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Federal Home Health and Hospice Updates

(July 9, 2024) Members are encouraged to review the following updates from LeadingAge National on home health, hospice, and home and community-based services (HCBS):

HHCAHPS Data Submission Deadline July 18th. The deadline for submitting Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey data for Quarter 1 of Calendar Year 2024 (CY2024,Q1) is Thurs., July 18, 2024. Home health agencies (HHAs) are encouraged to check the submission status of their data by signing into the For HHAs portal on the HHCAHPS website to ensure that the survey vendor has submitted data to the HHCAHPS Data Center on time and without data problems.

Home Health Medicare Payment Rule. Please see LeadingAge National’s detailed (and locked) article providing details on the Home Health Provider CY 2025 Payment Rule. Please reach out to LeadingAge National or LeadingAge NY with comments so we can include your feedback in our comments.

HHCAHPS Quarterly Newsletter. The July issue of the HHCAHPS Coordination Team Quarterly Review (CTQR) newsletter is now available. This quarter’s issue features a chart showing CY2023,Q4 response rates for all three survey modes and tips for survey vendors and HHAs to increase response rates. The team also provides data submission reminders for the upcoming July 18, 2024 CY2024,Q1 deadline.

Hospice and SNF: Non-Compliance Letters for FY 2025. The Centers for Medicare and Medicaid Services (CMS) is sending notices to hospices and skilled nursing facilities (SNFs) that were determined to be out of compliance with their respective Quality Reporting Program (QRP) requirements for CY 2023, which will affect their Fiscal Year (FY) 2025 Annual Payment Update (APU). On July 3rd, non-compliance notifications were distributed by the Medicare Administrative Contractors (MACs) and placed into Certification and Survey Provider Enhanced Reports (CASPER) folders in the Internet Quality Improvement and Evaluation System (iQIES) for hospices and into facilities’ My Reports folders in iQIES for SNFs. Providers that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 p.m. on Aug. 14, 2024. Instructions to submit a request for reconsideration are available here (hospices) and here (SNFs).

New Fraud Case Connected with Home Health and Hospice. The U.S. Department of Justice (DOJ) last week brought charges against four individuals in Arizona who allegedly filed $900 million in false and fraudulent Medicare claims for amniotic wound grafts beginning in November 2022. Many of the Medicare beneficiaries affected by this alleged fraud were terminally ill in hospice care and received expensive treatments for superficial wounds. However, this pattern of spending on amniotic wound grafts is showing up in other parts of the country as evidenced by seven Part A and B MACs submitting proposed Local Coverage Determinations (LCDs) to further define and restrict the use of these products. The three MACs covering home health and hospice have not submitted LCDs on this issue. Similar spikes in spending around urinary catheters have forced CMS to issue proposed rules to mitigate the impact of suspect spending on the Medicare Shared Savings Program financial calculations.

CMS Updates Enhanced Oversight for Hospices. In June, CMS released an updated fact sheet for the provisional period of enhanced oversight (PPEO) for new hospice providers in four states. This new fact sheet clarifies that new hospices include “those reactivating after being in a deactivated status.” In July 2023, CMS placed newly enrolling hospices located in Arizona, California, Nevada, and Texas under a PPEO based on reports of hospice waste, fraud, and abuse with the goal of reducing these issues and bringing new hospices into compliance. The PPEO can be for 30 days to one year and can include medical review such as prepayment review.

CMS to Host Webinar on State Strategies to Address HCBS Workforce Shortages. On July 10, 2024 at 2 p.m. ET, CMS will host a webinar focused on the types and categories of workers who provide HCBS, challenges contributing to worker shortages in these positions, and strategies states can deploy in response to shortages. Though this webinar is intended to offer strategies to states, there is no prohibition on others joining the call. Questions will be taken at the end of the session. Register for the event here.

LeadingAge National Joins Bipartisan Bicameral Call for Increased Guardrails on AI Use in Coverage Determinations. On June 25th, U.S. Representatives Judy Chu (D-CA) and Jerrold Nadler (D-NY) and U.S. Senator Elizabeth Warren (D-MA), along with 45 House members and four Senators, sent a letter to CMS urging it to increase oversight of artificial intelligence (AI) and algorithmic software tools used to guide Medicare Advantage (MA) plans’ decisions on coverage. The letter outlines many remedies that LeadingAge National has also requested CMS adopt, such as the need for more specific denial notices about why a service is denied, establishing an approval process to review AI and algorithmic tools and their inputs, and prohibiting the use of AI and algorithmic tools from denying care until a review is complete, among other issues. LeadingAge has offered its support to Senator Warren and Representative Chu on this letter, and LeadingAge President and CEO Katie Smith Sloan was quoted in the press release regarding the letter. See more developments on overpayments to MA here.

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