Its not until 1/1/20 and it appears they accepted many of the recommendations.  Most importantly it is revenue neutral so it is not a cost savings measure, just a reprioritization.  I don’t think it is reasonable to think they were not going to change the payment system with the way the therapy visits follow the reimbursement thresholds and how the big boys testified in front of congress to basically providing therapy to boost revenue.

 

Austin Figge

 

From: mhcabod@list.mnhomecare.org [mailto:mhcabod@list.mnhomecare.org] On Behalf Of Andrea Jung
Sent: Tuesday, February 13, 2018 9:21 AM
To: mhcabod@list.mnhomecare.org
Subject: RE: Policy Alert: Impacts to Home-Based Care

 

Not good.  HHGM on it’s way….

 

From: Kathy Messerli [mailto:kmesserli@mnhomecare.org]
Sent: Monday, February 12, 2018 3:00 PM
To: MHCABOD@list.mnhomecare.org
Subject: FW: Policy Alert: Impacts to Home-Based Care

 

Our listservs were down this weekend…… this is what I attempted to send regarding the congressional budget bill that passed…….

 

The budget bill passed late last week has implication for home health and hospice. Elevating HOME sent this summary Friday. We will include an update in the next Informer for all members. 

 

 

Kathy Messerli

Executive Director | Minnesota HomeCare Association

 

2550 University Ave. W.,  Ste. 350 S | St. Paul, MN 55114-1900

Direct: 651.635.0038 | Main: 651.635.0607

Toll-free: 866.607.0607 | Fax: 651.635.0043

www.mnhomecare.org | kmesserli@mnhomecare.org

 

Mission: MHCA represents and supports Minnesota home care providers committed to high quality home care services.

 

Vision: MHCA will shape the home care landscape to improve and sustain quality home care services.

 

2018 AM

 

 

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From: ElevatingHOME <elevatinghome@elevatinghome.org>
Sent: Friday, February 9, 2018 1:42 PM
Subject: Policy Alert: Impacts to Home-Based Care
To: Kathy Messerli <kmesserli@mnhomecare.org>

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Policy Alert:

Impacts to Home-Based Care

 

This morning the Bipartisan Budget Act was signed into law. This legislation includes language from the U.S. House of Representatives Continuing Resolution, which directs funding for the government through March 23, in addition to raising the debt ceiling and spending parameters for governmental budget caps through October 2019. As mentioned in Tuesday’s Policy Alert, there are significant implications for home health care and less extensive impacts to hospice providers. Highlighted below are the key impacts from the signed law.

 

Home Health

  • A modified extension of the rural add-on. Continuation of the rural add-on through the Senate Finance Committee’s proposal of a 5-year extension of this policy with reforms until October 1, 2022. 

·         For 2018, the rural add-on will remain at 3 percent

·         The reform of the rural add on includes a new methodology to target the add-on. 

·         For counties in the highest quartile of home health usage per 100 people based on 2015 data, the rural add on will be:

·         For episodes and visits ending by 2019 – 1.5 percent; and

·         For episodes and visits ending by 2020 – 0.5 percent.

·         For agencies serving those in counties with six or fewer individuals based on 2010 Census data, the rural-add-on will be:

·         For episodes and visits ended by 2019 - 4 percent; 

·         For episodes and visits ending by 2020 - 3 percent; 

·         For episodes and visits ending by 2021 - 2 percent; and

·         For episodes and visits ending by 2022 - 1 percent.

·         For patients served that do not fall into either category described above, the rural add-on will be:

·         For episodes and visits ended by 2019 - 3 percent; 

·         For episodes and visits ending by 2020 - 2 percent; and 

·         For episodes and visits ending by 2021 - 1 percent.

 

  • Home Health Payment Reform

·         Starting the Home Health Groupings Model (HHGM)/revised payment reform on January 1, 2020

·         There is to be a technical advisory panel – already held February 1, 2018.

·         By April 1, 2019, a report with recommendations from the TEP is to be sent to House Ways and Means Committee, Energy and Commerce Committee and the Senate Finance Committee.

·         By December 31, 2019, HHS will have completed rate and rulemaking for the new revised payment method.

·         Budget neutrality for HHGM/payment system.

·         Behavior modifications concerns with the legislative language – annually the “Secretary shall make assumptions about behavior changes that could occur as a result of the implementation.”

  • Defined as a 30-day “unit of service,” rather than a “30-day payment.” It is assumed that there will be two 30-day units of service within a traditional 60-day episode.
  • Market basket update percentage for 2020 will be set at 1.5 percent.

 

  • Updates to the face-to-face documentation process. The home health record “may” be used along with the physician record. While this is progress, unfortunately, Congress was unwilling to change the language to “shall” as was discussed and previously agreed. The Senate Finance Committee stated that the Congressional Budget Office tied a cost to “shall” that they were unable to include in the package.

 

  • Extends the Independence at Home demonstration for two additional years and increases enrollment to 15,000. Currently in its fifth year, CMS has evaluated the program’s success and found it to have saved money for the program in the first and second years (year three data is still being analyzed). Under statute, the demonstration in total must generate savings, and any practice that does not generate savings of 5 percent faces removal from the demonstration. This extension will provide CMS with additional time to evaluate the program’s effectiveness and any changes that may be needed so that Congress can weigh the benefits of the demonstration to program savings and beneficiary care and whether the program should be changed, extended, or made permanent.

 

  • Extends the Maternal, Infant, Early Childhood Home Visiting Program through 2022.

 

Hospice

 

  • Recognition of attending physician assistants as attending physicians to serve hospice patients. This is change will be effective starting January 2019.
  • Hospital transfer policy for early discharges to hospice care. Starting October 2018, hospitals will receive a per diem from Medicare rather than the full inpatient PPS rate when they discharge a patient to hospice. 

 

ElevatingHOME, in alignment with our strategic plan, will continue to pursue legislative and regulatory modifications on several of these components of the law. Please contactJoy Cameron, Vice President, Policy and Communications, with any questions or concerns.

 

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Launched in 2017 as the parent company to VNAA, ElevatingHOME is a 501(c)6 organization established to advance and strengthen the home-based care industry. Representing home-based care providers including home health, palliative care and hospice, ElevatingHOME aims to advance cost-effective, high-quality, patient-centered health care that starts at home.

 

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