In the News

Testimony: Florida Wrongly Cut People from Medicaid Due to ‘Computer Error,’ Bad Data

The Tributary | By Charlie McGee

A “computer error” and bad data from third-party vendors led Florida to wrongfully strip Medicaid coverage from residents, including new mothers who were denied postpartum care, federal testimony revealed Monday.

Will Roberts, a government operations consultant in the unit of Florida’s Department of Children and Families that decides if people are eligible for new or continued Medicaid coverage, confirmed some widespread problems that led the state to wrongly deny insurance to eligible Floridians.

Plaintiffs relied on Roberts’ testimony, the second so far in a bench trial overseen by U.S. District Judge Marcia Morales Howard, in their class-action challenge alleging Florida violated patients’ rights when it removed medical coverage from millions of Floridians without proper notice.

Roberts confirmed that due to a “computer system problem” in the software that Florida jointly operates with Deloitte Consulting LLP, at least some eligible women in Florida have been denied a year of continuous Medicaid coverage that they were entitled to after giving birth.

The Florida legislature and Gov. Ron DeSantis expanded these women’s Medicaid eligibility in 2021 from two months to 12 months of post-birth coverage, but the computer system DCF used to determine eligibility was not updated to comply with the expansion. Instead, the state automatically deemed women ineligible for coverage without giving them the context they’d need to challenge the decision.

Roberts did not say how many women lost coverage due to the state’s failures. The agency became aware of the glitch in April 2023, he said. One of the mothers suing the state, he confirmed, was still being deprived of her post-birth coverage as of earlier this year.

“Previously, we gave women two months of post-partum coverage,” Roberts said. “That was changed to 12 months. From what I understand, when you refer to this glitch, the system had reverted back to giving women two months rather than the 12 months they were entitled to.”

He said the state has since fixed the error.

Florida Policy Institute chief executive officer Sadaf Knight told The Tributary in an email that public-health advocates have suspected the state hadn’t properly implemented its post-birth Medicaid expansion since soon after it passed.

“Years later, we hear confirmation of what many on-the-ground health organizations and new parents have known to be true: the state agencies responsible for implementing this life-saving policy have failed to update their computer systems or train frontline staff adequately,” Knight emailed. “A law only represents change for families if it is competently implemented.”

Her organization, she said, wants the Legislature to hold a hearing on the implementation of the Medicaid policy.

Every state in the U.S. began rapidly shaving people from their Medicaid rolls after the March 2023 end of a COVID-era emergency rule that stopped states from canceling residents’ eligibility.

That effort to begin redetermining Medicaid eligibility is commonly known as the “unwinding”.

Since the start of the Medicaid unwinding process, Florida has disenrolled beneficiaries at the 14th highest rate among all U.S. states, according to KFF’s analysis of state-by-state data as of March.

The post-partum eligibility glitch wasn’t the only system error the state encountered when it began its unwind, Roberts testified. Some errors affected other criteria for Medicaid eligibility.

“There were things that we found once unwinding started – unwinding, when we could start taking action on Medicaid eligibility – there were other system issues that we found,” he said, though he couldn’t recall extensive detail on those other errors.

Separate from outright computer errors, Roberts’ testimony on Monday also suggested that in at least some cases, DCF used and still uses outdated or outright inaccurate information to determine basic facts like a Medicaid recipient’s household size and income level…

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Mass General Brigham Lands $4.6M To Study Rehab Care At Home

Home Health Care News | By Joyce Famakinwa

Mass General Brigham has been awarded a $4.6 million grant to examine the delivery of short-term rehab care at home as an alternative to skilled nursing facilities (SNFs).
The funds come from the Massachusetts Executive Office of Health and Human Services (EOHHS).

In the U.S., 40% of older adults leaving the hospitals need some form of post-hospital care. Roughly half of them get this care in an inpatient SNF, according to data from The Medicare Payment Advisory Commission (MedPAC).

“Our skilled nursing facility and post-acute care institutional settings do not work as we all would like them to,” Dr. David Levine, clinical director for research and development at Mass General Brigham’s Healthcare at Home, told Home Health Care News. “A quarter of people in America who get care in a post-acute facility will have an adverse event, for example. Some studies put it even higher than that. We don’t want to send people to a place where 25% of the time something wrong is happening. We’re looking for a better way, and rehab at home is a possible way, but needs to be tested.”

Levine is the principal investigator of the study Mass General Brigham will be conducting.
Mass General Brigham will examine the delivery of short-term rehab care at home by conducting a randomized control trial. Half the patients in the study will enter a SNF, and the other half will go home with Mass General Brigham’s specialized rehab-at-home team.
The patients that are part of the second group will see a nurse, certified nurse assistant, physician and home health aide as part of their admission into the study. Their care plan will also include daily remote physician and in-home certified nurse assistant visits, as well as physical, occupational and speech therapies, if needed.

Plus, they have access to 24-hour, in-home response from mobile integrated health paramedics.

The study will include 300 patients from five acute care hospitals across Boston.

“It’s the first opportunity ever, in the country, to really demonstrate this care model in a very robust way — to see if it’s helpful for patients and caregivers and clinicians,” Levine said.
If the results of the study are positive, it could lead to creation of a more permanent rehab care at home program at Mass General Brigham.

Levine pointed to the evolution of the hospital-at-home model, seeing it as an example of how the rehab care at home program could grow in the near-term future…

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Why Home Health Providers Should Expect to See a ‘Less Draconian’ Final Payment Rule

Home Health Care News | By Joyce Famakinwa

As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule.

“We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.”

Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.

“Our focus more than anything else is remedy coming by way of Congress,” Dombi said. “If we run the clock back 365 days, we had a Congress that was telling us, very overtly, ‘We will not help you.’ They were telling us that because they believed [providers] were making too much profit in the Medicare program. They were not understanding how the business runs. They weren’t understanding how any margin [providers] got was subsidizing other government programs like Medicaid and Medicare Advantage. They now understand it.”

Dombi credits a meeting the organization had with Sen. Ron Wyden (D-Ore.), which took place in Portland, Oregon and included five home health agency representatives from the state.

“Senator Wyden asked the question: ‘MedPAC says your margins average 22%, are those numbers wrong or has something changed?’” Dombi said. “One agency representative immediately spoke up and said, ‘the numbers are wrong and things have changed for the worse.’ He started explaining what happened within his home health agency. Now Senator Wyden is working with us to help us bring about some positive legislative changes.”

Dombi noted that there is already pending legislation.

Still, working with Congress isn’t the only way NAHC plans to address the issue. The organization is still moving forward on its plan to sue the Department of Health and Human Services.

“The action plan continues with this litigation,” Dombi said. “This litigation does not give us quick remedies. My estimate is if we succeed in the first round, we will be facing an appeal by the government. If we lose, they’ll be facing an appeal. Then there’s still the step above that — the U.S. Supreme Court. This kind of litigation may take many years to get through.”

However, Dombi believes that last month’s Supreme Court decision, which struck down the Chevron doctrine, may help NAHC’s lawsuit…

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US Judge Elects Not To Block Non-Compete Ban, Spelling Trouble For Home Care Providers

Home Health Care News | By Andrew Donlan

A U.S. judge decided not to block the Federal Trade Commission’s (FTC) ban on non-compete agreements this week, continuing an ongoing saga that home care providers are paying close attention to.

Broadly, the ban on non-competes is seen as generally positive for home care leaders, who can now freely move on to better career opportunities. It likely won’t affect caregivers much, as many already work for more than one agency.

Where it will likely have an effect, however, is in non-solicitation agreements. Those keep clients from using home care agency caregivers, and then ultimately hiring those caregivers directly and cutting out the agency. A non-solicitation is different from a non-compete, of course, but some states are already viewing them in the same light, which could be a major threat to home care operators.

The FTC in April banned non-competes in a 3-2 vote. It was a major change in direction, specifically because non-compete laws were historically handled on a state level. Some states – like California and Connecticut – already had very strict laws against non-compete agreements. Other states were less strict.
But this ban comes from the federal level.

“The rulings and the positions are going beyond just the traditional non-compete agreement into client service agreements that have direct-hire provisions or penalty provisions not allowing the client to hire the caregiver away,” Angelo Spinola, the home health, home care and hospice chair at the law firm Polsinelli, recently told Home Health Care News. “That’s a big concern with what the FTC is doing – that they’re going to take that position and apply the term non-compete very broadly. If you look at the language of the final rule, it absolutely suggests that’s going to be their enforcement position.”…

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CMS Issues Home Health Claims Processing Fix

NAHC Report

The Centers for Medicare & Medicaid Services has issue Change Request 13684 that provides instructions to the Medicare Administrative Contractors (MACs) to ensure home health claims submitted more than 24 months from the date of admission are not returned in error due to Notice of Admission records being purged from the Fiscal Intermediary Shared System (FSS).

During the processing of a Home Health (HH) prospective payment system claim, the claim is matched to the corresponding Notice of Admission (NOA) to determine the NOA receipt date. The NOA receipt date is then used to apply any applicable late NOA penalty to the claim payment. The NOA receipt date is stored in FISS in the HRAP (Request for Anticipated Payment) file). If an NOA receipt date is not found in the HRAP file, the claim is returned to the provider with reason code 19963.

Previous instructions stated where a corresponding NOA cannot be found and the claim From date is 24 months or more after the claim Admission date, the contractor shall send the claim Admission date to the HH Pricer in the RECEIPT DATE field.” In these cases, the NOA is assumed to have been received in the past and subsequently purged. However, a claim may have a From date within 24 months of the Admission date but a Through date that falls after 24 months. In these cases, the claim cannot be processed because the NOA will be purged.

This CR revises the criteria for reason code 19963 to send the claim Admission date to the HH Pricer in the RECEIPT DATE field in these cases also. Several home health agencies have reported a significant number of claims impacted by this issue claims and have had to rely on intervention by the MACs.

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