The final rule from CMS has been published and it's not good. If you're following this blog, you no doubt understand that the home care industry has experienced deep cuts to Medicare reimbursement. Despite valiant advocacy efforts, the most recent ruling contains more bad news.
This is a press release from the Visiting Nurse Associations of America:
Washington, DC – November 4, 2010 – In the final regulations on the Home Health Prospective Payment System Update for CY 2011, the Centers for Medicare and Medicaid Services (CMS) mandated cuts that exceed those legislated in the Affordable Care Act (ACA). Medicare home health provider rates will be cut across-the-board approximately 4.89 percent or $960 million in 2011 alone.
“Nonprofit home health providers simply cannot sustain this level of cuts and maintain the healthcare services that vulnerable patients rely upon,” stated Andy Carter, VNAA President and CEO. “VNAA worked hard to negotiate with Congress healthcare reform provisions designed to protect vulnerable patients from devastating cuts to Medicare home health reimbursement over the next ten years. We are disappointed that CMS has regulated additional Medicare cuts beyond the Affordable Care Act.”
VNAA is encouraged that CMS provided some flexibility on the requirements that home health and hospice patients must visit their physician or authorized practitioner in order to be certified for home health and recertified for hospice. For home health, CMS allows the visit to have taken place up to 90 days prior to the start of care instead of 30 days, as originally proposed, if the reason for the visit is related to why the patient needs home healthcare. If not, CMS will allow the visit to occur up to 30 days after the start of care instead of just 2 weeks, as issued in an earlier proposed rule. For hospice, CMS will also extend the timeframe for an in-person visit with a physician/authorized practitioner from 2 weeks to 30 days to recertify for hospice.
Many of the changes in the final regulations are designed to require providers to jump through hoops in an effort to address growing concerns about fraud and abuse in the Medicare home health benefit. Nonprofit home health agencies fully support federal action to thwart fraud and abuse but are concerned with the burdens placed on patients to meet the physician/practitioner visit requirements. It is very difficult to transport homebound patients to see their physician.
VNAA has developed concrete recommendations to reduce fraud and abuse in ways that do not incur significant burdens to reputable providers or patients. VNAA has also recommended CMS implement a temporary moratorium on new Medicare home health providers. (VNAA’s recommendations can be found at www.VNAA.org.)
“VNAA urges the federal government to exercise its power to establish a temporary moratorium on new Medicare agencies to put the brakes on fraud and abuse rather than mandate across-the-board cuts through legislation and regulation. Nonprofit home health agencies are already struggling and these additional cuts make it even harder for them to serve as a safety net in their communities,” stated Carter.
Visiting Nurse Associations of America
About VNAA: VNAA is a national association that supports, promotes and advocates for community-based nonprofit home health and hospice providers that care for all individuals regardless of complexity of condition or ability to pay. They provide comprehensive services for Medicare, Medicaid, uninsured, and privately insured patients. VNAA members share a mission to provide cost-effective and compassionate care to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. Visit http://www.VNAA.org today.