Home Health Agencies Should Brace for PDGM Battle Later This Year

Home Health Care News / By Patrick Filbin
 
Home health providers should brace themselves for a potential Patient-Driven Groupings Model (PDGM) battle with the U.S. Centers for Medicare & Medicaid Services (CMS) later this year.
 
Implemented on Jan. 1, 2020, PDGM is the largest overhaul to how Medicare-certified home health agencies are paid in two decades. And normally when CMS implements something of this magnitude, there are ongoing tweaks and changes to make sure reimbursement is fair to both the government and providers.
 
That balancing act is even more important with PDGM, which must be budget neutral, as mandated by Congress.
 
Yet because of the COVID-19 pandemic, any major recalibrations or corrections to PDGM’s foundation have, so far, been delayed, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi. That could begin to change later in 2022, when CMS is gearing up to release its proposed payment rule for 2023.
 
“We’ve been having those conversations for three years,” Dombi told Home Health Care News during an interview at the Capital+Strategy conference. “We had those conversations before PDGM was put into the law because we knew, going down the pike, you’re going to be seeing what we’re facing from a Medicare home health priority perspective.”
 
Typically, CMS releases its proposed payment rule in late June or early July. With two years of PDGM observations and the public health emergency starting to wane, the agency may float big adjustments at that time.
 
“The concept [of budget neutrality] is a lot easier to state than it is to apply,” Dombi said. “The application of it, right now, has been … kicked down the road for a couple of years with the explanation being, ‘The data is not yet sufficient for us to make the judgment on it.’ The data will be sufficient for 2023.”
 
Now, Dombi said, CMS will be determining what the methodology is for determining whether the budget has been neutral or not.

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In Post-Acute Care, Many Prefer to Go Home

Managed Healthcare Executive | By Ron Southwick
 
More patients are opting for home health services over skilled nursing facilities, and a new analysis expects that trend to continue.
 
In an analysis of post-acute care trends, Trella Health noted an uptick in home health instructions between 2020 and 2021, while skilled nursing instructions dipped over the same time frame. In fact, the skilled nursing industry’s struggles look to continue for the foreseeable future with no end in sight, the report states.
 
In its 2021 Post-Acute Trend Industry Report, Trella Health also pointed to the growth of Medicare Advantage enrollment, opportunities for telehealth and projections for expansion of the hospice industry. Trella Health, based in Atlanta, Ga., provides data analytics for post-acute care providers, including home health agencies, skilled nursing facilities and hospice providers.
 
After a dip due to the emergence of COVID-19, post-acute care instructions rebounded to pre-pandemic levels. Between the fourth quarter of 2020 and the third quarter of 2021, post-acute care instructions rose to 52.2%, up from 51.1% during the previous four quarters.
 
Here is a rundown of some key findings in the Trella Health report…

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A Staffing Crisis is Causing a Months Long Wait for Medicaid, and it Could Get Worse

Korra Elliott has tried to avoid seeing a doctor while waiting to get on Medicaid. She worries she can't afford more bills without any insurance coverage. But in early March — five months, she said, after applying and with still no decision about her application — a suspected case of the flu sent her blood pressure soaring and landed her in the emergency room.

The 28-year-old mother of four from Salem, Mo., is among the tens of thousands of uninsured Missourians stuck waiting as the state slogs through a flood of applications for the state-federal health insurance program. Missouri expanded the program last year after a lengthy legal and political battle, and it now covers adults who earn up to 138% of the federal poverty level — about $18,800 annually for an individual

Missouri had nearly 72,000 pending Medicaid applications at the end of February and was averaging 119 days to process one, more than twice the maximum turnaround time of 45 days allowed by federal rules. Adding people to Medicaid is labor intensive, and the jobs require training and expertise. The program covers many populations — children, people with disabilities, seniors, adults who are pregnant or have children, and some without children. Different rules dictate who qualifies.

Missouri simply doesn't have the workers to keep up. Last fiscal year, 20% of its employees who handled Medicaid applications left their jobs, said Heather Dolce, a spokesperson for the Missouri Department of Social Services. And the average number of job applications received for each opening in the department's Family Support Division — which oversees enrollment — dropped from 47 in March of 2021 to 10 in February of 2022.

Just about every industry is struggling to find workers now, but staffing shortages in state Medicaid agencies around the country come at a challenging time. States will soon need to review the eligibility of tens of millions of people enrolled in the program nationwide — a Herculean effort that will kick off once President Joe Biden's administration lets the covid-19 public health emergency declaration expire. If Missouri's lengthy application backlogs are any indication, the nation is on course for a mass-scale disruption in people's benefits — even for those who still qualify for the insurance.

"If you don't have people actually processing the cases and answering the phone, it doesn't matter what policies you have in place," said Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C.

Federal officials have said they will give states 60 days notice before ending the public health emergency, so it's unlikely to expire before summer. Once it does, enrollees won't be kicked off immediately: States can take up to 14 months to complete renewals, although budget pressures may push many to move faster. A bump in federal Medicaid funds to states, provided by Congress through covid relief legislation in 2020, will end shortly after the emergency's expiration.

Ultimately, workers are needed to answer questions, process information confirming that someone's Medicaid enrollment should be renewed, or see whether the person qualifies for a different health coverage program — all before the benefits lapse and they become uninsured.

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Biden Announces Long COVID Strategy as Experts Push for More

Washington Post / By Dan Diamond and Frances Stead Sellers 
 
President Biden on Tuesday directed government agencies to take additional steps to research and treat long covid, a condition that remains often mysterious even as it has sickened millions of Americans.
 
Under a memorandum issued by Biden, the Department of Health and Human Services will coordinate a government-wide action plan to address long covid, which is estimated to afflict anywhere from 7.7 million to 23 million Americans, according to a recent federal watchdog report.
 
The government also will issue a report in 120 days detailing available services and support for those who suffer from long covid, accelerate efforts to enroll participants in a clinical research study and pursue federal protections for people with the condition.
 
The government will expand a nationwide network of long covid clinics being run through the Department of Veterans Affairs, with officials saying they are already providing new insights on how to care for long covid patients. Federal officials will also launch a new initiative, dubbed the “Health+ project,” to solicit feedback from people living with long covid and use it to shape practices at clinics nationwide.
 
Experts who have been studying the condition, which is linked to fatigue, brain fog and other symptoms that can linger for weeks, months or even years, hailed Biden for assembling a government-wide effort to combat long covid. They said it was an overdue recognition of the condition’s impact and reach. But many also said the administration must go further in devoting resources and making long covid a priority, reiterating that millions of people are eager for immediate treatment and help.

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