Healthcare at Home: The Rowan Report

by Elizabeth E. Hogue, Esq.
Many providers have expressed concern about the use of “guidance” and “interpretive guidelines,” for example, by the Centers for Medicare and Medicaid Services (CMS) to make major changes to requirements of the Medicare Program. On June 3, 2019, the U.S. Supreme Court issued an important decision that requires CMS to provide notices and comment periods in formal rulemaking processes when establishing or changing “substantive legal standards” (Azar, Secretary of Health and Human Services v. Allina Health Services et al., No. 17-1484, U.S. Supreme Court, June 3, 2019). The Court said that when CMS doesn’t identify a lawful excuse for neglecting its obligations to provide statutory notices and comment periods, policies that aren’t based on such notices and comment periods must be vacated.”guidance issue” of course, what counts as a “substantive legal standard.” CMS said that the statute requiring notice and a comment period distinguishes substantive from interpretive legal standards. “Substantive rules” have the “force and effect of law” while “interpretive rules” just “advise the public of CMS’ construction” of statutes and rules that it administers.
The Court rejected CMS’s argument [and HCTR readers interested in the Court’s reasoning in this matter should return to the original article for these details.]

©2019 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.elizabethhogue@elizabethhogue.netThis article originally appeared by permission in Tim Rowan’s Home Care Technology Report. homecaretechreport.com

By Tim Rowan,

Editor & Publisher of Home Care Technology Report

On June 20, 2019, the Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.
This guidance follows a series of steps that CMS has taken since 2017, including its Medicaid Program Integrity strategy released last year, in an effort to reduce Medicaid improper payments across states to protect taxpayer dollars while enhancing the financial and programmatic integrity of the Medicaid program.
$1 billion backlog
Further steps include addressing a nearly $1 billion backlog of impermissible state financial claims, initiating new federal audits of state eligibility determinations and managed care financial reporting, and achieving significant milestones for enhanced state data reporting that support program integrity efforts. CMS is also auditing Medicaid managed care plans’ financial reporting and Medical Loss Ratios (MLRs) to ensure plans are not being overpaid; this includes reviews of high-risk vulnerabilities identified by the Government Accountability Office and the U.S. Department of Health and Human Services (HHS) Services’ Office of Inspector General (OIG).

Since 2014, the Medicaid program has added more than 15 million new working-age, adult enrollees who primarily qualify as part of the Patient Protection and Affordable Care Act’s Medicaid expansion, for whom the federal government finances 90 percent or more of the cost. The guidance issued today addresses concerns raised by recent audits conducted by the OIG and others that found that some states did not always determine Medicaid eligibility for expansion adults in accordance with federal and state requirements.
The guidance specifically emphasizes CMS’s expectations for states that may be considering or who have implemented the Medicaid expansion. This comes in recognition of the increased risk resulting from the enhanced federal share of costs. States in the process of expanding coverage to the new adult group should provide these assurances of compliance with applicable program requirements when submitting the appropriate state plan amendments to CMS.
“Assurance” template [–see original article in Home Care Technology Report for specifics.]

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. This reprinted article appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com Please duplicate and distribute freely. editor@homecaretechreport.com

By Tim Rowan, Editor & Publisher of Home Care Technology Report

The Centers for Medicare & Medicaid Services recently announced a new primary care payment model that will provide an alternative to Comprehensive Primary Care Plus. This new model, called Primary Care First[or PCF] will be offered in 26 states and regions beginning January 1, 2020. Department of Health and Human Services Secretary Alex Azar predicts that the models will enroll 25 percent of traditional Medicare beneficiaries and providers, who must apply to take part, and the program may roll out to all states after five years pending its success.[Expected benefits of PCF are described key among them being providing primary care practices a range of opportunities to advance their care delivery, increase their revenue, and reduce their administrative burden. Rewards to providers using PCF are indicated. Jeremy Powell, founder and CEO of Acclivity Health based in Jacksonville, Florida, noted an expected significant decrease in routine paperwork from providers when dealing with patients under PCF and quicker payments, too. A detailed description of how Acclivity Healthcare now manages Seriously Ill Populations–or SIPs–and hospice patients is provided and benefits noted.]

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

1) eSolutions Acquires RCM Solutions Software Vendor–Practice Insight

eSolutions, a healthcare revenue cycle management technology company, announced that it has acquired Practice Insight, a Houston, Texas-based clearinghouse and RCM software vendor that provides integrated EDI solutions. [Details about this company and about eSolutions generally are provided in this article, as are details about Pracice Insights technology on which 68,000 eSolutions customers rely.]
More than 68,000 providers rely on Practice Insight’s technology to edit and track claims in real-time, verify patient eligibility, process patient statements, and provide patients with advance notice of procedure costs. Through this transaction, an eSolutions news release says, it bolsters own clearinghouse solutions and has an opportunity to introduce new product offerings to its respective markets, two of which are home health and hospice. [Details about this company and about eSolutions generally are provided in this article.]
Article #2 of 2 HIPAA One service available to users of Casamba Skilled, Casamba Clinic and Casamba Home & Hospice
Casamba, a provider of electronic medical record (EMR) solutions for outpatient therapy, home health agencies, skilled nursing facilities and contract therapy providers, announced the addition of HIPAA One to its partner network.
A provider of HIPAA compliance software including third party validation of controls and data security services, HIPAA One will make its service available immediately to users of Casamba Skilled, Casamba Clinic and Casamba Home & Hospice.

ABOUT CASAMBA
Founded in 1997, Casamba provides EMR solutions in contract therapy, skilled nursing facilities, outpatient clinics, and home health and hospice care settings. Its solutions are designed for providers across the entire continuum of post-acute care. Casamba’s acquisitions of TherapySource and HealthWyse have enabled the organization to become one of the largest post-acute care software and services companies in the industry, servicing over 275,000 providers in more than 10,500 clinics nationwide. Casamba is headquartered in Agoura Hills, California and has locations in Wilmington, MA, and Hoover, AL.
casamba.net
ABOUT HIPAA ONE
HIPAA One® is a scalable HIPAA compliance software solution. Designed for auditors seeking advanced functionality, the HIPAA One automated Risk Analysis software suite scales to healthcare providers, payers, and business associates of all sizes.

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article was reprinted in The Home Care Technology Report from eSolutions and Casamba press releases. homecaretechreport.com. editor@homecaretechreport.com

Vendor Watch:1) eSolutions Acquires RCM Solutions Vendor Practice InsightCMS Issues Renewed Guidance in Effort to Ensure Medicaid Program Integrity
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Tim Rowan, Editor & Publisher of Home Care Technology Report

Homecare Homebase, a provider of mobile home health and hospice software, has announced a new Revenue Cycle Management (RCM) service at the company’s annual Users Conference this week in Dallas. [Details about the new offering are provided in this article. Features include: a collection of technology-enabled services designed to alleviate the burden associated with time consuming administrative functions and staffing oversight that often keep home health agencies from spending more quality time with patients. It is also noted that the new RCM offering “allows agencies to reduce their in-house billing staff by pushing the lion’s share of the administrative billing and collections tasks – and the headaches and hassles associated with them – to an experienced HCHB team of billing experts.” More details about the in-house billing tasks are noted. In addition further company details about Homecare Homebase, LLC, and about Hearst Health Network are also provided in this article.

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article was reprinted in The Home Care Technology Report from a HCHB press release. homecaretechreport.com. editor@homecaretechreport.com

Two companies we have long been tracking, one of them a sponsor of this publication, have been awarded the 2019 MedTech Breakthrough Award. Since 2016, this award has celebrated the world’s most outstanding Digital Health and Medical Technology products, services and companies. Award categories include:
Clinical and Health Administration,
Patient Engagement, and Electronic Health Records

Brightree® Home Health and Hospice EMR solution has been named Best Overall Health Administration Software. In announcing the award, MedTech said “Brightree Home Health and Hospice EMR stands out for its ideal combination of a native iPad point-of-care app and cloud-based back-office software that makes it easy, intuitive, and efficient to use. [Many other features were noted as well.]

[According to Roman Pysmennyy, Brightree Home Health and Hospice product director: “We are proud to receive this prestigious MedTech Breakthrough Award for a technology that helps thousands of home health and hospice agencies across the country serve their patients better and faster.”
Best Patient Relationship Management Solution
Technology company Synzi’s virtual care and patient engagement platform won “Best Patient Relationship Management Solution.” Synzi’s platform allows users to connect with everyday devices such as smartphones, tablets and personal computers; staff can use video-based virtual visits, email, text messaging, and secure messaging to communicate with patients. Messaging can also be translated.
More details are provided in this article about MedTech Breakthrough Awards, and about Brightree, and about Synzi.

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article was reprinted in The Home Care Technology Report from a Brightree press release. homecaretechreport.com. editor@homecaretechreport.com

REGISTRATION OPEN – Home Health Quality Reporting Program: Achieving a Full APU/Market Basket Increase Webinar on June 19, 2019
The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar on Achieving a Full Annual Payment Update (APU)/Market Basket Increase for home health providers on Wednesday, June 19, 2019 from 2:00 to 3:30 p.m. ET.
The purpose of the webinar is to educate providers about the Annual Payment Update (APU) process and the requirements associated with achieving a full APU. Specifically, this webinar will cover:
*The relationship between the APU and the Home Health Quality Reporting Program.
*Associated data submission requirements.
*The reconsideration process for providers who are identified as being noncompliant.
Registration for this webinar is limited to 1,000 people on a first-come, first-serve basis.
Please register only if you know you will be able to attend the webinar, as space is limited. If you would like your name placed on a list to receive an email notification when the recorded version of the webinar is available, please CLICK HERE to be placed on an email notification list.
CLICK HERE to register for the Home Health Quality Reporting Program: Achieving a Full APU/Market Basket Increase Webinar.
If you have questions or need additional information regarding the logistics of this training session, please email the PAC Training mailbox at PACTraining@econometricainc.com.
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article was reprinted in The Home Care Technology Report from a CMS press release. homecaretechreport.com. editor@homecaretechreport.com

Stephen M. Golant, Professor Emeritus at the University of Florida, has published a research paper titled, “Women Caring for Our Aging in Place Seniors Will Lose Out because of U.S. Immigration Policies.” 1 [The author of this article provides many anecdotal examples of older women taking care of their aged family members, but the author does note many difference in today’ aging population and care for them. For instance, many are far less mobile and suffer from advance chronic diseases.
Although the connection may not appear obvious, this country’s immigra-
tion policies will make it more challenging for older persons and their
families to hire these workers.
The entire document is available from ResearchGate.net
Quoting from Professor Golant’s abstract:
Most older people experiencing chronic health problems, physical disabilities, and memory losses are still able to age in place in their own homes. However, they often need help from others to enjoy healthy, active, and independent lives. They turn mostly to family members, mainly women and usually their daughters, daughters-in-law or wives. But caring for frail elders has become more demanding and complex, and these family members often feel physically and emotionally overwhelmed and burnt out.
This country’s immigration policies will make it even more difficult for women caring for older persons to hire these workers. Over 25 percent of home care workers are low-skilled immigrants or foreign-born. However, the Trump administration’s policies reduce the number of immigrants entering the U.S. and specifically choke off the various pathways that enable low-skilled persons to be hirable in the home care sector. Female caregivers seeking relief from their caregiving responsibilities will lose out unless we remove these immigration barriers.
Finally, Golant draws the following conclusion:
Immigration policies that contribute to the future shortage of low-skilled home care workers do not bode well for the women who care for our frail old. We should not jeopardize their opportunities to hire paid help. We should not make it harder for them to get well-deserved relief from their caregiving responsibilities – their health is at stake. We should not make it more difficult for them to remain in the workforce, thereby crippling their income and career ontioned immigration barriers constructed by the Trump administration would be a start.
over 65 live with multiple chronic health conditions, ranging from diabetes to dementia.
The nation’s strained healthcare system is trying to keep sick seniors out of hospitals, assisted-living facilities and nursing homes and instead have them cared for in their homes.
The U.S. spent an estimated $103 billion on home health care last year, according to the Centers for Medicare & Medicaid Services.
Overall employment of in-home aides is projected to grow 41 percent from 2016 to 2026 — translating to 7.8 million job openings.

023, up from $4.5 billion in 2017, according to Research & Markets. Health-related exhibitors at this year’s CES in Las Vegas were up 25 percent over 2018, he learned.
Woods sees growing adoption of smart speakers and other voice-activated devices from Google, Amazon, Apple, Microsoft, and Samsung to provide medication and doctor appointment reminders, activate TVs, appliances and therapeutic equipment, and communicate with remote physicians and nurses. He predicts smart watches and other wearables gaining more acceptance to monitor vital signs in real time and transmit data to practitioners. He ranges from current technologies such as telemedicine and future, robot-like gadgets that will serve as companions and dispense medications.
In his 2017 book “Who Will Care for Us: Long-Term Care and the Long-Term Workforce” MIT Sloan School of Management professor Paul Osterman summed up both Golant’s and Woods’ conclusions. “Technology can improve the quality of home care. It can help make aides more effective and improve communications. Yet tech won’t replace aides anytime soon. It’s not going to resolve the c
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

By Tim Rowan. Editor & Publisher of Home Care Technology Report Last year Congress passed Health benefit. One such provision called for budget neutrality in any change to the payment model, so that future spending would remain consistent with projections of current spending levels. Additionally, Congress authorized CMS to make changes in reimbursement rates based on assumptions of provider behavior in response to the payment model reforms.
CMS has since taken this authority and incorporated behavior based rate-reductions to take effect in 2020 as included in the final Medicare home health rule. These reductions are based on the assumptions that providers will up-code and also add additional visits to LUPA cases to obtain the full episodic payment. It is notable that these projections significantly differ from their 2017 assumptions in the Home Health Groupings Model (HHGM). Further, in their finalized rule for the Skilled Nursing Facilities payment rule, CMS states that they did “not have any basis on which to assume the approximate nature or magnitude of these behavioral responses.” It is wildly inconsistent for assumptions to be made about one provider type, but not another.
Legislation (S. 433/H.R. 2573) introduced by Senators Collins, Stabenow, Kennedy, Jones, Cassidy, Paul, and Shaneen, and Represetnatives Sewell, Buchanan, Abraham, Kuster, Marchant, Arrington, Graves, Larson, Thornberry, DesJarlais, and Panetta seeks to remedy these inconsistencies by removing the ability to adjust rates based on assumptions, but rather in response to observed evidence of bevioral changes. The legislation would also allow for waivers to the homebound requirement for beneficiaries in Medicare Advantage plans and innovative Medicare payment models such as ACOs.
Please urge your Legislators to support S. 433/H.R. 2573. https://p2a.co/DyTJVMk Stop CMS from making rate changes based on assumptions. #Advocacyinaction #NAHCHeartbeat
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. This reprinted article appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com Please duplicate and distribute freely. editor@homecaretechreport.com