Here’s what’s happening with hospice in Utah and around the nation.

Events

Southern Utah Home Care and Hospice Coalition Meeting Tuesday at 12:30

COP Webinar Series: Emergency Preparedness, Compliance & Clinical Records 5.2.19

HIPAA for Email & Texting: Communicating with Patients, Providers & Peers 5.9.19

2019 National Training Program Workshops

CHAP 2019 Hospice Accreditation Intensive Webinar Series

One week-UHPCO Bereavement Education

News

CMS FY2020 Hospice Payment Rule Rebases RHC, GIP and IRC; Imposes New “Transparency” Requirements

How to Find Success with the New Payment Landscape

New Medicare Alternative Payment Model Announced

NAMD Update

Recently Added OIG Work Plan Item May Impact Home Health and Hospice Providers

Home Health Leads Rapid Health Care Job Growth, Spending Slows

Home Health and Hospice News from CMS and CGS

Updates From Carepoint Group Purchasing

CMS Announces New Opportunities to Test Innovative Integrated Care Models for Dually Eligible Individuals

Hospice: FY 2020 Proposed Payment Rate Update

CDC Clarifies Applicability of Opioid Prescribing Guidelines, Excepts End-of-Life and Palliative Care

Medicare Trustees Report Hospital Insurance Trust Fund to be Depleted by 2026

MLN Connects 4-25-2019

News from the Alliance March/April 2019

Proposed Hospice Rule Summarized

A Time for Second Chances

You Can Help Shape the Future of Nursing

Interest Items

Industry News Articles


Events

Southern Utah Home Care & Hospice Coalition Meeting Tuesday 

The next Coalition Meeting is scheduled for the last Tuesday of this month.  Here are the details for this quarter’s meeting:

      • When: April 30th @ 12:30 p.m.
      • Where: Intermountain Homecare – 555 S. Bluff St., Ste. 100, St. George, Utah 84770
      • Lunch Sponsor: Intermountain Homecare and Hospice
      • Presenters: Southern Utah Veterans Home and Guardian Transportation

Please come hungry and come prepared with any challenges you presently face that the group could potentially troubleshoot together – we’re all going to be stronger and more successful if we work together to push and support one another.  Additionally, it would be great to have a conversation about what we are all doing to prepare for the PDGM transition in 2020. 

Conditions of Participation Series: Emergency Preparedness, Compliance & Clinical Records 5.2.19

HIPAA for Email & Texting: Communicating with Patients, Providers & Peers 5.9.19

2019 National Training Program Workshops

Via CMS: “Registration for the 2019 Centers for Medicare & Medicaid Services (CMS) National Training Program (NTP) workshops will open in mid-May. You’ll receive an email with registration and reservation information. To help you plan, the cities and dates for the workshops are listed below. You’re invited to attend at the location and days of your choice to meet your schedule and learning needs.

      • Philadelphia, Pennsylvania: July 30–August 1
      • San Francisco, California: August 6–8
      • Chicago, Illinois: August 13–15
      • Arlington, Texas: August 20–22
      • Providence, Rhode Island: September 10–11

The workshops in Philadelphia, San Francisco, and Chicago will be 2½ days long. In Arlington and Providence, the workshops will be 3 full days. Agendas vary slightly in each city and will be available on the registration website.

What We’ll Cover:

      • High-level and specific information on key aspects of the Medicare program
      • Information on opioids
      • A “Current Topics” session to raise awareness of program changes and innovations
      • An overview of the new Plan Finder on Medicare.gov
      • Scenario-based learning
      • Please note, these workshops don’t include information on billing

NTP training workbooks will be provided onsite for Day 1 and Day 3. Additional meeting materials will be available for download on the registration website prior to the workshops. If you would like access to these additional materials, please download and/or print them. Free Wi-Fi will be available in the meeting room.

NOTE: Registration requests will be considered on a first-come, first-serve basis until each meeting reaches capacity. The number of attendees from the same organization may be limited.”

Please send all correspondence to:
cms@seiservices.com

CHAP 2019 Hospice Accreditation Intensive Webinar Series

Via CHAP: “CHAP has released the 2019 revised hospice standards! Effective October 1, 2019! This blended learning experience beginning May 6 includes self study readings, interactive courses, live or on demand webinars and an online discussion forum designed to help you retain knowledge. Earn 13.0 contact hours as CHAP accreditation experts cover the CHAP accreditation process as well as the updates in the NEW 2019 CHAP Hospice Standards.”  Interested? Register here…

May 3: UHPCO Bereavement Education

Via UHPCO: “Join us next week, Friday, May 3rd, at 9:30 am for a discussion from David Shelley on, ‘Design Awareness for the Dying’ Presentation will introduce accessible design thinking that can be helpful in considering the environmental experience for people dying. Ideas will draw on traditional concepts from Feng Shui, and principles of Natural Design, Design Psychology, Jungian Philosophy, and Depth Psychology. “

Location: Larkin Mortuary, 1950 E. 10600 S. Sandy;  Time: 9:30 am – 10:30 am

UAHC Annual Convention

UAHC’s 2019 State Convention and Annual Meeting  will be May 7-8 at Salt Lake Community College Karen Miller Conference Center 9750 S 300 W Sandy, UT. Register here…

Dinner With Bill Dombi

Ask Bill everything you wanted to know about hospice and home care regulatory issues and laws, but were afraid to ask. 

News

CMS FY2020 Hospice Payment Rule Rebases RHC, GIP and IRC; Imposes New “Transparency” Requirements

Via NAHC Report: “On Friday, April 19, 2019, the Centers for Medicare & Medicaid Services (CMS) posted its proposed FY2020 payment rule titled, “Medicare Program; FY 2020 Hospice Wage Index and Payment rate Update and Hospice Quality Reporting Requirements”. Comments on the rule will be accepted until 5 p.m. on June 18, 2019. The rule is scheduled for publication in the Federal Register on April 25, 2019. A permanent link to the rule is available HERE. The National Association for Home Care & Hospice (NAHC) is continuing to analyze proposals included in the rule for their impact on hospice providers and the patients they serve and will be seeking member input on these changes for incorporation as part of comments to CMS. NAHC will also host a webinar in the coming weeks to provide additional insights into the proposed rule.” Read the full article here…

How to Find Success with the New Payment Landscape

Via NAHC Report: “The National Association for Home Care & Hospice (NAHC) will present an important new webinar entitled Success Under CMMI ACO & BPCI Programs on Tuesday, April 23, 2019 from 2:00 PM to 3:00 PM EDT. This webinar is free to NAHC members.” Read more here…

New Medicare Alternative Payment Model Announced

Via CAPC: “The Center for Medicare and Medicaid Innovation (CMMI) has announced new payment models, available in twenty-six geographic regions, which could provide exciting new opportunities to provide palliative care in home and community settings. Yesterday, Health and Human Services (HHS) Secretary, Alex Azar, and (Centers for Medicare & Medicaid Services) CMS Administrator, Seema Verma, announced the “Primary Cares” Initiative: five new primary care payment models designed to incentivize the entire healthcare system to transition to value-based care and care coordination.

Palliative care programs and hospices are eligible to participate within the options under the new “Seriously Ill Population” option. Payment comprises a monthly per patient fee, as well some limited encounter payments and performance-based payments based on hospitalization rates. CMS will be identifying eligible patients for participating programs based on comorbidities, past utilization, and a proxy for frailty.
The initiative also makes dramatic changes for participating primary care practices, providing fixed payments and similar performance-based payments and losses. Primary care practices participating in the new models will thus have strong financial incentives to improve patient experience and reduce avoidable spending, creating new opportunities for partnership and contracting for palliative care services.
The Request for Applications is expected to be released around June 2019, and the new models should begin operations in January 2020. Currently, a second round of applications is also anticipated.
CAPC tools and technical assistance can help programs succeed under this payment model:
Limited information is available on the CMMI website here, and a series of webinars will provide more details, on April 30 and May 16.”

NAMD Update

From NAMD’s 4-23-2019 Update:

CMS Extends Comment Period for Interoperability Rule
On April 19, the Centers for Medicare and Medicaid Services (CMS) announced a 30-day extension of the comment period for its health information technology interoperability proposed rule. This rule would require states and Medicaid managed care plans (among other entities) to implement data sharing tools to allow Medicaid beneficiaries to access their health data, including claims and encounter data as applicable. The new comment period deadline is June 3, 2019.
Webinars, Podcasts, Materials from 2019 CMS Quality Conference Now Available
The Centers for Medicare & Medicaid Services (CMS) podcast “CMS: Beyond the Policy” shares highlights from the 2019 CMS Quality Conference, including  excerpts from Administrator Seema Verma’s key note speech. You can listen to the podcast on Google Play and iTunes.
The 2019 CMS Quality Conference presentations are now available for download at the conference website here.
Video recordings from two Medicaid sessions at the Quality Conference are also available. Register using the links below to access these webinars.

Medicaid Quality Measure Reporting: Moving Beyond Claims

Click here to register and access the recording for the webinar.

Performance Measurement for Accountability and Quality Improvement – an Update on the Medicaid and CHIP Scorecard and Core Sets

Click here to register and access the recording for the webinar.
Resources from CMMI’s InCK and MOM Models
CMS’s Center for Medicare and Medicaid Innovation has shared several resources for states interested in the Integrated Care for Kids model and the Maternal Opioid Misuse Model:

Integrated Care for Kids APM webinar slides and recording are both available under the “How to Apply” section of the model website, available here. The webinar provides an APM overview, guidelines, requirements, and design considerations for developing one or multiple APMs as required in the InCK Notice of Funding Opportunity.

This factsheet addresses InCK and MOM model overlaps.

We welcome interested states to e-mail the teams with questions directly: Integrated Care for Kids Model at HealthyChildrenandYouth@cms.hhs.gov and Maternal Opioid Misuse Model at MOMmodel@cms.hhs.gov”

Recently Added OIG Work Plan Item May Impact Home Health and Hospice Providers

Via NAHC Report: “The Department of Health and Human Services (HHS) Office of Inspector General (OIG) work planning is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues. A Work Plan has been developed, made public, and updated monthly with new issues. This month, there are two new issues of interest to NAHC members. While the issues do not directly address home health and hospice providers, they do address home health agencies and hospices partner with in the care of patients.” Read the full article here…

Home Health Leads Rapid Health Care Job Growth, Spending Slows

Via NAHC Report: “Employment in the health care sector continues to grow at a record pace, according to the latest data from the Bureau of Labor Statistics (BLS), but spending in the sector continued to grow more slowly than the rest of the economy.” Read the full article here…

 and Hospice and Home Health News from CMS and CGS

MM11003 – Implementation to Exchange the List of Enrollment in Electronic Medical Documentation Requests (eMDR) for Registered Providers via the Electronic Submission of Medical Documentation (esMD) System

REVISED: SE18027 – Medicare Fee-for-Service (FFS) Response to the 2018 Alaska Earthquake

Join the CGS Provider Outreach and Education (POE) staff for the following educational event.

Wednesday, June 12, 2019
11:00 p.m. – 1:00 p.m. Central Time

Please join CGS as we begin our website review series. During this webinar we will focus on the Claims Tab and all the available offerings and resources. Did you know there are 20 plus sub topics under the Claims Tab? We will highlight these sub topics and so much more. Feel free to pre-submit questions to be addressed during the event to J15_HHH_EDUCATION@cgsadmin.com by June 7, 2019. Please note we will not be addressing claim specific questions during this event. Those are handled by our Provider Contact Center (PCC) at 1.877.299.4500, Option 1.

May 2019 Home Health and Hospice Provider Contact Center (PCC) Training Medicare is a continuously changing program, and it is important that we provide correct and accurate answers to your questions. Read more…

Foot Care – Coverage of routine foot care services such as the cutting or removal of corns and calluses, the trimming, cutting, clipping or debridement of nails and general hygienic or preventative maintenance care are generally excluded by Medicare coverage (only covered with certain exceptions). Read more…

Medicare Credit Balance Quarterly Reminder: (Please choose ONE option to submit and do not submit duplicate reports) – As a reminder, the Medicare Credit Balance Report for the quarter ending March 31, 2019 is due in our office postmarked by April 30, 2019. Read more…

Updates From Carepoint Group Purchasing

Find out about the new Carepoint website here…

CMS Announces New Opportunities to Test Innovative Integrated Care Models for Dually Eligible Individuals

Via CMS: “Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid.  Many of the 12 million dually eligible beneficiaries have complex healthcare issues, including multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. CMS and states spend over $300 billion per year on the care of dually eligible individuals, yet still do not achieve acceptable health outcomes. Today’s letter opens new ways to address those complex needs, align incentives, encourage marketplace innovation through the private sector, lower costs, and reduce administrative burdens for dually eligible individuals and the providers who serve them.

“Less than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems.  This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all,” said Administrator Seema Verma. “We must do better, and CMS is taking action.”

As one of CMS’ Strategic Priorities for 2019, we are redoubling efforts to better serve older adults and people with disabilities dually eligible for Medicaid and Medicare. Our goal is to bring shared accountability for creating a more seamless experience for beneficiaries and providers across the two programs, while ensuring that the program’s incentives are aligned and pointed toward lower cost and better outcomes.

Approaches discussed in the State Medicaid Directors letter include:

    • The Capitated Financial Alignment Model. Through a joint contract with CMS, states and health plans, this model option creates a way to provide the full array of Medicare and Medicaid services for enrollees for a set capitated dollar amount.
    • Managed Fee-for-Service Model. This model is a partnership between CMS and the participating state and allows states to share in Medicare savings from innovations where services are covered on a fee-for-service (FFS) basis.
    • State-Specific Models. CMS is open to partnering with states on testing new state-developed models to better serve dually eligible individuals and invite states to come to us with ideas, concept papers, and/or proposals.

Today’s letter complements a State Medicaid Director Letter CMS released in December 2018 that highlighted ten opportunities to improve care for dually eligible individuals, including using Medicare data to inform care coordination and program integrity initiatives, and reducing administrative burden for dually eligible individuals and the providers who serve them. The opportunities in today’s letter, together with the Primary Cares Initiative, present an array of options for transforming care delivery.

The State Medicaid Director letter is available through Medicaid.gov at:  https://www.medicaid.gov/federal-policy-guidance/downloads/smd19002.pdf.

A letter from Administrator Verma to state Governors is available here:  https://www.cms.gov/sites/drupal/files/2019-04/04-24-2019%20Governor%20Letter.pdf

A blog by Administrator Verma, titled “Better Care For People Dually Eligible For Medicare And Medicaid,” is available in Health Affairs here: https://www.healthaffairs.org/do/10.1377/hblog20190423.701475/full/”

Hospice: FY 2020 Proposed Payment Rate Update

Via CMS: “On April 19, CMS issued a proposed rule that would update the hospice payment rates, wage index, and cap amount for FY 2020. This rule also:

    • Proposes to rebase the continuous home care, general inpatient care, and inpatient respite care per diem payment rates in a budget-neutral manner
    • Proposes to modify the election statement requirements to require the hospice to include additional information aimed at increasing coverage transparency for patients that elect hospice
    • Solicits comments on the interaction of the hospice benefit and various alternative care delivery models

As proposed, hospice payment rates are updated by 2.7 percent ($540 million increase in their payments) for FY 2020. This is based on the proposed FY 2020 hospital market basket increase of 3.2 percent reduced by the multifactor productivity adjustment of 0.5 percentage point, resulting in a proposed 2.7 percent increase in hospice payment rates for FY 2020. Hospices that fail to meet quality reporting requirements receive a 2 percentage point reduction to the annual market basket update for the year.

The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments per patient made to a hospice annually. The proposed hospice cap amount for the FY 2020 cap year will be $29,993.99, which is equal to the FY 2019 cap amount ($29,205.44) updated by the proposed FY 2020 hospice payment update percentage of 2.7 percent.

CMS will accept comments on the proposed rule until June 18. See the full text of this excerpted CMS Fact Sheet (issued April 19).”

CDC Clarifies Applicability of Opioid Prescribing Guidelines, Excepts End-of-Life and Palliative Care

Via NAHC Report: “The Centers for Disease Control has released a letter clarifying that its 2016 Guideline for Prescribing Opioids for Chronic Pain was not intended to apply to cancer treatment, palliative care, or end of life care.

Recent efforts by policymakers to stem the nationwide epidemic of opioid abuse culminated in the enactment of the 2018 SUPPORT Act, which includes federal authority for hospice staff to dispose of controlled substances under specific circumstances (previous NAHC Report coverage is available HERE, HERE.)

Some efforts at the state level to address the opioid epidemic have placed additional limitations on prescribing practices for controlled substances, taken directly from the CDC’s 2016 Guidelines. These policies include placing limitations on the duration and strength of opioid prescription dosages and requiring that the prescriber have a “bona fide” relationship to the patient (in some cases defined as having taken a complete history and physical of the patient prior to prescribing and that an additional evaluation be completed prior to each prescription renewal).” Read the full article here…

Medicare Trustees Report Hospital Insurance Trust Fund to be Depleted by 2026

Via NAHC Report: “The annual Medicare Trustees report on the financial state of Medicare, released earlier this week, projects funding for the Hospital Insurance (HI) Trust Fund to be depleted in seven years. This projection is unchanged from last year’s Trustees’ report.

The trustees oversee Medicare’s two separate trust funds, the Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, and the Supplementary Medical Insurance (SMI) Trust Fund, which funds Medicare Part B and D.

The shortfall of funds is blamed on a decrease in income and payroll taxes from the taxation of Social Security benefits, as well as a modest increase in expenditures.

In 2026, it is predicted that the HI will generate only 89 percent of program costs, and worsen to a mere 77 percent by 2046. The trustees note that “current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation.”

Congress has previously taken steps to ensure the HI Fund is not exhausted.

“If we do not take the fiscal crisis in Medicare seriously, we will jeopardize access to healthcare for millions of seniors,” said Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), in response to the report.

The report concedes that projections such as this one are complicated by the likelihood of the development of new technologies, efficiencies, and treatments that do not currently exist. In addition, payment updates to physicians and other Medicare providers are challenging and subject to change.

The SMI trust is not at risk of becoming insolvent, as it is relies on general fund revenues and premiums paid by enrollees”

MLN Connects 4-25-2019

Read the latest from CMS & CGS in their latest MLN Connects here…

News from the Alliance March/April 2019

Read the latest from the Alliance for Home Health Quality and Innovation here…

Proposed Hospice Rule Summarized

Via Fazzi Home Care & Hospice: “On Friday, April 19, the Federal Register posted the public inspection copy of the FY2020 Hospice Wage Index proposed rule. Comments on the proposal are due to CMS by June 18, 2019. Fazzi is pleased to provide you with a comprehensive summary of the proposed rule prepared by Catherine Dehlin, Fazzi’s Director of Hospice Services.” Read the summary here…

A Time for Second Chances

Via HHS: “Second Chance Month is an opportunity for everyone to reflect on the power second chances have to transform lives and strengthen families and communities.” Read more here…

You Can Help Shape the Future of Nursing

Via NAHC Report: “The Committee on the Future of Nursing 2020-2030 is holding three regional meetings to hear from you.The committee is interested in your insights on how to advance the profession of nursing to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century.Each meeting will feature panel discussions around a specific topic, followed by time for public comments. The committee would like to hear from you in person.”  Read the full article here…

Interest Items

Industry News Articles

From Ellen Almond’s Home Health Media Clips 4-24-2019:

Home Health Industry Reacts to CMS Value-Based Primary Care Initiative  Home Health Care News

House Dems to hold hearing on ‘Medicare for All’ next week  The Hill

Sticker Shock as Sicker Patients Dump Medicare Advantage Plans  Bloomberg BNA

Washington state lawmakers approve public long-term care insurance program  Politico

A machine learning device, meant to monitor the chronically ill, moves into homes  Stat News

Obama Playbook Still Governs Policing of Home Care Labor Actions  Bloomberg Law