A bill designed to keep the federal government funded through March 23 has several provisions involving home health, including revisions to the face-to-face requirement and the addition of a new payment model similar to the Home Health Groupings Model (HHGM).
The House is expected to vote today on the bill, which was filed Feb. 5.
Among the home health-related items within the bill:
- A revised payment system launching Jan. 1, 2020. The payment system would include a budget-neutral transition to a 30-day unit of payment for home health. It also would eliminate the use of therapy thresholds in case-mix adjustment factors for calculating payments.
- Rural-add on payments are extended to continue in 2018. Then they’d change. The payments, beginning in 2019, would depend upon population density and the area’s usage of home health services. The payments would be reduced over time.
- Revisions to the face-to-face requirement.
- Market basket reduction. The bill says the market basket “for 2019 shall be 1.4%.”
There’s still some question about this.
Bill Dombi, president of the National Association for Home Care & Hospice, says there will be a technical correction and the bill will say the market basket for 2020 shall be 1.4%. The bill also would eliminate a productivity adjustment.
Over a 10-year period, that might result in a payment reduction for home health of about $1.5 billion to $1.75 billion, Dombi says.
Face-to face-documentation update
One thing the bill states that agencies are sure to like: Reviewers “may” use documentation in the medical record of the home health agency as supporting material to justify that the patient is homebound and requires skilled care.
NAHC is working to have the word “may” replaced with “shall.”
“This language would let reviewing entities know they should consider agency-generated documents as part of the totality of the record, says Joe Osentoski, reimbursement recovery and appeals director with Quality in Real Time (QIRT) in Troy, Mich.
The current requirement states that information from the agency must be corroborated “by other medical record entries” and align with the time in which services were rendered, he says. The certifying physician must review and sign off on anything incorporated into the medical record that’s used to support the certification of patient eligibility.
Many agencies don’t currently attempt to provide supplementary materials to physicians to corroborate information, Osentoski says.
The goal of the change would be for the physician to not have to sign off on and incorporate the agency’s documentation into the record, Dombi says.
The bill states that “in addition to using documentation in the medical record of the physician who so certifies or the medical record of the acute or post-acute care facility … the Secretary may use documentation in the medical record of the home health agency as supporting material, as appropriate to the case involved.”
“This should be a help to agencies’ efforts to meet eligibility requirements,” Osentoski says.
While that’s true, it comes with a caveat that agencies must ensure their own clinicians do a good job documenting information that shows the patient is homebound and requires skilled care, says attorney Elizabeth Pearson of Pearson & Bernard in Edgewood, Ky.
“They really need to have some serious in-servicing of their clinicians and of their contracted therapists,” she says. “That’s the one that worries me the most because you have very little control of those people.”
Documentation should clearly state the reason home health is necessary, such as that the patient is in need of physical therapy to assist with balance and strengthening to avoid future falls (HHL 4/11/16
). It should specifically reference the patient’s physical condition and need for assistive devices.
The agency should make sure to include a statement that links the patient’s condition to the patient’s homebound status. For example, the agency could write, “Patient is homebound due to [patient condition], which requires [assistive device] and [further description of physical limitations which limits patient’s ability to leave the home].”
Bill recommends appeals settlements
The new bill also notes that no later than one year after the date of enactment, HHS’ Secretary shall establish a settlement process involving home health claims denials.
Many of the denials being appealed involve issues related to the face-to-face requirement.
When establishing a settlement process, HHS’ Secretary “shall consider” the settlement amount used for CMS’ hospital appeals settlement that began in 2014 — 68% percent of the net payable amount, according to the bill.
Agencies should strongly consider taking such an offer, Osentoski advises.
In an unrelated settlement option that currently exists for many home health agencies — the Low Volume Appeals (LVA) option — CMS would settle eligible appeals at 62% of the net allowed amount.
Bill would change rural add-on payments
Several Medicare policies expired without Congressional action by the end of 2017, including 3% add-on payments for rural agencies.
The new bill would continue the 3% add-on payments for 2018, Dombi says.
But beginning in 2019, rural add-on payments would change and be reduced over time.
Agencies in rural counties with the greatest usage of home health would receive 1.5% add-on payments during 2019 and 0.5% add-on payments during 2020.
Agencies in counties with a population density of six people or fewer per square mile would receive 4% add-on payments in 2019, 3% in 2020, 2% in 2021 and 1% in 2022.
Agencies in other rural counties would receive 3% add-on payments in 2019, 2% in 2020 and 1% in 2021.
“You’re going to lose providers and access to providers in those rural areas because of those cuts,” Pearson contends.
Under the bill, the HHS Office of Inspector General (OIG) would report to Congress no later than Jan. 1, 2020, and annually thereafter through Jan. 1, 2024, a report that includes a recommendation about whether rural add-on payments should continue to be made based on county data.