Impending Onset of Medicare Home Health Clawback Payments Gnaws at Providers

McKnight’s Home Care | By Liza Berger
 
Home health providers have been laser-focused in recent months on the permanent Patient-Driven Groupings Model payment cut — 3.925% — which went into effect on Jan. 1. But there is a looming cut that threatens even more instability for providers: the temporary clawback payments related to PDGM. These reductions, which are expected to total at least $3 billion, may take effect as soon as next year.  
 
“I can’t say you can rate one as scarier than another,” Bill Dombi, president of the National Association for Home Care & Hospice, said of the permanent and temporary cuts to McKnight’s Home Care Daily Pulse. “In combination, they are a disaster.”
 
Capstone, a global policy analysis and regulatory due diligence firm, might agree. In a recent policy analysis of “underappreciated developments in healthcare in 2023,” it found that temporary clawbacks in 2024 “represent a potentially larger threat to home health,” than a cut to the market basket.
Other home health leaders have voiced serious concerns about the clawback payments.
 
“We are very, very concerned about what happens in ’24,”  Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, told McKnight’s Home Care Daily Pulse. “It’s not a positive picture at all for home health. It’s pretty dire. They are significant reductions to the Medicare home health program. They won’t be implemented without significant harm to patient access.”
 
It’s not clear yet exactly how much money home health will owe from the temporary cuts related to PDGM overpayments and when. The proposed home health rule, which is due out this summer, will give providers a glimpse of what CMS is planning and how it intends to levy the adjustment, Cunningham said.
 
“The heat is dialed up now that we are looking at 2024,” she said. “We should see in rulemaking exactly how they are going to extract those [payments], which they didn’t do in 2023.”
 
The temporary PDGM cuts, like the permanent reductions, are a result of CMS’ overpayments to home health as a result of the transition from the old payment to PDGM in 2020. Home health providers likely owe at least $1 billion each year between 2020 and 2022. Both NAHC and the Partnership disagree with the methodology that CMS used to arrive at the overpayment figures.
 
This year, both organizations are going to continue to argue this point to members of Congress. They believe they have convinced Congress of their position somewhat, as the recent omnibus bill, which passed into law, required CMS to provide transparency around how it arrives at rate cuts.
 
Dombi thinks it is unfair to target traditional Medicare home health for cuts as the program helps to subsidize the underpayment from Medicaid and Medicare Advantage. His organization is pushing CMS to suspend all cuts in 2024 until there is a recognition of a need to fundamentally overhaul the payment system.
 
“We need to create a bridge between today and tomorrow without disruption,” he said.

CDC Launches Website to Help Consumers Find Free COVID-19 Testing Sites

Today CDC launched the COVID-19 Testing Locator website, which will allow consumers to search for free COVID-19 testing sites near them. The locator is part of the CDC Increasing Community Access to Testing (ICATT) program, which provides access to COVID-19 testing, focusing on communities at a greater risk of being impacted by the pandemic, people who do not have health insurance, and surge testing in state and local jurisdictions.

Tests offered may include laboratory-based nucleic acid amplification tests (NAATs), including polymerase chain reaction (PCR) tests, and rapid antigen point-of-care (POC) testing. Results are typically provided within 24–48 hours. Testing is available at pharmacies, commercial laboratory sites, community sites, and retail locations.

COVID-19 testing is available at no-cost at ICATT sites to people with or without health insurance who are experiencing symptoms or have been exposed to someone with COVID-19. The tests are billed to third-party payers, such as Medicare, Medicaid, and private health insurers. People without health insurance do not have to pay for COVID-19 testing at ICATT locations. Consumers can access the Testing Locator at testinglocator.cdc.gov.

Year-End Funding Package Includes Medicare and Medicaid Policies

Medicare Rights Center | By Lindsey Copeland

In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal year (September 30, 2023) and makes several important changes to Medicare and Medicaid.

Medicare

Medicare Telehealth

PHE Waiver Extension—The bill extends most of the COVID-19 public health emergency (PHE) Medicare telehealth flexibilities through 2024 and directs the Department of Health & Human Services (HHS) to study telehealth utilization and assess potential fraud.

Medicare Mental Health Care

Provider Expansions—Medicare mental health coverage has known gaps, which the spending bill helps close. One long-sought change will allow Medicare Part B to cover services provided by marriage and family therapists and licensed professional counselors beginning January 1, 2024.

Intensive Outpatient Services—To further ease access, the package revises Medicare’s partial hospitalization benefit to establish coverage of intensive outpatient services beginning January 1, 2024.

Crisis Psychotherapy Services—It also increases payments for mobile crisis care (crisis psychotherapy services furnished by a mobile unit or in other non-facility settings) starting on January 1, 2024.

Workforce Development—It provides for 200 new Medicare-supported graduate medical education (GME) residency positions, half of which are allocated for psychiatry and psychiatry subspecialties.

Provider Outreach—To promote uptake, the omnibus requires HHS to educate providers on the availability of crisis psychotherapy services, behavioral health integration services, and opioid use disorder treatment services under Medicare.

COVID Treatments—The bill temporarily (through December 2024) allows Part D plans to cover oral antiviral treatments that have an emergency use authorization (EUA). This update will permit Medicare to cover COVID-19 treatments like Paxlovid once the PHE ends and those products shift to the commercial market.

Medicare Coverage Changes and Extenders

Lymphedema Compression Garments—Under the bill, compression garments for the treatment of lymphedema will be covered under Part B as durable medical equipment (DME) starting in January 2024.

In-home intravenous immune globulin services (IVIG)—It also provides permanent Medicare coverage for items and services related to the administration of IVIG, beginning on January 1, 2024.

Durable Medical Equipment—The omnibus continues the blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non-competitive bid areas through 2023.

Hospital at Home Waiver—It extends (through December 31, 2024) the Acute Hospital Care at Home initiative.

Medicaid

Medicaid Home- and Community-based Services (HCBS)

Money Follows the Person and Spousal Impoverishment—The bill continues the Medicaid Money Follows the Person program and protections from spousal impoverishment for people receiving HCBS through September 30, 2027. These critical Medicaid policies that we have long supported help older adults and people with disabilities live with choice, dignity, and independence.

Medicaid PHE Coverage

Continuous Coverage Requirement—The omnibus sunsets the Medicaid continuous coverage requirement. Created in 2020 by the Families First Coronavirus Response Act (FFCRA), this provision has allowed states to maintain their Medicaid rolls in exchange for a 6.2% federal match rate (FMAP) bump. The FFCRA tied this coverage policy to the duration of the PHE; it will now end on April 1.

At that time, the enhanced FMAP will begin to reduce gradually, eventually reaching zero on December 31, 2023. The maintenance of effort (MOE) requirements tied to the FMAP increase—that states may not make eligibility standards, methodologies, or procedures for determining Medicaid eligibility more restrictive than they were on January 1, 2020—will continue to apply during the phase-down period.

Medicaid Eligibility and Funding

Enhanced Eligibility Postpartum and for Children—The bill also requires states to give children (under the age of 19) 12 months of continuous coverage in Medicaid and CHIP and permanently extends the American Rescue Plan policy allowing states to provide 12 months of postpartum coverage to pregnant individuals in Medicaid and CHIP.

Funding for the U.S. Territories—The omnibus extends Puerto Rico’s higher federal Medicaid match (76%) through September 30, 2027, and permanently extends a higher federal match (83%) for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. These updates will provide much-needed consistency and fiscal stability.

Elimination Of Non-Competes Would Have ‘Major’ Effect On Home-Based Care World

Home Health Care News | By Andrew Donlan
 
In early January, the Federal Trade Commission (FTC) proposed a ban on non-compete agreements nationwide.
 
The rule is likely to be finalized. When and if it does, it is also likely to have a massive effect on the home health and home care industries.
 
Such a move would not just hurt companies by allowing leaders to jump ship, but it would also muddy the waters on a slew of contractual agreements between caregivers and clients.
 
“I definitely think it’s major. It’s extraordinarily significant,” Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, told Home Health Care News. “If you can’t stop a key executive from leaving and competing against you, that will have a significant impact on the industry.”
 
The proposed rule can be traced back to the Biden administration’s Aug. 2021 request to the FTC to take a longer look at restricting or banning non-compete agreements. Broadly, the idea was that non-competes restricted workers’ mobility and ability to make a livable wage.
 
It seemed at the time that President Biden was referring to low-wage workers specifically. And while this would have an effect on, for instance, the caregiver-provider relationship, it would also be a major shake-up in what home-based care leadership could do when looking for new opportunities.
 
For instance, Spinola offered up the example of a home health administrator. They could be trained up by a home health organization, promoted and given access to all the patient data and pricing of an organization.
 
“Now that individual says, ‘You know what, I’ve got all the relationships. And I’ve been collecting a salary from the owner. But now I’m just going to go across the street, and I’ll open my own agency. I’ll wait for those clinicians to call me and start working with me. And the relationships I’ve developed with the facilities and those referral relationships, I’ll just bring those over,” he said.
 
Home-based care leadership has already been in disarray, to a certain extent. Big-time executives have either left their posts or been forced out in the wake of COVID-19 and other unfavorable market conditions.
 
If the FTC ruling becomes final, that could become even more so the case.
 
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