MedPAC Explores Standardized Plan Options in Medicare Advantage

Fierce Healthcare | By Robert King
 
Affordable Care Act (ACA) plans may not be the only ones to introduce standardized options, as a key advisory panel wants to apply a similar strategy to the popular Medicare Advantage (MA) program. 
 
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, is researching how standardized benefit options would work for MA. The goal is to include the findings in an annual report to Congress next year and explore how standardization could help simplify choice for seniors. 
 
“I think there’s some reasonable evidence about the challenges of choice,” said Michael Chernew, the commission chair, during the panel’s Thursday meeting.
 
MA plans are required to offer services under Medicare Parts A and B, but there are some differences based on cost-sharing and other supplemental benefit packages. The MA program has gained in popularity in recent years and with it an abundance of plan choices for seniors.
 
Commission staff gave an example of how standardized benefit packages work by breaking out three options based on how generous they were for cost-sharing. What types of plans would be subject to the standard package would have to be decided and could be vital.
 
“This requirement would aim to ensure a minimum level of access to standardized plans, but its impact could be limited if the plans that insurers are required to offer are unpopular,” said MedPAC staff member Eric Rollins.
 
Letting insurers offer both nonstandardized and the standard options could also help reduce any disruption for existing enrollees but could reduce any gains from standardization, he added. Only offering the standardized benefit plans, on the other hand, could cause too much disruption.
 
There could be a benefit to insurers, though, by avoiding paying a broker that guides seniors through different plan options. 
 
“There’s a huge financial incentive for them,” said commission member Lynn Barr.
 
However, some commission members were concerned about the impact standardization could have on plan innovation. 

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Home Health Referrals Skyrocketed, Patients Became More Complex During Pandemic

Home Health Care News | By Patrick Filbin

As predicted by many at the onset of the pandemic, home health providers gained a larger share of post-acute referrals in recent years than they did prior to COVID-19.

At the same time, data shows that patients coming to post-acute care are sicker and have more complicated care needs than before, all while staffing shortages continue to put a strain on home health agencies.

A new report from the post-acute technology company WellSky shows that by May 2022, home health referrals were at 123% of what they were in 2019.

The COVID-19 emergency added value to, and demand for, home-based care delivery. The industry should expect that demand to stick.

“As you start to bring to bear science on the discharge dynamic, you will continue to see a growing number of patients moving into home-based care settings,” Tim Ashe, chief clinical officer at WellSky, told Home Health Care News. “Complex care plans can be safely delivered effectively and efficiently at home.”

Referrals staying near 123% of 2019 might not be a realistic expectation, Ashe said. But now that the industry is removed from the worst of the pandemic, there is still plenty of room for growth.

“I don’t know what the growth rates are going to be, but I personally anticipate continued growth,” Ashe said. “That’s going to take some investments in the infrastructure across the home health industry. How do we make sure the tide is rising so that all providers can provide care at scale to complex patients?”

One of those solutions could be the Choose Home Care Act of 2021, a piece of legislation that — among other things — supports in-home care alternatives to skilled nursing facilities (SNFs).

The bipartisan bill is currently in limbo in Washington D.C., but would be a vehicle of relief for SNFs and a boon for home health agencies.

That’s particularly relevant given the WellSky report also found that during the first quarter of 2022, referral rate rejection among home health referrals climbed to 71% due to a lack of staff.

“That’s a direct result of staff capacity,” Ashe said. “Those rejection rates are concerning. It goes back to enabling the industry to scale and incent professional and paraprofessional care providers to come into the industry because it is a really attractive space. We just need to solve some of those economic and potential safety issues that I think were highlighted during the pandemic.”

Even if home-based care demand rises, without the corresponding staff capacity, that demand could be all for naught.

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Special Report — Complying with Wage and Hour Regulations (Part 3 of 3)

The SESCO Report July/August, 2022 (Part 3 of 3)

Common Misconceptions and Compliance Issues

SESCO is available through a Professional Service Agreement or through a per diem fee to conduct a thorough Wage and Hour as well as HR and employment law audit. Contact SESCO to learn more about our Professional Service Agreement and services provided to clients in all industries across the country — [email protected] or 423-764-4127.

Calculating Overtime

Misconception 8: We have multiple locations and at times require our employees to travel to other sites during their work day. We require them to clock out when they leave and clock back in when they arrive at the new location. As such, we do not have to pay for this drive/non-working time. Travel to and from work or travel outside the normal work day is generally not considered compensable time. However, travel time must be counted as hours worked to include:

• It is time spent traveling from one work site to another
• It is driving even after hours to fulfill an employer's requirements or requests such as going by the bank on the way home
• If the employee has gone home from work for the day but is called out again to travel, this would be compensatory.

Misconception 9: Sometimes we offer training to our employees. Since we are paying for the training and they are not doing any work, we do not have to pay our employees. Anytime an employer requires an employee to attend training during working hours, that time will be considered working time. Training is not considered hours worked if all of the following conditions are satisfied:

• Meetings are held outside of hours worked
• Employee attendance is completely voluntary
• If an employee does not show they are not disciplined in any way
• The training is not directly related to the employee's job
• The employee does no work during the training time
• The course or training is held after work hours and is not a requirement of the job even if the subject matter pertains to the job.

Misconception 10: We have to use a time clock or electronic timekeeping system to keep track of the hours of our nonexempt employees.

The DOL states that employers may use any timekeeping method that they choose. This would include allowing employees to record their hours of work by hand. Regardless of the method, SESCO always recommends that the employee and manager/HR Director sign off agreeing that true and accurate hours of work have been recorded.

Misconception 11: Our company supports our community in a number of different ways to include supporting charities. We recommend to our employees that they should volunteer. As it is not working time, we do not have to pay them.

Charitable work performed at the employer's request as part of the job or during working hours is considered work time. Charitable work/volunteering will not be considered hours worked if:

• It is completely voluntary (even if the program is sponsored by the employer)
• It is performed outside of scheduled working hours

If employees get the impression that their jobs would be in jeopardy in any way or that they would receive fewer perks for failing to contribute to charity work, a court could say that the hours were not voluntary but were coerced. In addition, employees cannot perform volunteer work for an organization that employs them if the work is similar to that for which they are paid.

Misconception 12: We pay our employees bonuses and incentives for things such as meeting production goals, good attendance, good safety goals, etc. We are not required to pay overtime on these additional earnings.

There are technically two (2) different types of bonuses which include discretionary and non-discretionary. Discretionary bonus payments are completely that, discretionary. These bonuses are not communicated to employees, employees are not working towards accomplishing goals to receive the bonus and these bonuses are not regular and recurring. Typically defined discretionary bonuses which would not be required in overtime calculations are such as Christmas bonuses. Non-discretionary bonuses are required to be included in overtime payments. Non-discretionary bonuses are bonuses that incentivize an employee's behavior or production. These monies must be included in the regular rate for the purposes of overtime. Even if these non-discretionary bonuses are paid on a monthly, quarterly or even an annual basis. An employer is required to go back and roll these non-discretionary bonuses into each workweek and calculate overtime on these bonuses. If your organization pays these non-discretionary bonuses to employees, you should contact SESCO to learn more about the calculation of overtime as well as request SESCO's staff recommendation which will provide an "easy" method to calculate the overtime due.

Given Regulatory Uncertainty, Hospital-At-Home Models Are Losing Momentum

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) gave health systems and providers the ability to take hospital at home as a concept and run with it during the public health emergency (PHE).
 
Those providers did so, and now they’re wondering what comes next. With regulatory uncertainty moving forward, the hospital-at-home momentum has been put on pause – but not because of patient preference or provider enthusiasm.
 
“There is over 250 hospitals and 100 health systems across 30-plus states that have now been granted CMS waivers,” Biofourmis CMO and co-founder Maulik Majmudar said on a Moving Health Home webinar Tuesday. “However, it is also clear that a sizable part of the country does not have any offerings today. And more importantly, the number of CMS waivers granted in the last few months has been on a decline.”
 
The Boston-based Biofourmis is a tech-enabled at-home care enabler. The startup recently reached unicorn status.
 
Indeed, there are plenty of hospitals that have been approved to provide hospital-level care in the home under the CMS waiver. But many have not begun to do so given the regulatory cliff they face. The Acute Hospital Care at Home waiver is tied to the PHE, which could be ending by the end of this year.
 
Some health systems have found other mechanisms to provide hospital-at-home care independent from the waiver. There is also introduced legislation that would extend the Acute Hospital Care at Home waiver by two years past the PHE. But nothing yet has been set in stone.
 
And thus leads to the halted momentum: only two hospitals in the country have treated more than 2,000 patients under the hospital-at-home waiver, according to Majmudar.
 
“The key point is that there’s a lot of opportunity and room for technology to drive both safe and effective deployment of these programs, but especially in a way that allows us to achieve scale,” he said.
 
The resulting hesitation from the regulatory holdup has spurned innovation, and also providers’ ability to learn from their mistakes on the fly as they scale.
 
At the same time, there are health systems – like Advocate Aurora Health, for example – that love the opportunity to provide this care in the home, but not exactly as its allowed right now under the waiver.
 
“We certainly support the continuation of the waiver,” Dawn Doe, the VP of value-based programs and continuing health at Advocate Aurora Health, also said on the webinar. “But we ask for more flexibility on the structure, and the entities that can provide the program, for us as an integrated health system.”
 
For instance, as currently constituted, the waiver makes it so Advocate Aurora Health is forced to have its 27 hospitals all have different hospital-at-home programs.
 
That, Doe said, just doesn’t make sense for Advocate Aurora based on how it’s structured.
 
“We would like to see reimbursement models that really provide patients the ability to stay in their home while avoiding expensive institutional care,” Doe said. “And that the waivers for telehealth and remote monitoring reimbursement be made permanent. This not only improves patient outcomes, but will also address the strain on staffing resources.”

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