By Joyce Famakinwa | September 2022

Home health stakeholders – and many others – recently had the opportunity to weigh in on the way Medicare Advantage (MA) is currently administered by the U.S. Centers for Medicare & Medicaid Services (CMS).

The National Association for Home Care & Hospice (NAHC) and Moving Health Home are among the two groups that answered CMS’ request for information.

In July, CMS released that request for information seeking public comment on the MA program. Comments were to be submitted by Aug. 31, 2022.

“The significance is that CMS is beginning to evaluate the plans more closely in terms of provider relations and approaches to health care delivery for enrollees and how the plans can improve health care services for these beneficiaries,” Mary Carr, vice president of regulatory affairs at NAHC, told Home Health Care News in an email.

Broadly, the comment period gave home health stakeholders the opportunity to affect potential future rulemaking on various aspects of the MA program. This is notable because Medicare Advantage enrollment continues to grow — having more than doubled over the last decade.

In fact, Medicare Advantage has 28.4 million beneficiaries, or 45% of the Medicare population. By 2030, Medicare Advantage is expected to have over 52% of total Medicare enrollment, according to data from the research and advocacy organization Better Medicare Alliance.

With enrollment on the rise, it’s likely that providers will become even more entangled with health plans offering Medicare Advantage. And as this happens, it’s the responsibility of providers and plans to work together, NAHC President William A. Dombi wrote in the organization’s comments to CMS.

“It is imperative that the [MA] plans and the provider community work together to ensure patient-centered, high quality health care is provided to all beneficiaries,” he said.

This comment period is also significant because it gives home health stakeholders the floor to share their point of view. In the past, providers have been vocal about the challenges surrounding MA.

Specifically, providers have struggled with receiving fair rates for the services they deliver. NAHC took the time to directly address this in their comments.

“[Providers] continue to struggle with the payment structures and payment rates for care

by the MA plan,” NAHC wrote. “MA plan reimbursement for home health services is below the cost of care in many plans. With the growing proportion of home health patients enrolled in MA, that level of reimbursement jeopardizes the ability of the HHA to continue to operate.”

Overall, NAHC addresses the questions that CMS lays out while offering recommendations. In order to make sure that all enrollees receive the care they need, NAHC suggests that CMS focus on language.

“All communications with enrollees, including service/claims determinations, should be in plain language using the medium of language best understood by the specific enrollee,” NAHC wrote.

In its comments, NAHC also criticized the misinformation surrounding MA.

“Much of the information provided to the public regarding MA plans is misleading in terms of the limitations of MA plans and benefits of choosing traditional Medicare,” the organization wrote. “Plans should be required to use uniform content and display format in describing benefits and cost within each plan. For example, CMS should require the plans to use side-by-side comparisons for cost sharing, utilization data and how provider networks differ from traditional Medicare.”

NAHC also noted that there is confusion among beneficiaries when it comes to what the individual MA plans offer.

“Enrollees may believe they are required to choose an MA plan for their Medicare benefits,” NAHC wrote. “All MA plan marketing should be subject to CMS approval for accuracy and comprehensiveness and celebrity endorsement or promotions should be prohibited. All MA plan marketing should include a reference regarding an option to enroll in traditional Medicare and include information as stated in the previous response.”

On its end, the Washington, D.C.-based advocacy coalition Moving Health Home believes that CMS should urge MA plans to provide access to in-home care through the network adequacy standards.

“The scope could focus on certain specialties where in-home care is appropriate or on specific patient populations who may benefit the most from in-home care such as high-cost, high-need patients,” the organization wrote. “The existing process for requesting an exception to network adequacy requirements should remain for those plans who are unable to offer in-home care, or who believe it is inappropriate for their patient populations.”

Moving Health Home also suggests that CMS replicate the MA telehealth bonus.

“CMS now provides a 10-percentage point credit towards meeting time and distance standards for affected providers in states that have certificate of need laws,” Moving Health Home wrote. “The telehealth and the CON credits can be combined together to reduce the percentage of beneficiaries that are within the maximum time and distance requirements. Under this option, CMS could replicate one or a combination of these policies to encourage MA plans to cover in-home services.”

In addition to this, NAHC pointed out the important role telehealth played in home health care during the public health emergency.

“The value of telehealth will continue even after the PHE ends and will likely remain an essential tool for HHAs that provide care in the home to vulnerable populations,” the organization wrote. “Telehealth should be equally available as a benefit under MA Plans and traditional Medicare as it brings value to enrollees and improves access, especially for the homebound.”

Ultimately, NAHC hopes that CMS will ensure there is uniformity of coverage for home health services among Medicare Advantage plans and traditional Medicare.

“We also hope that beneficiaries are fully informed of the differences in the offerings between the plans and traditional Medicare,” Carr said. “Further, we hope that the plans recognize home health care as an important, if not necessary, step along the care continuum in ensuring that beneficiaries obtain their maximum level of health and avoid unnecessary health care costs.”

As WiAHC members know well, grassroots advocacy is critical in our efforts to influence Congress and its actions that impact home health care in Wisconsin and across the country. Being a strong advocate can have far-reaching positive impacts on the home health care profession and the patients you serve. And with Congress currently considering several proposals to strengthen home health care, it is a great time to engage your Members of Congress and urge their support for these important initiatives.

Of course, when advocating for home health with your Members of Congress, it is important to ensure your message is both compelling and clearly presented. Thankfully, our national partner, the National Association for Home Care and Hospice (NAHC), has made connecting with your elected representatives as easy as a few clicks on your computer or mobile device. Simply CLICK HERE to visit NAHC’s Legislative Action Center, choose the issue or issues that matter most to you, fill in your name and contact information, and hit SEND.

Please find below just a few of the legislative proposals you can advocate for through the NAHC Legislative Action Center:

·         The Preserving Access to Home Health Act of 2022 – Tell Congress to pass critical legislation pausing devastating home health payment cuts that will impact access for vulnerable Medicare beneficiaries and their families.

·         The Choose Home Care Act of 2021 – The Choose Home Act would create an enhanced home health benefit providing additional services and supports, including personal care services, non-emergent transportation, meal delivery, and respite care among others that serve to support a patient in their home as they recover post hospital discharge. It is a step towards providing individual choice in where a patient decides to receive care and an important modernization in the Medicare program.

Earlier this year, you had an opportunity to respond to WiAHC’s Legislative and Regulatory Priorities survey, allowing you to provide your input on what policy issues are most important to you, your organization, and the Wisconsin home health care industry. The purpose of surveying the membership was to collect valuable data to help association leadership develop the WiAHC Policy Agenda and determine what legislative and regulatory issues the organization should make a priority in 2023-2024.

As such, the WiAHC Legislative Committee is pleased to present an outline of the association’s 2023-24 Policy Agenda. The Agenda, which will be used to guide the association’s advocacy efforts over the next two years, is pending final WiAHC Legislative Committee approval before it is sent to the full board for review

In addition to using your feedback to develop the association’s advocacy roadmap, the WiAHC Legislative Committee considered the following criteria when developing the Policy Agenda and issue priorities: 1.) The benefit to WiAHC members; 3.) The extent to which it will improve home health care in Wisconsin; and 3.) The likelihood of legislative/regulatory success.

The WiAHC Policy Agenda provides a broad policy vision for advancing home health care in Wisconsin and identifies the following specific legislative and regulatory goals for 2023-24:

• ·         Regulatory reform legislation to modernize DHS 133, including provisions to better align Wisconsin home care regulations with federal home care regulations.

• ·         Promote public awareness and increase policy influence of home health care, such as the creation of a Home Health Care Advisory Council at the Wisconsin Department of Health Services.

• ·         Grow/strengthen Wisconsin’s home health care workforce: Secure additional state funding to support    increasing the supply of nurse educators in Wisconsin.

Thank you to all WiAHC members who responded to the Legislative and Regulatory Priorities survey. Your feedback is invaluable to the policy agenda development process.

By Hoven Consulting – WiAHC’s lobbying firm

• New Marquette Law School Poll Released on September 14

On September 14, Marquette Law School released a new statewide political poll. Please fond below an overview of the poll’s key findings:

NOTE:  Joan Beglinger ended her gubernatorial campaign on September 6, 2022 and endorsed Republican candidate Tim Michels.  However, her name will remain on the November general election ballot.

The September poll also asked respondents if they approved or disapproved of how Governor Evers is handling his job.  The poll found the following:

The poll also asked respondents if they have a favorable or unfavorable opinion of Lt. Governor Mandela Barnes and U.S. Senator Ron Johnson.  The poll found the following:

• Legislative Council Study Committee on Uniform Death Reporting Standards - Update

The Legislative Council Study Committee on Uniform Death Reporting Standards held its second meeting on Wednesday, August 17 at the Capitol building in Madison.  Senator Joan Ballweg (R-Markesan) and Representative Jesse James (R-Altoona) serve as Senate and Assembly co-chairs, respectively, and heard from various presenters, which are summarized below.   

The committee heard from the Dane County chief medical examiner, who discussed staffing concerns, particularly the shortage of coroners and medical examiners in Wisconsin.  She also mentioned the challenge of having high caseloads. 

Then, representatives from the Wisconsin Funeral Directors Association and the Funeral Service & Cremation Alliance of Wisconsin made a joint presentation to the committee.  Both presenters discussed their involvement in completing death records.  In particular, they described that they receive information about the cause of death from physicians or – in certain cases – medical examiners or coroners.  They noted several problems:  (1) experiencing delays in receiving cause of death information from physicians, even though they are required to provide this information within five days and (2) difficulty in reading the information provided by physicians, as this is often sent via fax.

Representatives from the National Center for Fatality Review & Prevention showed committee members their case reporting system, a web-based standardized case report tool that is available to all states.  It allows local and state government users to enter data and create standardized reports with respect to fetal, infant and child death data.  Some committee members expressed concern that people outside of local and state government who are working on these issues are not able to access this website (or “dashboard”).  National Center staff responded that this dashboard is new, as it was rolled out during the COVID-19 pandemic.  Co-Chair Ballweg asked if they could provide dashboard access to local/non-profit partners who work on these issues. 

The presenter from the Colorado Department of Public Health discussed her agency’s work on developing a child suicide death reporting form.  In particular, she discussed how they offered “mini-grants” to coroner/medical examiner offices in the state to assist them with the processing of these forms. 

Michael Staley, of the Utah Department of Health and Human Services, discussed how collecting suicide data is easier in Utah since they have a very centralized system.  Specifically, any death in Utah under the purview of a medical examiner gets reported to a central office in Salt Lake City.  In Utah, his agency also has the authority to request nearly any kind of state and local record related to death.  In addition, he discussed the interview his agency performs with the next of kin in the case of suicide deaths – he referred to such an interview as a “psychological autopsy.”  Generally, they try to perform such interviews about two weeks after a death but definitely no longer than 12 months after a death. 

After the presenters were finished, committee members discussed several issues.  The discussion focused on fatality-related data – standardization of data, the confidentiality of data and format of data submitted to government agencies.  In particular, it was mentioned that in the case of other states, counties share fatality data when states have laws in place that explicitly allow for that.  There have been unsuccessful attempts to move such legislation in Wisconsin in previous years.  The data format discussion focused on how smaller entities – including hospices, funeral homes, hospitals, and law enforcement agencies – still fill out forms by hand and fax forms, instead of sending such data to county public health departments in an electronic format.  It was noted that this is a big problem. 

A list of committee members, the full meeting agenda, as well as written presentations may be viewed on the legislature’s website. 

This study committee’s next meeting was initially scheduled to occur on October 4.  However, Co-Chair Ballweg mentioned during the meeting that she is going to try to reschedule that meeting date.  Once it is scheduled, the next meeting date will be posted on the committee’s page on the legislature’s website.  Once again, the full meeting will likely be streamed live on www.wiseye.org. 

• Legislature’s Joint Finance Committee Approves Modified Spending Plan for Opioid Settlement Funds

On Thursday, September 8, 2022, the legislature’s Joint Finance Committee (JFC) on Thursday voted 16-0 to modify a plan to spend $31 million in funds from an opioid lawsuit settlement.  DHS initially submitted a spending proposal to JFC in July 2022, but an anonymous JFC member objected, resulting in the September 8 committee meeting and vote. 

The committee’s changes to the DHS plan include:

Understanding Home and Community Based Services (HCBS)

Register for webinars to learn more about HCBS. During this webinar we will discuss:

• VA CCN HCBS Overview
• Network Requirements
• Provider Portal
• Standardized Episode of Care (SEOC) and Referrals
• Claims and Billing Guidelines
• Demographic Updates
• Online Resources.

If you were not yet aware, we would like to remined you about WiAHC’s Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiAHC members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

The program is now live on the WiAHC website and members can easily and quickly sign-up as a Key Contact. With the campaign season winding down, and the 2023-24 legislative session right around the corner, it’s more important than ever for WiAHC to have a robust Key Contact Program. It is essential to raising our profile in the State Capitol and beyond.

As a Key Contact, you can help influence the legislative process by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature (as well as the Wisconsin Congressional  Delegation), you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in the home health care field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

 

WiAHC is happy to remind members about and provide links to the latest articles and information on the home health care industry from Home Health Care News and other publications:

·   Home Health Job Growth Improving, But Outpaced By Other Health Care Settings

Home Health Care News - By Robert Holly | August 19, 2022

Workers are steadily rejoining the home health care field, new data confirms. Their return comes after many retired or switched to other jobs during the COVID-19 pandemic. According to the latest labor brief from health care research and consulting firm Altarum, upwards of 1.57 million workers were employed in home health care in July 2022. Altarum’s analysis is based on U.S. Bureau of Labor Statistics data. Read more…

·   Medicare Beneficiaries Overwhelmingly Against Proposed Home Health Payment Cuts

Home Health Care News - By Andrew Donlan | August 18, 2022

It has been well documented how home health providers and advocacy organizations feel about the Centers for Medicare & Medicaid Services’ (CMS) home health proposed payment rule for CY 2023. What has not been, up to this point, is how Medicare beneficiaries feel about it. That changed Wednesday, as a poll conducted by Morning Consult – on behalf of the Partnership for Quality Home Healthcare (PQHH) – was released. Read more…

·     Congress Isn’t Done with Messy Health Care Fights

Axios – By Victoria Knight | August 17, 2022

The Inflation Reduction Act is law. But that doesn't mean major health care interests are done testing their lobbying clout. Many are already lining up for year-end relief from Medicare payment cuts, regulatory changes and inflation woes. The big picture: Year-end spending bills often contain health care "extenders" that delay cuts to hospitals that treat the poorest patients or keep money flowing to community health centers. But lawmakers may be hard-pressed to justify the price tag this time, and are seeing an unusual assortment of appeals for help. Read more…

·   Hundreds Of Stakeholders Voice Concerns As Home Health Proposed Rule Commenting Period Ends

Home Health Care News - By Joyce Famakinwa | August 16, 2022

The public comment window for the home health proposed payment rule closed on Tuesday. Overall, industry stakeholders had submitted 691 comments to the U.S. Centers for Medicare & Medicaid Services (CMS) as of Tuesday morning. From the start, home health stakeholders took issue with CMS’ methodology for determining whether the Patient-Driven Groupings Model (PDGM) led to budget-neutral spending in 2020. Read More…

Home Health Care News, which is part of the Aging Media Network, is a leading source for news and information covering the home health industry.

The Wisconsin Department of Health Services (DHS) is investing American Rescue Plan Act (ARPA) funds to create a statewide home and community-based services (HCBS) grant program. The ARPA HCBS Grants offer an exciting opportunity for entities active in the state's Medicaid HCBS system to apply for $25,000 to $2 million in grant funds.

The program goal is to disburse grants across all Medicaid HCBS programs, distribute funds geographically across the state in both rural and urban areas, and support diverse organizations and populations served. Grant funding will strengthen the HCBS system and support quality and innovation in the delivery of HCBS in Wisconsin.

For example, grants may be used to:

• Support organizations and providers as they recover from the impact of the COVID-19 pandemic.
• Develop and implement specialized training for direct care workers and managers.
• Help individuals with intellectual, developmental, and other significant disabilities find and retain work.
• Improve person-centered planning and implementation.
• Increase specialized care, services, and engagement for individuals with dementia, autism, children’s long-term care needs, or persons with other disabilities.  
• Expand the use of technology and telehealth by assisting HCBS providers with supplies and equipment.
• Reduce disparities and improve access to a diverse and culturally competent pool of HCBS providers.
• Develop other innovative ideas to improve HCBS services.
• Prepare information, including public health and educational materials, in accessible formats for people getting HCBS.
• Promote access to technology to facilitate human connection for people getting HCBS and their caregivers.
• Support quality initiatives that improve services and supports, and increase community engagement.
• Fund recruitment and retention activities for direct services workers of Medicaid HCBS providers.
• Purchase personal protective equipment and routine COVID-19 tests for direct services workers.

Applications will open August 11, 2022.

Visit the ARPA HCBS Grants webpage for details about the grant opportunity. You’ll find information about funding amounts, eligibility, timelines, and more.

By the National Association for Home Care and Hospice

On August 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued extensive materials providing guidance related to the planned phase-out of various waivers, regulations, enforcement discretion, and sub-regulatory guidance that were utilized to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 Public Health Emergency (PHE). According to the documents — issued under the rubric “Creating a Roadmap for the End of the COVID-19 Public Health Emergency” (Roadmap) — most of these waivers and broad flexibilities will terminate at the eventual end of the PHE, as they were intended to address the acute and extraordinary circumstances of a rapidly evolving pandemic and not replace existing requirements.

As previously indicated by Administration officials, to minimize any disruptions including potential coverage losses following the end of the PHE, the materials state that HHS Secretary Becerra will give states and the health care community writ large 60 days’ notice before ending the PHE. In the meantime, CMS is encouraging health care providers to prepare for the end of these flexibilities as soon as possible and to begin moving forward to reestablishing previous health and safety standards and billing practices.  Even though providers will receive 60 days’ notice before the ending of the PHE, they should begin preparing for the end of the waivers now.  In order to come into compliance with the conditions of participation at the end of the PHE, it may take some providers a significant amount of time. Therefore, NAHC recommends that providers utilizing any of the PHE waivers assess the need for continued use of the waiver(s) and begin transitioning away from utilization, as possible.  If it is not possible to stop utilizing the waivers, providers should develop a plan for tapering use, if possible.

While the COVID-19 PHE remains in effect CMS will use its Pandemic Plan as a guidebook for evaluating all existing flexibilities, while developing a comprehensive long-term approach for the health care system based on recovery and resiliency. Given the importance of this effort, CMS’ strategic plan includes a cross-cutting initiative to address the current PHE and ensure that CMS has a roadmap to support a health care system that is more resilient and better prepared to adapt to future disasters and emergencies. This work complements the work already underway to ensure as many eligible individuals as possible maintain a source of coverage, whether through Medicaid/CHIP, Marketplace, employer coverage, or Medicare.

As part of its Roadmap CMS has issued provider-specific guidance that details plans for the phase out of various waivers and flexibilities. NAHC previously posed questions to CMS regarding some of the waivers and flexibilities and had hoped answers to those questions would be found in this most recent Roadmap.  However, NAHC has continuing questions and concerns.  Below are links to two documents that address home health and hospice waivers and flexibilities:

• COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (Updated 8/18/2022)

• Fact Sheet: Home Health

WiAHC Signs on as Supporting Organization

Earlier this month, the National Association for Home Care & Hospice (NAHC) submitted its formal comments on the CY 2023 Medicare home health services Proposed Rule, which includes 2023 payment rates, along with a variety of other changes affecting the value-based purchasing demonstration program and the collection of quality-of-care data. It’s estimated the proposal would slash aggregate home health payments by 4.2%, or $810 million, next year. The Wisconsin Association for Home Health Care (WiAHC) officially signed-on to the comments as a supporting organization. 

“The proposed rule is the most impacting of policy actions by CMS (Centers for Medicare & Medicaid Services) in years,” said William A. Dombi, President of NAHC.  “The proposed payment rate cut of 7.69 percent would send 51.5 percent of all home health agencies into financial deficit in 2023. That would place over three million of the most vulnerable Medicare patients and the five million of Medicaid, VA, and Medicare Advantage patients they serve in real jeopardy of losing care. Medicare would also lose the value that home health services brings to health care overall, likely increasing care costs through extended hospitalizations and higher use of institutional care to fill in the gaps,” added Dombi.

The comments submitted by NAHC argue that:

• More than 300,000 Medicare beneficiaries have lost access to home health services in recent years, with over 1000 HHAs have closing, and Medicare spending in 2020-2021 at its lowest point since 2010.
• Congress required that CMS institute a budget neutral payment model in 2020. That model underpaid home health agencies by 2.5-3.2% in contrast to the 6.9% overpayment alleged by CMS.
• CMS’s evaluation as to whether the new payment model was “budget neutral” is fatally flawed in its methodological approach and is inconsistent with comparable evaluations CMS applied in other sectors.
• CMS’s evaluation methodology is at odds with the clear mandates established by Congress in 2018 in all respects.
• CMS compounds the risks to patient care by adding new, unnecessary costs while failing to adequately recognize the significant labor and transportation cost inflation that has hit home health services.
• CMS is pulling resources from home health care at a time it is depending on that care to reduce Medicare spending on hospitalizations and other care.

CLICK HERE to review the full text of NAHC’s comments on the proposed rule.

Bipartisan legislation, the Preserving Access to Home Health Act of 2022 (S. 4605/H.R. 8581), is currently pending in the United States Senate and House of Representatives, would suspend any payment rate reductions, thereby allowing CMS additional time to reconsider its proposed actions. GO HERE to tell your members of Congress to support this critical legislation!