Earlier this week, we highlighted the implementation by Centers for Medicare & Medicaid Services (CMS) of enrollment revalidations and screening categories, and which categories CMS places certain long-term care providers. It is important for providers and suppliers to understand what each screening category (limited, moderate, or high) entails and be aware of any events which could elevate screening categories. While these posts focus on long-term care providers, the enrollment revalidations and screening categorizations are applicable to all Medicare providers and suppliers. Continue Reading →
As an update to the previous post on the revalidation enrollment procedures it is important for hospices, home health agencies, and DMEPOS to know what level of screening they will receive from the Medicare Administrative Contractor (“MAC”). In some instances these providers and suppliers will be screened at either a “high” or “moderate” level of risk by the MAC. The risk category assigned corresponds with the amount of possible fraud and abuse that CMS believes is applicable to providers and suppliers.
All hospices (current and newly enrolled) will be screened at a “moderate” level of risk. Newly enrolling home health agencies will be screened at a “high” level of risk. The only other “high” category is newly enrolling DMEPOS. DMEPOS or home health agencies that are publicly traded on the NYSE or NASDAQ are classified as “limited” risk. Currently enrolled home health agencies and DMEPOS will be screened at a “moderate” level of risk.
It is VERY important that currently and newly enrolled hospices, home health agencies and DMEPOS accurately complete the revalidation process when completing the applicable CMS Form 855 due to the level of screening it will receive from the MAC. It is also VERY important to know that the CMS Form 855 has recently changed and requires, in some instances, much more detailed information. For example, the providers are required to provide much more detail on its ownership and operating structure.
Should you have questions on the revalidation process or the new CMS Form 855, please contact Todd Selby at 317.977.1440 or email@example.com, Brian Jent at 317.977.1402 or firstname.lastname@example.org, David Bufford at 502.568.9368 or email@example.com, or your regular Hall Render attorney.
As of March 2011, the Centers for Medicare & Medicaid Services (CMS) implemented new screening criteria in the Medicare provider/supplier enrollment process. Newly enrolling and revalidating providers and suppliers are placed in one of three categories – limited, moderate, or high – each representing the level of risk to the Medicare program for that provider’s/supplier’s particular category. The categorization will determine the degree of scrutiny the Medicare Administrative Contractor (MAC) will utilize when screening the enrollment application. Continue Reading →
While Congress was able to present the President with a compromised solution to cut Federal spending and raise the Government’s debt ceiling earlier this month, all long-term care providers should anticipate future reimbursement changes. Under the current law, the Budget Control Act of 2011, Medicare and Medicaid are unchanged. However, the Act requires for the creation of a Joint Select Committee on Deficit Reduction, whose members have until November 23rd of this year to find $1.5 trillion in spending cuts. Continue Reading →
The Centers for Medicare & Medicaid Services (CMS) increased fiscal year (FY) 2012 Medicare payments by 2.5% for hospice providers in a final regulation released July 29. Also included in the final regulation are requirements for hospice providers to start collecting quality of care data and changes to the way CMS counts hospice patients for the 2012 cap accounting year.
Recently, the Office of Inspector General (“OIG”) published a report of its findings pertaining to the nearly 70% growth of Medicare spending for hospice care provided to nursing facility (“NF”) residents from 2005 – 2009. During that time, Medicare spending on hospice care for residents in NFs increased sixty-nine percent (69%) from $2.55 billion to $4.31 billion; while the number of NF residents receiving Medicare-funded hospice care increased only by forty percent (40%). In its report, the OIG informally designated hospices with more than 2/3 of their patients residing in NFs as “high-percentage hospices.” This report comes on the tail of the Medicare Payment Advisory Commission (“MedPAC”) 2009 report to Congress that hospices and NFs may be involved in inappropriate enrollment and compensation.
The OIG recommended to the Centers for Medicare and Medicaid Services (“CMS”) that CMS: (1) Monitor hospices that depend heavily on NF residents and (2) Modify the payment system for hospice care in NFs. CMS concurred with both of OIG’s recommendations. CMS stated it will share the information with Recovery Audit Contractors (“RAC”), who review Medicare claims on a post-payment basis to identify inappropriate payments, and Medicare Administrative Contractors (“MAC”) to monitor high percentage hospices. CMS further stated it is in the early stages of reform efforts for the payment system that may be currently and unintentionally be incentivizing hospices to seek out beneficiaries in NFs.
Clearly, this July 2011 report is neither the beginning nor end of the scrutiny over high-percentage hospices and CMS has indicated changes in payment for hospice care to NF residents are on the horizon. The OIG’s report, the first in a series, focuses on the OIG’s and MedPac’s increasing concerns pertaining to the relationships between hospices, especially for-profit hospice providers, and NFs. The OIG plans to look at and later release companion reports on the marketing practices of these hospices and their business relationship with NFs. Enforcement activity is anticipated to increase.
Given these trends and the OIG’s and CMS’ increased scrutiny of these high percentage hospice’s business practices – namely involving marketing and patient enrollment – hospices and NFs should exercise extreme vigilance to ensure compliance with all of the rules and regulations governing Medicare reimbursement.
If you have any questions regarding this OIG report, please contact your regular Hall Render attorney, or Todd Selby at firstname.lastname@example.org or 317.977.1440, or Kendra Conover at email@example.com or 317.977.1456.
Michigan’s Department of Community Health will enforce Michigan’s Medicaid Asset Recovery Act (MCL Sec. 400.112g) with efforts starting July 1, 2011. Michigan may file claims in the probate estates of individuals age 55 or older who received Medicaid benefits that paid for long term care services after September 30, 2007. Michigan’s claim would seek reimbursement for the expenses paid by Michigan for the deceased individual’s long term care services. Michigan may also file claims in the probate estates of the surviving spouse of a Medicaid recipient.
Michigan will likely seek recovery from an estate if an individual owned a residence that was exempt from Medicaid requirements when the individual applied for and qualified for Medicaid benefits. When a Medicaid beneficiary age 55 or older dies, Michigan will send an estate recovery notice to the estate’s representative or heirs. The estate recovery notice will tell them that Michigan plans to file a claim and how much Michigan will claim. Some exceptions and hardship waivers are available to avoid Michigan’s recovery of assets in some circumstances. Michigan has contracted with Health Management Services, Inc. to pursue Michigan’s estate recovery claims.
When the new hospice Conditions of Participation (CoPs) became effective in Decmeber of 2008 there was a provision in the CoPs stating a hospice must have an agreement with a nursing home if the hospice provides services in the nursing home. While it was a standard business practice for hospices to have agreements with nursing homes prior to enactment of the CoPs, the CoPs were specific as to what must be included in the agreement.
One of the questions we continue to get is whether a hospice is required to have an agreement with an assisted living facility (“ALF”)? Legally speaking there is no requirment for the hospice to have an agreement with an ALF. Practically speaking we believe it is a good idea.
From a legal perspective CMS stated, in commentary to the CoPs, that a hospice is only required to have agreements with nursing homes that participate in either Medicare and/or Medicaid and ICFs/MR. The rationale of CMS was that ALFs are not Medicare-certified and therefore do not receive Medicare funding which would exempt them from the CoP requiring an agreement. Therefore, there is no legal obligation for a hospice to have an agreement with an ALF.
From a practical perspective, we generally advise that a hospice have an agreement with an ALF. First of all, it is good business practice that defines the role of the hospice and the ALF in the provision of hospice services. Another good reason for an agreement is that many states license ALFs and the applicable state regulations may require an agreement. Finally, since the same surveyors often times conduct surveys in both nursing homes and ALFs, it can avoid confusion by the surveyors over whether an agreement is required.
Should you have questions, please contact Todd Selby at 317.977.1440 or firstname.lastname@example.org, Brian Jent at 317.977.1402 or email@example.com, David Bufford at 502.568.9368 or firstname.lastname@example.org, or your regular Hall Render attorney.
In response to the changes contained in the Patient Protection and Affordable Care Act (ACA) designed to address increasing lengths of stay in hospice programs, CMS added a “face-to-face encounter” requirement to the hospice certification requirements.
Effective January 1, 2011, a hospice physician or nurse practitioner must have a “face-to-face” encounter with each hospice patient whose total length of stay is anticipated to reach the third benefit period. This encounter must be performed no more than thirty days prior to the third benefit period recertification, and no more than thirty days prior to any subsequent recertification.
CMS recently provided two answers addressing billable physician and nurse practitioner visits concurrent with the required face-to-face encounter. Continue Reading →
Indiana recently enacted the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (the “Act”). The Act is effective July 1, 2011, and is designed to eliminate multi-state jurisdictional issues and “Granny snatching” cases. The Act is located in Indiana Code 29-3.5.
Typically, the fact pattern arises when (1) an Indiana older adult resident visits a child in another state (Ohio) for vacation, or (2) a child comes to Indiana, grabs Mom and takes her to the home (Ohio) of the visiting children in a state other than Indiana. Frequently, the misconduct is designed to financially exploit the parent and deprive the Indiana courts of jurisdiction, as the parent’s home state. Such actions by the child are intended to take the parent out of the reach of an Indiana guardianship. If the receiving state (Ohio) has adopted the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act, attorneys can rely upon the new Indiana statute.
Also, adult guardianships have increasingly become more complex due to jurisdictional issues. For instance, imagine an elderly adult who owns property in more than one state or the circumstance where an incapacitated adult needs to be moved from one state to another for medical or financial reasons. Which state has jurisdiction? Continue Reading →