drive the cut deeper.

The Home Care Alliance will be assembling with other advocates in Washington DC and online in a campaign to persist in opposing the cuts from CMS.

About the Home Care Alliance:

With a mission to unite people and organizations to advance community health through care and services in the home, the Home Care Alliance of Massachusetts is a non-profit trade association and advocacy group representing the voice of the state’s home-based health and care services. Founded in 1969, the Alliance represents 200 home care and home health agencies. For more information, visit www.thinkhomecare.org.


Return to www.thinkhomecare.org.

Are You Prepared for the May1st PECOS Edit?

Effective May 1st, CMS will deny home health claims where the physician on the claim does not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS).

CMS released MLN Matters-SE1305, on March 1st, detailing information regarding this new “phase 2” edit.  Phase 2 is part of CMS’s implementation of Section 6450 of the Affordable Care Act, which requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries, even if those physicians do not directly bill Medicare for any services.

Home Health claims will be denied with one of two reason codes, according to the March 1st MLN Matters article:

  • 37236: The statement “from” date is on or after May 1, the type of bill is “32” or “33” and the attending physician’s national provider identifier (NPI) is not present in PECOS. The claim could also be denied if the NPI is present in PECOS but the name given on the claim doesn’t match the one on the physician’s enrollment record.
  • 37237: Same as above, but this denial reason code will be assigned only when the type of bill frequency code is “7,” which indicates an adjustment, or “F-P.”

Check your referring physicians’ status in PECOS; agencies may be forced to hold billing the claim for physicians who are not enrolled.

Return to www.thinkhomecare.org.

New Info Coming Soon on Money Follows the Person Initiative

The Massachusetts version of the federal Money Follows the Person initiative, held a stakeholders meeting at the Worcester Public Library with a review of activity and a “heads-up” that an RFR will be coming out next month for the five coordinating entities that will manage money and services.

Dubbed Regional Coordinating Offices, or RCO’s, these newly formed entities will provide access to housing search for MFP transitional entities along with transition assistance itself as participant move from a facility to the community. RCO’s will also provide orientation and mobility training, assistive technology, and case management. The five RCO’s will chosen by January 2013 based on an RFR due out by this November.

In February 2011, CMS awarded a five-year Money Follows the Person Demonstration grant to Massachusetts. The funding will, according to the state’s office of Health and Human Services, will help transition more than 2,200 individuals out of nursing facilities, long-term care facilities, chronic care hospitals, and intermediate care facilities into community-based care.

HCA will continue to provide updates on this program, which are also available at on mass.gov here.

Return to www.thinkhomecare.org.

Last Chance to Apply for CMS Community-Based Care Transitions Program

The final deadline for applications for the Community Based Care Transitions Program, administered by the Center for Medicare and Medicaid Innovation (CMMI), is quickly approaching.

Any interested applicants must have their proposals in by September 3rd to make the final panel review on September 20th. Any interested home health agencies can contact James Fuccione at the Home Care Alliance for assistance. Additionally, CMMI has made a slide deck available with everything health care providers and community-based organizations need to know for the application process.

Recently, there were 17 proposals that were accepted in the third round of site selections and, again, a Massachusetts project was among them. Here is the “site summary:”

Somerville-Cambridge Elder Services, a Massachusetts-designated Aging Services Access Point (ASAP) and an Area Agency on Aging (AAA), is partnering with Mystic Valley Elder Services,  two large integrated hospital networks (Cambridge Health Alliance and Hallmark Health System) and dozens of community-based health and social service providers to provide care transitions services to high-risk Medicare beneficiaries throughout Middlesex County, Massachusetts.

For more on HCA’s work on care transitions issues, see these blog posts.

Return to www.thinkhomecare.org.

Home Care Alliance, National Organizations Make Statements on Supreme Court Decision

In light of the Supreme Court’s decision to uphold the Affordable Care Act, the Home Care Alliance of Massachusetts and other organizations representing health care providers and consumers had this to say:

“Today’s decision of the US Supreme Court has established the Affordable Care Act as the law. With their ruling, the Supreme Court has removed enormous uncertainty – particularly in states other than Massachusetts and for those involved in ACA funded demonstrations – as to whether to move forward. They now can, and we think they must.  While some parts of the law will impact Massachusetts far less directly than other states, there is evidence that our state has already benefited by some provisions. Most notably, 62,000 seniors and people with disabilities in Massachusetts have seen significant savings on their prescription drugs because the law was upheld.

All providers, including home health care, were subject to Medicare rate reductions in the ACA in order to expand coverage and pay for reform demonstrations.  These cuts have not been easy to absorb. With this ruling, we must now get to work to deliver on the promise in our state not just of universal access to insurance, but to a better coordinated, and ultimately more cost effective delivery system.”

-Patricia Kelleher, HCA Executive Director

Statement from the National Association for Home Care & Hospice (NAHC):

“NAHC has long supported reforms that increase access to health care for all in the United States and supports health delivery reforms and the expansion of Medicaid eligibility. The ACA rightly shifts the focus of care from inpatient services and institutional care to the community setting, which home health agencies and hospices have effectively served for decades.

NAHC believes that the Affordable Care Act can and should be improved. Accordingly, NAHC will continue to work with both Democrats and Republicans to improve the legislation. NAHC will ask that its implementation date be delayed for two years so that states have the time to prepare for implementation, including the creation of exchanges. This delay will also save approximately $200 billion, which can be applied to deficit reduction, extending the SGR “doc fix” and avoiding the need for any further cuts to Medicare. NAHC will continue to argue that home health care has been cut disproportionately and will oppose the imposition of copayments or additional cuts. NAHC believes that a good case can be made for expanding the scope of Medicare home health services to reduce hospitalization costs and improve services for the 5 percent of Americans who are responsible for 50 percent of total U.S. health care costs.”

-Val Halamandaris, NAHC President

Here are other statements from the following organizations:

And statements from political leaders:

Return to www.thinkhomecare.org.

CMS Announces New Accountable Care Organizations in Massachusetts

Two out of the first 27 accountable care organizations (ACO’s) in CMS’ new Shared Savings Program reside in Massachusetts and will be online with its counterparts from across the country this month.

According to a press release by CMS, “The selected organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in eighteen states through better coordination among providers.”

The CMS statement continues that all ACOs that succeed in providing high quality care may share in the savings to Medicare, as long as their performance reduces the cost of care and is sufficiently rated on 33 quality measures. The quality measures relate to, among other things, care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care.

The Massachusetts ACO’s include Jordan Community ACO and Physicians of Cape Cod AC. CMS provides summaries of each ACO and the Massachusetts initiatives are described here:

  • The Jordan Community ACO is a not-for-profit organization based in Plymouth, Massachusetts and founded in 2012. The Jordan Community ACO consists of more than 100 physicians from Plymouth Bay Medical Associates, Jordan Physician Associates, and a number of specialty physicians from Jordan Hospital. Together, the Jordan Community ACO physicians coordinate the healthcare of more than 6,000 Medicare beneficiaries in Plymouth and Barnstable Counties. This approach ensures that patients receive the right care from the right provider at the right time, making it possible to identify and address problems early, before hospital care becomes necessary.
  • Physicians of Cape Cod ACO has been coordinating care for beneficiaries through a managed care program for 10 years, and intends to bring the expertise developed in that program to the ACO model for fee-for-service beneficiaries. It is expected to serve approximately 5,000 beneficiaries living in Cape Cod, Massachusetts.

Five of the 27 ACO’s are also participating in the Advance Payment ACO program, although none of them are in Massachusetts. One project is located in northern New Hampshire and called the North Country ACO. These 27 ACO’s join the 32 “Pioneer ACO’s” that have 5 projects in Massachusetts.

CMS revealed they are reviewing 150 additional applications for the Medicare Shared Savings Program, of which more than 50 are aiming to be in the Advance Payment Model.

More information is available in CMS’ announcement.

Return to www.thinkhomecare.org.

HCA Informs Members on Pioneer ACO and Independence at Home Programs

The Home Care Alliance held a well-attended conference call to inform members about two major programs recently announced by CMS:

First, the Department of Health and Human Services announced the first 32 organizations in 18 states that will participate in the new Pioneer Accountable Care Organization (ACO) initiative. This program is operated by the CMS Innovation Center under Section 3022 of the Affordable Care Act. Selected Pioneer ACOs include “physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country.” Five of those organizations are in Massachusetts:

  • Atrius Health Services
  • Beth Israel Deaconess Physician Organization
  • Mount Auburn Cambridge Independent Practice Association (MACIPA)
  • Partners Healthcare
  • Steward Health Care System

This Pioneer ACO Presentation was given by HCA Executive Director Pat Kelleher on the call and explains some of the points that home care agencies should be aware of as the initiative moves forward.

The CMS Center for Innovation also has a site full of resources on Pioneer ACO’s including FAQ’s and brief summaries of the selected ACO’s.

WBUR’s CommonHealth Blog had a feature on Pioneer ACO’s and asked each of the five accepted systems in Massachusetts what the program will mean for patients.

The second program announced was a solicitation for the new Independence at Home Demonstration Program (IAH), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

HCA also gave this presentation on the Independence at Home Demonstration on the conference call for members to explain that home care agencies can be a major partner to physician practices, despite the fact that the program is directed by a physician or nurse practitioner-led practice with experience in making home visits.

The IAH Demonstration’s webpage also has FAQ’s as well as the solicitation and application.

The Alliance will pass along any more information as it becomes available.

Return to www.thinkhomecare.org.


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