CMS Pulls Back COVID-19 Vaccination Requirement 

CHAP

The following final rule was posted on the Federal Register Public Inspection desk on 5/31/2023. 

This final rule from CMS withdraws the regulations in the interim final rule with comment (IFC) “Omnibus COVID-19 Health Care Staff Vaccination” published in the November 5, 2021, Federal Register.  The regulations in this final rule are expected to be published in the Federal Register on June 5, 2023, and are effective 60 days after publication, or on Friday, August 4, 2023. Until the effective date, the requirement for staff to be vaccinated against COVID-19 or documented as exempt is in effect and will be assessed during a compliance survey.

Specific provider-specific regulations that will be removed by the effective date include:

Home health: § 484.70(d) 
§ 484.70(d) Standard: COVID–19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID–19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID–19. The completion of a primary vaccination series for COVID–19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. 

Hospice: § 418.60(d) 
§ 418.60(d) Standard: COVID–19 Vaccination of facility staff. The hospice must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID–19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID–19. The completion of a primary vaccination series for COVID–19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine.

Home Infusion Therapy: § 486.525(c)
§ 486.525(c) COVID–19 Vaccination of facility staff. The qualified home infusion therapy supplier must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID–19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID–19. The completion of a primary vaccination series for COVID–19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine.

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Denials of Health Insurance Claims are Rising—and Getting Weirder

Fierce Healthcare / By Elisabeth Rosenthal
 
Millions of Americans in the past few years have run into this experience: filing a health care insurance claim that once might have been paid immediately but instead is just as quickly denied. If the experience and the insurer’s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims—sometimes bundles at a time—without reviewing the patient’s medical chart. A job title at one company was “denial nurse.”
 
It’s a handy way for insurers to keep revenue high—and just the sort of thing that provisions of the Affordable Care Act (ACA) were meant to prevent. Because the law prohibited insurers from deploying previously profit-protecting measures such as refusing to cover patients with preexisting conditions, the authors worried that insurers would compensate by increasing the number of denials.
 
And so, the law tasked the Department of Health and Human Services (HHS) with monitoring denials (PDF) both by health plans on the Obamacare marketplace and those offered through employers and insurers. It hasn’t fulfilled that assignment. Thus, denials have become another predictable, miserable part of the patient experience, with countless Americans unjustly being forced to pay out-of-pocket or, faced with that prospect, forgoing needed medical help.
 
A recent KFF study of ACA plans found that even when patients received care from in-network physicians—doctors and hospitals approved by these same insurers—the companies in 2021 nonetheless denied, on average, 17% of claims. One insurer denied 49% of claims in 2021; another’s turndowns hit an astonishing 80% in 2020. Despite the potentially dire impact that denials have on patients’ health or finances, data show that people appeal only once in every 500 cases.
 
Sometimes, the insurers’ denials defy not just medical standards of care but also plain old human logic. 

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Why Palliative Care Offerings Can Be A Differentiator For Home Health Providers

Home Health Care News / By Joyce Famakinwa
 
With a tricky payer landscape and lower margins, palliative care isn’t always the most obvious investment for home health providers.
 
However, providers that have gained a foothold in the palliative care space have seen strong clinical value in it.
 
Broadly, palliative care is both an approach to care, as well as an actual medical subspecialty, according to Rory Farrand, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization (NHPCO).
 
“The goal of palliative care is to improve the quality of life for people living with serious illness, whether that illness is going to be life limiting, terminal, or just something that’s really serious,” she told Home Health Care News. “Our objective is to manage pain, symptoms and provide other types of support, depending on a person’s individual situation or their specific needs.”
 
The Washington, D.C.-based NHPCO is the largest membership organization for providers and health care professionals who care for people affected by serious and life-limiting illness.
 
Oftentimes, palliative care is conflated with hospice care services.
 
“The biggest difference between palliative care and hospice is that [the former] can be provided at the same time someone is receiving curative care or disease modifying therapies like treatments for cancer or dialysis,” Farrand said.
 
Palliative care is sometimes operated by home health or hospice companies — 41% of home-based palliative care programs are operated by hospice agencies and 7% are operated by home health agencies, according to Center to Advance Palliative Care and Palliative Care Quality Collaborative data.
 
Still, the reimbursement landscape for palliative care isn’t always as straightforward as it is for home health or hospice.

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LHC Group, VNS Health, Curana Execs On How To Take ‘Baby Steps’ Into Value-Based Care

Home Health Care News / By Patrick Filbin
 
Post-acute care has steadily been shifting toward value-based care and away from fee-for-service payment models. But despite the fact this trend is years in the making, many home health providers are still asking themselves, “How do we get started?”
 
Executives from four different post-acute and value-based care-focused organizations explored that question on Tuesday during a webinar conversation hosted by the health care technology company Netsmart.
 
“If you’re starting right now, partnering with another organization — especially the payviders — is a great place to start,” Devin Woodley, vice president of managed care contracting at VNS Health, said during the panel. “We’re empathetic towards the provider side. We understand what providers are looking for and where they’re trying to go. Partnering with a payvider or a consultant is the best place to start in order to take those steps in the right direction.”
 
The New York-based VNS Health is one of the largest and oldest nonprofit home- and community-based health care organizations in the U.S. The company’s service offerings include home health, hospice, personal care, palliative care services, mental health support and more.
 
In health care, the term “payvider” refers to an organization that operates both as an insurer and a provider of services. Take Humana Inc. (NYSE: HUM), which has CenterWell and then its insurer arms, as an example.
 
About 25 years ago, VNS Health also built out its own health plan. With over 35,000 members, it’s now where most of the company’s revenue comes from.
 
By partnering with a payvider like VNS Health, Woodley said providers can avoid a lot of the pitfalls that come in the early days of value-based contracting.
 
Finding the right value-based partner with similar expectations is another key component in establishing a presence in value-based care, Amy Kaszak, EVP of strategic initiatives at Curana, said during the webinar.
 
“Finding a partner that will meet you where you are [is also important] so your first step doesn’t have to be into the deep end,” Kaszak said. “There are more ways to do that today like Medicare Advantage plans and smaller organizations focused on the populations that you care for – that’s a great place to start.”

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