Home Health Industry Unscathed In Latest CMS Improper Payments Report

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) released its improper payment report last week. It was another win for the home health industry, which has become less of a culprit in the reports over the years.
 
Overall, the Medicare fee-for-service (FFS) estimated improper payment was 7.38%, or $31.2 million. That was the seventh consecutive year it has been below the 10% threshold established by improper payment statutory requirements, according to the agency.
 
In 2022, the improper payment rate was 7.46%.
 
“While CMS’ improper payments reporting programs are designed to protect the integrity of CMS programs, not all improper payments are fraud or abuse. It is important to understand that improper payments are payments that do not meet CMS program requirements,” CMS wrote in a corresponding fact sheet on improper payments. “They can be overpayments or, underpayments, or payments where insufficient information was provided to determine whether a payment was proper.
 
From 2016 to 2020, home health improper payments decreased by $5.9 billion. Then, in 2020, the industry had a 9.3% improper payment rate. In 2021, it had a 10.24% estimated improper payment rate.
 
In the latest report, home health was not included as one of the sectors contributing most to overall improper payments.
 
Those sectors were skilled nursing facilities, outpatient hospitals, inpatient rehabilitation facilities and hospice.
 
Review Choice Demonstration (RCD) could be helping the home health industry improve on payments, at least in Illinois, Ohio, North Carolina, Florida and Texas.
 
CMS did mention RCD’s expansion within the report.
 
“HHS announced expansion to the Review Choice Demonstration for Home Health Services to Oklahoma, starting December 1, 2023,” the agency wrote. “This demonstration is also ongoing in Illinois, Ohio, North Carolina, Florida, and Texas. It offers Jurisdiction M providers three initial options: pre-claim review, post-payment review, or minimal post-payment review with a 25% payment reduction for all home health services. A provider’s compliance with Medicare billing, coding, and coverage requirements determines their subsequent steps in the demonstration.”

Fact Sheet: Nondiscrimination on the Basis of Disability Proposed Rule Section 504 of the Rehabilitation Act of 1973

U.S. Department of Health and Human Services

The Department of Health and Human Services (HHS) has issued a proposed rule to advance equity and bolster protections for people with disabilities.  The proposed rule, Discrimination on the Basis of Disability in Health and Human Service Programs or Activities, updates, clarifies, and strengthens the implementing regulation for Section 504 of the Rehabilitation Act of 1973 (Section 504), the statute that prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities that receive Federal financial assistance or are conducted by a Federal agency.

The historic proposed rule provides robust civil rights protections for people with disabilities in federally funded health and human services programs. It advances the promise of the Rehabilitation Act and helps to ensure that people with disabilities are not subjected to discrimination in any program or activity receiving funding from HHS just because they have a disability.  This proposed rulemaking is consistent with Section 504 statutory text, congressional intent, legal precedent, and the Biden-Harris Administration’s priority of advancing equity and civil rights and protecting Americans’ access to health care and human services programs and activities.  

Read the full Proposed Rule

[The first 50 pages are the rationale and students that support changes that are relevant to in-home providers; Pages 340-400 are the actual proposed rule]

Read a Summary of the Rule

The United States Department Of Labor Issues Template Home Care Worker Employment Agreements

Polsinielli | By William C. Vail and Clayton Nedza

The U.S. Department of Labor recently issued a template home care worker employment agreement to increase visibility of employee rights and employer responsibilities. This document comes as a result of an April 2023 Executive Order titled Increasing Access to High-Quality Care and Supporting Caregivers.

The Executive Order called on the Department of Labor to develop “compliance assistance and best practices” for, among others, home care workers. The DOL explained that the informal and non-binding sample agreement is not required by law. Rather, it is better viewed as “tools” that may help household employers and workers develop their own employment agreements together, “thereby reducing potential future misunderstanding or conflict and strengthening the employment relationship and trust.”

The DOL further states that the agreement reflects topics that employers and employees may voluntarily choose to address. For example, the template agreement provides for an explanation of benefits like health insurance, paid leave, pay if the employer cancels a shift on short notice, and on-call pay – none of which are required by federal law. The DOL is also careful to note that the sample agreement does not constitute legal advice, an official statement of position by the DOL or reflect the full range of laws that may apply in every situation, such as local and state laws. It also notes that the use of an employment agreement cannot waive the rights or protections of an employee under applicable federal, state, or local law.

Any questions may be directed to your Polsinelli attorney, the Authors of this article, or any attorney in our Labor & Employment Department.

Nursing Home Care Continues to Outpace Most Categories of National Health Spending: Altarum

McKnight’s Senior Living | By Kathleen Steele Gaivin

Nursing home care in September once again represented one of the fastest-growing categories of national health spending, second only to spending on prescription drugs, according to Altarum’s monthly Health Sector Economics Brief, released Friday. 
 
Spending on nursing home care has increased 9.8% since September 2022, “a result of increases in both prices and utilization,” Altarum fellow and Senior Researcher George Miller told the McKnight’s Business Daily.
 
Spending on home care, on the other hand, showed the slowest growth rate among major categories of national health spending, increasing just 5.5% in September, he noted.
 
“This was in spite of the fact that home healthcare prices have been growing at a rate that is among the fastest among the major categories, increasing by 4.6%, year over year, in October,” Miller said. “The relatively low increase in spending was instead due to a slight decline in utilization of home healthcare services.”
 
Year-over-year spending growth among the other major healthcare categories, according to the report: prescription drugs (11.8%), dental care (9.8%), physician and clinical services (8.9%) and hospital care (6.9%).
 
National health spending overall increased 5.7%, year over year, reaching a seasonally adjusted annual rate of $4.78 trillion, accounting for 17.2% of gross domestic product.
 
“While the GDP growth rate continues to outpace the growth in total health spending, personal healthcare spending (spending on healthcare goods and services, which excludes categories such as the net cost of insurance and public health expenditures) has grown at a rate faster than GDP since February 2023 and grew by 7.4%, year over year, in September,” according to the brief.
 
“Nursing homes showed modest employment growth in October, adding 4,400 jobs. Our just-released blog characterizes nursing home staffing trends through the COVID-19 pandemic and compares recent staffing levels with the federal government’s newly proposed staffing requirements for nursing homes,” Miller said. “At the same time, home healthcare added 9,500 jobs in October, slightly above the monthly average over the past year.'