- If Approved, Preclaim Review could spread to Utah in time
- Utahns Will Vote on Medicaid Expansion and Medical Marijuana in November
- Updated Home Health and Hospice Processing Issues Log (CPIL)
- Wave of Opioid Bills in Senate Will Impact Hospice
- Download the new Home Health and Hospice Medicare Bulletin
- Avoid Redetermination Dismissals
- Hospice Provider Review Reports Now Available
- Trump signs ‘Right to Try,’ says it will save ‘tremendous’ number of lives
- NAHC on Right to Try
- IRS Updates Standard Mileage Rates for Use of Passenger Vehicles
- Upcoming Total Cost of Care Report Discussion
- Listen to the May Policy and Regulatory Call
- June 2018 Home Health and Hospice Provider Contact Center (PCC) Training
- Proposed Rule Listening Session on June 13
- CMS Posts Targeted Probe and Educate Video
- CMS Provides HQRP Training
- Virtual Hill Week is Coming June 18-22
- Chat Recordings on MyNHPCO
Interest Stories and Other Items
- New Medicare Beneficiary Identifier (MBI) Get It, Use It
- Palliative Care Reduces Suicide Risk for Veterans with Lung Cancer
- The Lowdown—Avoiding Common HIPAA Violations/Coverage Insights/Featured Blog/Full-Line Coverages
- Recent hospice settlements highlight where things go wrong
- With Aspire Deal, Anthem’s The Latest Insurer To Seek Medicare’s Sickest Patients
- One Woman Helps Others Make Sure End-Of-Life Planning Is ‘Good To Go’
- California Court Invalidates End of Life Option Act
- Forced to Lie About Assisted Suicide
- Right to die: Doctors barred from prescribing life-ending drug
- Call for Rural Provider Stories
If Approved, Preclaim Review could spread to Utah In Time
CMS is requesting reinstitution of its preclaim review demonstration in some Palmetto-covered states. If such prior-authotization-like processes restart, Utah agencies could feel the pinch before we know it.
Read up on the issue: CMS Floats New Version of Pre-Claim Review for Home Health , Home Health Ready to Fight Pre-Claim Review’s Dreaded Return
Click here to find out how to voice your opinion to CMS.
Read the CMS FAQs here.
Medical Marijuana and Medicaid expansion will both be on the Utah ballot this fall
Both Medicaid expansion and Medical Marijuana will be on ballot for Utah voters this November. Read an overview from Lee Davidson in The Salt Lake Tribune here.
Updated Home Health and Hospice Processing Issues Log (CPIL)
Via Home Health and Hospice News from CGS: “Current system-related claims processing issues may be viewed on the Home Health and Hospice Claims Processing Issues Log (CPIL). Refer to this web page periodically for the most recent updates.”
Wave of Opioid Bills in Senate Will Impact Hospice
Via 5-31-18 NAHC Report: “Leaders of the Senate Finance Committee, Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) have announced the introduction of the 22 opioid epidemic-related bills that fall under their committee’s jurisdiction. While not scheduled yet, the Finance Committee plans to hold a mark-up on these measures in the weeks ahead. As all these bills will be under their purview, they will have a substantial impact on the Medicare and Medicaid programs.
Similar legislation has been approved in recent weeks by the House of Representatives Ways and Means, and Energy and Commerce Committees, as we covered in NAHC Report here (PDF is titled HouseofRepsCoalesing). These bills will have minimal, if any impact on home care patients and providers, but there are some important points that hospice providers need to be aware of.”
Download a PDF of the NAHC article here.
Download the new Home Health and Hospice Medicare Bulletin
Avoid Redetermination Dismissals
Avoid Redetermination Dismissals – When submitting a request for a redetermination, which is the first level of appeal, the request must include the following information.
- Beneficiary full name;
- Beneficiary’s Medicare identification number;
- Specific services(s) and/or item(s) for which the redetermination is being requested;
- Specific date(s) of service (To and From);
- Printed name of requestor; and
- Signature of the requestor.
If the above information is missing, incorrect or incomplete, your redetermination request will be dismissed. You may resubmit a completed redetermination; however it must be submitted within 120 days from the date of receipt of the notice of initial determination. Please refer to the CMS Medicare Publication 100-04, Chapter 29, Section 310.6 for additional information.
Hospice Provider Review Reports Now Available
Via CMS: “Hospice provider preview reports and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey ® provider preview reports have been updated and are now available. These two separate reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder. …Providers have 30-days to review their HIS and CAHPS® results (June 1, 2018 through June 30, 2018).
Should a provider believe the denominator or other HIS quality metric to be inaccurate or if there are errors within the results from the CAHPS® Survey data, a provider may request CMS review. Providers must adhere to the process outlined on the Public Reporting: HIS Preview Reports and Requests for CMS Review of HIS Data webpage and the Public Reporting: CAHPS® Preview Reports and Requests for CMS Review of CAHPS® Data webpage.”
Trump signs ‘Right to Try,’ says it will save ‘tremendous’ number of lives
Via Brooke Singman of Fox News: “President Trump on Wednesday signed into law a bill that would allow those with potentially terminal diseases to try experimental treatments and bypass the U.S. Food and Drug Administration.” Read the full article here.
NAHC on Right to Try law
Via 6-1-18 NAHC Report: President Donald J. Trump signed into law the Right to Try Act on Wednesday, May 30, 2018, a piece of legislation he called for in his last State of the Union address, and predicted it would save a “tremendous number of lives.” Opinion is divided on how many lives it will save, if any, but it could have an impact on hospice care in the United States.
The new law gives terminally ill patients the right to seek experimental drug treatments that remain in clinical trials and have not been approved by the FDA, but “have passed Phase 1 of the Food and Drug Administration’s approval process.” Supporters of the law, like President Trump, say it will save many lives. Detractors say it is unnecessary, changes little for patients, but could have a detrimental impact on the FDA’s ability to safeguard the public against ineffective or harmful drugs.”
Read the full article here.
IRS Updates Standard Mileage Rates for Use of Passenger Vehicles
Via NHPCO’s NewsBriefs: “The IRS has issued additional guidance about the deductibility of unpaid mileage costs, to accompany the update of the 2018 standard mileage rates for taxpayers. Standard mileage rates for 2018 include:
- Business use of personal vehicle 54.5 cents/mile
- Charitable use of automobile 14.0 cents/mile
- Medical travel/moving 18.0 cents/mile
The IRS has now issued Notice 2018-42, which effectively suspends all unpaid mileage costs from being deductible on individual income tax returns as a result of Public Law 115-97, which amended the Internal Revenue Code. Healthcare providers, proprietary and tax-exempt, often pay employees for use of personal vehicles in the conduct of business. In some cases, volunteers are compensated for miles traveled on behalf of the provider and their patients. In these cases, with submission of appropriate documentation, the allowable mileage rate can be paid by the healthcare provider with no tax consequence to the recipient.
However, if less than the standard rate is paid, the recipient can no longer deduct the difference between the rate paid and the standard rate on their individual income tax return as an itemized deduction.
If the healthcare provider provides employees with per-visit, per-day, or other fixed payments in lieu of travel expenses incurred, healthcare providers need to be aware of the tax implications to them, how such amounts are reported for tax purposes, and how such payments need to be reported by the recipient.” Read Notice 2018-42.
Upcoming Total Cost of Care Report Discussion
HealthInsight and the Office of Healthcare Statistics will host two meetings to discuss “the value and potential impact of the recently distributed 2015 Total Cost of Care Reports for Utah…to discuss the value of the private reports to our community, talk about high-level learning from the reports, and have open dialogue about the future public reporting of this measure at the clinical level” (Suzy Wickens writes on behalf of Dr. Sarah Woolsey).
On Monday, June 18 from 5:00 to 6:30pm the meeting will focus on the adult report.
On Tuesday, June 26 from 7:30 to 9:00am the meeting will focus on the pediatric report.
These events will both take place at HealthInsight: 756 E. Winchester St, Suite 200, SLC, UT 84107. It will also be available virtually.
Contact Bri Marshall BMarshall@healthinsight.org and she will send you a calendar invite for your preferred date.
For more information, on the reports, consult the following resources:
Listen to the May Policy and Regulatory Call
A recording of the May Policy and Regulatory Call can be accessed here.
The next Policy and Regulatory Call will be Wednesday, June 13 at 4:00pm.
June 2018 Home Health and Hospice Provider Contact Center (PCC) Training
Via Home Health and Hospice News from CGS: “Medicare is a continuously changing program, and it is important that we provide correct and accurate answers to your questions. To better serve the provider community, the Centers for Medicare & Medicaid Services (CMS) allows the provider contact centers the opportunity to offer training to our customer service representatives (CSRs).” Read more.
Proposed Rule Listening Session on June 13
NHPCO’s Listening Session regarding the FY2019 Hospice Wage Index Proposed Rule is coming up on June 13. It will be held at 9:00am MST. Call 518-530-1840. Use the ID: 740-064-448.
CMS Posts Targeted Probe and Educate Video
Via NHPCO’s NewsBriefs: “The CMS Targeted Probe and Educate program helps providers and suppliers reduce claim denials and appeals through one-on-one help. Check out a five-minute video that explains the TPE process in more detail, and visit the TPE webpage.”
CMS Provides HQRP Training
Via NHPCO’s NewsBriefs: “CMS provided a hospice data submission and reporting webinar on Wednesday, May 30, 2018. The training summarized the HQRP program, data submission requirements, Hospice Compare reported data, and hospice provider preview reports. View the CMS handouts for this training.”
Virtual Hill Week is Coming June 18-22
Via NHPCO’s NewsBriefs: “Are you an advocate of hospice and palliative care? Do you want to become more involved in the legislative process? Is it easier to advocate from your home rather than come to Washington, DC? If so, then mark your calendar to join us for Virtual Hill Week, June 18-22. Anyone can participate in Virtual Hill Week, and gathering friends, family, and coworkers to join you is encouraged. To ensure that everyone feels prepared for Virtual Hill Week, NHPCO will be hosting TWO training webinars in June:
Thursday, June 7 from 3:30 – 4:30 p.m. EST – Register Here
Friday, June 15 from 2:00 – 3:00 p.m. – Register Here
Check out our blog to learn more, or email us at firstname.lastname@example.org with any questions.”
Chat Recordings on MyNHPCO
New Medicare Beneficiary Identifier (MBI) Get It, Use It
Via CMS: “he Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the MBI in phases by geographic location. You can start using the MBIs even if the other health care providers and hospitals who also treat your patients haven’t. When the transition period ends December 31, 2019, providers must use the MBI for most transactions. Here are 3 ways you and your office staff can get MBIs. Read more.”
Palliative Care Reduces Suicide Risk for Veterans with Lung Cancer
Via 5-29 NAHC Report: “A 2017 study found that patients with lung cancer commit suicide at more than four times the rate as the general population, according to study results presented at the American Thoracic Society International Conference. The results of the study demonstrated that suicide risks for lung cancer patients increased far more than it did for patients with other types of cancer.”
Read the full NAHC article here.
The Lowdown—Avoiding Common HIPAA Violations/Coverage Insights/Featured Blog/Full-Line Coverages
Caldwell Insurance Services’ newsletter covers these topics and more. Read the latest here.
Recent hospice settlements highlight where things go wrong
Via Shannon DeBra and Avery Schumacher at JDSUPRA: “Two recent settlements highlight important Medicare hospice program requirements and the need to remain vigilant about compliance with Medicare program rules.
The first settlement involved Charles Cole Memorial Hospital’s (CCMH) failure to perform required face-to-face (FTF) encounters with Medicare hospice patients prior to the third benefit period recertification and every subsequent benefit period recertification. CCMH self-disclosed the compliance issue to the Department of Health and Human Services Office of Inspector General (OIG) and agreed to pay over $373,000 to resolve its liability related to this compliance issue (along with an unrelated compliance issue the hospital also self-disclosed).
In the second settlement, which occurred in November 2017 but was just announced by the Department of Justice in May 2018, Health and Palliative Services of the Treasure Coast, Inc., Hospice of Martin and St. Lucie, Inc. and Hospice of the Treasure Coast, Inc. agreed to pay $2.5 million to settle false claims allegations brought on by two whistleblowers who were medical doctors formerly employed by these hospices. The settlement related to allegations that the hospices billed Medicare for patients who were not terminally ill and, thus, did not qualify for the hospice benefit. In addition to the $2.5 million settlement, the hospices entered into a five-year corporate integrity agreement with the OIG. The whistleblowers received over $476,000 as their share of the settlement.”
Read the full article here.
With Aspire Deal, Anthem’s The Latest Insurer To Seek Medicare’s Sickest Patients
Via Bruce Jaspen at Forbes: “Anthem’s acquisition of palliative care provider Aspire Health is the latest effort by the health insurance industry to tap further into the management of serious advanced illness and end of life care, particularly for seniors in Medicare Advantage “the growth in seniors selecting Medicare Advantage plans that are a big revenue source for Humana, Anthem, Aetna, Cigna, UnitedHealth Group and other insurers. If health insurers can better manage the care of the sickest of patients, there’s a financial reward awaiting them because that’s where the costs can be the greatest.” Read the full article here.
One Woman Helps Others Make Sure End-Of-Life Planning Is ‘Good To Go’
Via Lisa Napoli on NPR: “Only one-third of Americans older than 65 have living wills. That’s according to a survey published last year in the journal Health Affairs. Not surprisingly, younger people are even less likely to have made preparations for their death. One woman in Los Angeles has made it her business to help people get their affairs in order. Every month or so, 49-year-old Amy Pickard hosts a potluck gathering at her apartment. She walks them through a 50-page document she’s created called the “Good to Go” Departure File. Achingly specific details of one’s death are covered.” Read the full article here.
California Court Invalidates End of Life Option Act
Via Deathwithdignity.org: “Riverside County Superior Court judge Daniel A. Ottolia yesterday officially overturned the California End of Life Option Act. The formal ruling in Ahn v. Hestrin confirmed his earlier verbal ruling, thus far unsuccessfully appealed by the state’s Attorney General).
The California End of Life Option Act is no longer in effect (for now). Patients can no longer request prescriptions from their physicians to peacefully hasten their death and the process stops for all those who were already in the process at the time of the ruling.” Read the full article here.
Forced to Lie About Assisted Suicide
Via Wesley J. Smith at National Review: “The assisted-suicide movement often lies, prevaricates, spins, word engineers, and obfuscates in its advocacy memes.
Lying in debates is one thing. But legally forcing doctors and public officials to participate in these tactics in their official capacities is quite another. Yet, that is what many assisted-suicide laws and legislative proposals do.” Read the full article here.
Right to die: Doctors barred from prescribing life-ending drug
Via Lisa M. Krieger at The Mercury News: “The terminally ill patients who call Berkeley physician Dr. Lonny Shavelson are reconciled to waiting for death. But now they must wait for something else, too: The slow wheels of justice, delivering a court decision that determines whether or not they’ll have access to life-ending medication.
A Riverside Superior Court judge on Wednesday morning rebuffed an effort to restore California’s End of Life Options Act, which gives dying patients the right to end life on their own terms. So the state must try again. The next motion — urging the judge to cancel a ruling last week invalidating the law — is set for June 29, a month from now.
Meanwhile, major hospital systems such as Stanford, Kaiser Permanente, UC-San Francisco, John Muir and California Pacific Medical Center are suspending access to the medication, which has been legal since June 2016.” Read the full article here.
Call for Rural Provider Stories
Via NHPCO’s NewsBriefs: “The My Hospice campaign is looking for stories about the challenges of providing hospice care in rural communities. Submissions might be developed into a My Hospice blog piece, featured in NHPCO’s social media platforms, shared with members of Congress, or shared with local newspapers. They can be serious, factual, heart-warming, or light (one rural provider once shared how her home visits were delayed because a rather large herd of cows was crossing the road. Too bad she didn’t snap a picture!). Pictures make a story more compelling and personal, so we ask that you share a picture along with your submission, maybe one that includes your version of the My Hospice sign (PDF). NHPCO staff will follow up if we have questions or need additional information. Submit your My Hospice story online.”