Federal HCBS/Home Care Updates

(Aug. 27, 2024) Please see the following home health, hospice, and home and community-based services (HCBS) updates from LeadingAge:

LeadingAge Comments on CY 2025 Home Health Proposed Rule, NHSN Reporting Proposal. On Aug. 26^th, LeadingAge submitted comments on the Calendar Year (CY) 2025 Home Health Proposed Rule. LeadingAge argued against the proposed cut and for greater flexibility in completing the Outcome and Assessment Information Set (OASIS), especially with the potential addition of more social determinants of health measures. LeadingAge also strongly articulated its objections to the proposed Conditions of Participation (CoPs) and offered other suggestions for dealing with the delays in accessing home health. LeadingAge opposed provisions to expand and make permanent National Healthcare Safety Network (NHSN) reporting requirements for nursing homes, pointing out that this data no longer serves the same purpose as when first implemented and reminding the Centers for Medicare and Medicaid Services (CMS) that nursing homes will continue tracking and sharing data on respiratory illnesses as appropriate based on existing requirements for the Infection Prevention and Control and Quality Assurance and Performance Improvement programs.

CMS Updates Section GG MDS and OASIS Web-Based Training. CMS updated a five-part series of web-based training courses that provide an overview of the assessment and guidance to promote accurate coding of the post-acute care (PAC) cross-setting Section GG data elements. Each course contains interactive exercises to test providers’ understanding.

KFF and MedPAC Reports Show Medicare Advantage Prior Authorization Denials and Plan Rebates Are on the Rise. A series of reports issued in recent months from KFF and the Medicare Payment Advisory Commission (MedPAC) show that as Medicare Advantage enrollment has reached 54 percent, the number of prior authorization denials are increasing, while plans are receiving more rebate dollars to offer supplemental benefits with which they can entice more beneficiaries to enroll – even if it is not in their best interest. Read LeadingAge's full article here.

LeadingAge's Hospice Quality and Compliance Workgroup to Meet Aug. 28^th. LeadingAge's Hospice Quality and Compliance Workgroup will meet on Wed., Aug. 28^th at 1 p.m. ET. During the meeting, LeadingAge will review the most recent Care Compare updates and discuss next steps on the finalized Hospice Outcomes and Patient Evaluation (HOPE) tool. Register for this workgroup here.

LeadingAge Submits Response to RFI on PEPPER. On Aug. 19^th, LeadingAge submitted a response to a Request for Information (RFI) from CMS on the Program for Evaluating Payment Patterns Electronic Reports (PEPPERs). A PEPPER is an electronic report that delivers provider-specific Medicare statistics for discharges and services vulnerable to improper payments. Home health, hospice, and skilled nursing facilities are all settings which previously received these reports prior to CMS temporarily pausing the program in January. PEPPERs are used to educate providers by showing them how they compare to their peers and alerting them of potential over-utilization and potential payment errors. LeadingAge’s response focused on making sure that the language used in the reports is for providers, not auditors. Many of the reports discuss “targets,” which to a provider could mean something to work toward, but the opposite is true in the reports, since they are geared more toward auditors looking at “targets” for aberrant billing. Overall, members shared that the reports are very useful, but need to be revised to make them more user-friendly. CMS expects these reports to be re-released in the fall of 2024; LeadingAge will keep members updated on any new information.

GAO: VA Needs Better Contract Oversight in Community Care Program. In a report released on Aug. 21^st, the Government Accountability Office (GAO) reviewed the Veterans Community Care Program, which is administered by the U.S. Department of Veterans Affairs (VA). The program allows eligible veterans to access necessary medical care from community providers rather than VA Medical Centers. The program is administered over five geographic regions by two third-party payers, Optum and TriWest, which credential providers, enroll them in the Community Care Network, and pay for services delivered to veterans via approved service plans. The GAO report outlines shortcomings in VA contract oversight of the third-party administrator contracts and recommends that the VA establish policies to better assess contract compliance, ensure that all necessary contract compliance roles and responsibilities are covered, and establish best practices and lessons learned to inform contract amendments in upcoming cycles. These findings and recommendations are consistent with member struggles to become credentialed providers or obtain payment for approved services provided to veterans. The VA’s poor contract oversight compromises their ability to assess:

provider network adequacy in any provider category, but particularly in specialist and long-term services and supports like adult day or home health.
if enrolled providers used to determine network adequacy are accepting new patients, submitting claims to the VA, or even operational.
if veterans can access services from their preferred provider, as outlined in the regulations.

The lack of internal controls in the VA puts veterans, their health, and the provider infrastructure serving them at risk. The report renders a history of the program and offers suggestions to re-establish health contract oversight within the program. Highlights from the report, along with the full report, are available for review. If you are experiencing struggles with the VA, please reach out to LeadingAge's Georgia Goodman to share your experience.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871