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Home Health Providers Upset By Review Choice Demo During Pandemic

Monday, July 20, 2020   (0 Comments)
Posted by: Kyle Simon

By Michelle M. Stein, Inside Health Policy (July 16, 2020)

Home health providers in North Carolina and Florida were shocked that the Centers for Medicare & Medicaid Services (CMS) decided to start the Review Choice Demonstration (RCD) in those states in August, and lobbyists say they hope the decision to launch the demo in two new states in the middle of a pandemic was an oversight that will be corrected. Providers in those states could be forced to shut down if they have to handle both the demonstration and the pandemic at the same time, according to the lobbyists, who are also reaching out to lawmakers for help in the event CMS doesn’t change its mind.

“This is going to be a logistical and clinical nightmare on top of a serious pandemic where people are already taxed to the max physically and mentally. I want to make it clear we didn’t expect this to go away, we just didn’t expect it to come back in the middle of the biggest public health crisis of our generation,” said Tim Rogers, president and CEO of the Association for Home & Hospice Care of North Carolina and chair of the Council of State Home Care & Hospice State Associations.

The Medicare demonstration had been operating in a few states prior to the pandemic, including Illinois, Ohio and Texas. It requires providers to choose either a pre-claim review or post-payment review of their home health claims. Agencies can also choose to undergo minimal post-payment reviews with a 25% pay cut, but Illinois providers previously told Inside Health Policy that this is not a viable option. CMS effectively paused the demonstration earlier this year, saying it would use enforcement discretion due to the pandemic.

CMS recently announced it would stop exercising enforcement discretion on a number of program integrity initiatives — effectively restarting programs that had been paused initially due to the public health emergency.

“As states reopen, and given the importance of medical review activities to CMS’ program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency. If selected for review, providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness,” CMS says in frequently asked questions about audits from Recovery Audit Contractors, Supplemental Medical Review Contractors, targeted probe and educate pre-pay reviews conducted by Medicare Administrative Contractors (MAC) and MAC post-pay reviews.

CMS also said it would kick-start the Review Choice Demonstration for home health providers come Aug. 3, including in North Carolina and Florida — states which had not yet been part of the program. The home health agencies in those states will have a selection period to choose how they wish to participate from Aug. 3 through Aug. 17. After that, CMS says home health claims in all demonstration states — Illinois, Ohio, Texas, North Carolina, and Florida — with billing on or after Aug. 31 will be subject to review under the terms selected by the provider.

CMS’ website also says that once the demo has resumed, MACs will handle postpayment reviews of claims that were paid during the pause but would have otherwise been subject to the demonstration. CMS says it will post more information on that process soon.

Rogers, National Association for Home Care and Hospice President Bill Dombi and Home Care Association of Florida Executive Director Bobby Lolley said the home health industry was surprised by CMS’ announcement.

At the least, Lolley said, the move was disheartening, and Dombi called it disappointing.

“The reasons for the pause earlier still exist today, if not even more so in Florida and North Carolina. Home health care needs to be focused on caring for patients and infection control, not spending time on a demonstration program that can be postponed without any consequences to Medicare. Clinicians should be providing clinical care not chasing paperwork for purposes of enlightening CMS on the pros and cons of RCD,” Dombi said.

“The vast majority of HHAs in Florida and North Carolina have patients that are actively infected with COVID-19. Should resources be spent on them or submitting documents to Medicare?” he asked.

Dombi said NAHC asked CMS to reconsider its plan, and so did Rogers and Lolley. Rogers is optimistic about meeting with CMS, as he thinks the restart may have been an oversight when CMS put other program integrity measures back in place. Lolley agreed.

“The timing could not be worse,” Lolley said, adding, “We will take our turn at RCD, but for God’s sake, not now.”

Rogers said much of home health corporate staff are remote and working from home — where there are broadband issues for some in parts of North Carolina. Meanwhile, hospitals have reassigned home health staff to help with COVID-19 testing and other pandemic priorities. So those who would handle the reviews for the demonstration under normal circumstances are either remote or reassigned to more pressing matters and the home health providers don’t have the availability or workforce to stop what they are doing to focus on audit capacity, he said. Rogers added that physicians are also not meeting in person with many patients, so getting the necessary paperwork from them at this time would also be difficult. CMS needs to think about this from a public health standpoint, from a continuum of care standpoint and, with a presidential election coming up, from a political standpoint, he said.

Lolley added that other states haven’t had to deal with a pandemic in the middle of their learning curve for the demonstration and CMS’ decision doesn’t line up with CMS Administrator Seema Verma’s push for Patients Over Paperwork.

Rogers and Lolley said if the demonstration kicks in during a pandemic, some agencies will likely close their doors in Florida and North Carolina. Rogers said he doesn’t think that is what CMS intended and he doesn’t think the agency is that callous.

The Center for Medicare Advocacy also said CMS should not be restarting the demonstration.

“It’s wrong to pursue this misguided process, especially during the pandemic — and in many of the states with increasing COVID infection. This is not the time to add any disincentives to provide necessary home health care for older and disabled Medicare beneficiaries. We’re talking about people who need care at home more than ever in order to remain safe and healthy,” said Judy Stein, executive director of the Center for Medicare Advocacy.

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