Home and Community-Based
Services Policy Forum
Peter Notarstefano, Director of
Home and Community-Based Services
March 18, 2014
FEDERAL
UPDATE
Federal budget FY2014 and 2015
House and Senate
• $20 billion decrease from FY13 post-sequester levels
• Increases funding Aging & Disability Resource
Centers, Congregate and Homebound meals,
Community Development Block Grants
• Level funding Social Service Block Grants
• New authority and $14 million in funding for the
Corporation for National and Community Service
President’s FY 2015 budget
2015
• Introduce home health co-payments
for new beneficiaries
• Social Services Block grants are
budgeted at $1.8 billion, which is the
pre-sequester funding
• Improve and extend Money Follows
the Person through 2020
• Older Americans Act Supportive Services, Meal
Programs, National Family Caregiver programsame as 2014
• Aging & Disability Resource Centers $5 million
increase
Sequestration:
the Congressional Piggy bank
• Debt Ceiling bill- To offset the cost of restoring
middle-aged military retirees’ full pension
COLA- extension of the 2% Medicare
sequestration on all health care providers for
another year, through 2024
In the Senate Sustainable Growth Rate bill:
• Remote Monitoring pilots for home health
• Increase operational flexibility for P.A.C.E.
• A number of offsets being discussed
House bill did not include these amendments
• March 31st, 2014 Deadline
• OAA Reauthorization Act of 2013 S1562 Bipartisan
Senate bill
• OAA Reauthorization Act of 2013 HR3850 Bipartisan
House bill
• OAA Reauthorization Act of 2013 HR 4122 Democrat
House bill
• transportation services
• elder abuse prevention
• supplemental foods as an option in meal programs
• “hold harmless”/ formula Poss. Amendment
HCBS Characteristics rule
• Providers on the grounds of, or immediately adjacent
to SNFs, Institutions for MH , ICFs for individuals with
intellectual disabilities and Hospitals must fit the
HCBS criteria to receive Medicaid waiver funding.
What is the HCBS criteria?
• States -1 year to develop transition
plan
• States- 5 years to be in full compliance
• Residential and non-residential regs.
• Separate 1115 waiver regs
Changes in Diagnosis
Home Health
• 170 ICD-9 codes
removed for being too
acute or no impact on
home health services
• Grouper refined for
ICD 10 implementation
on 10/1/14
• 13,000 codes to
70,000 codes
HH- Rebasing
• Rule proposes a 3.5% rebasing cut for each of
the next four years (FY14, 15, 16, and 17)
• 4-year phase-in and 3.5% annual cap on
payment changes
Fails to account for the
costs on new regulatory
obligations of HHAs
Quality
Measure Changes
• Adds two new HH quality measures based on
CMS claims data rather than agency reported
OASIS data- Hospitalizations & ER
• Home Health Compare for public reporting in
2015
• Remove 9 OASIS-based measures from
CASPER reports that it believes are redundant
Second round HH Temporary
Moratoria
• Regional, temporary moratoria on
enrollment of new fee-for-services
Medicare, Medicaid, and CHIP
providers and suppliers
• Includes Ft. Lauderdale, Detroit,
Dallas, Houston
• Extends round one moratoria of HH
agencies in Chicago and Miami
• Based on OIG & DOJ findings- fraud
risk & high utilization
Home Health
• Policies and procedures
• Plans for each patient in Pt. assessment
• Inform state and local Emergency
preparedness officials of HH patients needing
evacuation
• Inform new patients of the role of HHA in an
emergency
Home Health Medicare Eligibility, Billing, Medical
Reviews and Appeals
• Face to Face Documentation
• Additional
Documentation
Request
• Administrative Law
Judge Hearings
• Recovery Audits
Medicare Improvement
Standard
• Determine if skilled services of a health care
professional are needed, not whether the
Medicare beneficiary will improve
• Increase access -certain chronic conditions
• Medicare maintenance standard
• Medicare Policy Manuals have been revised
HH Legislation
Fostering Independence
Through Technology
Clarifying Diagnosis Coding in
Hospice Claims
• Certain non-specific diagnosis or
diagnosis that, under coding
guidelines, are not principal
diagnosis
• Adult Failure To Thrive and
Debility can no longer be used as
primary hospice diagnosis, but
CMS will delay returning claims
to providers until October 1,
2014
Hospice Item Set
• Complete the HIS at admission and discharge
on all patients admitted to hospice starting
July 1, 2014
• 7 National Quality Forum-endorsed (NQF)
Measures
Hospice staff- GIP Care
• Additional reporting
requirements: Claims hospice
patients in skilled nursing
facilities or in hospitals
• Visit and visit length for
hospice nurses, aides, SW, PT,
OT and Speech Language
Pathologists
Hospice
• Hospice inpatient already has Emergency
Preparedness regs.
• Community-based-must have written plan
that is periodically rehearsed & Policies and
Procedures
• Inform state and local Emergency
preparedness officials of Hospice patients
needing evacuation
Part D Payment- Medications
Hospice patients
• Office of the Inspector General report
• Medicare Part D paid for medications that
should have been covered by Medicare Part A
under the hospice benefit
• More oversight from CMS
Fair Labor Standards Act:
Domestic Service- Final Rule
• Companionship services”
defined
• Third party employers of direct
care workers are not permitted
to claim either the exemption
for companionship services or
the exemption for live-in
domestic service employees.
• effective January 1, 2015
Adult Day Services
Adult Day Services - VA
• Proposed Rule Allows
Veterans Administration
Provider Agreements
• Applies to Adult Day, Home
Health
• Veteran Centered care
• Reimbursement methodology
tied to established payments
( Medicare, Medicaid)
FIDE SNPS- ADS
• 40 Fully Integrated Dual Eligible Special Needs Plans
Managed Care Organizations in 7 states
Arizona
California
Hawaii
Massachusetts
Minnesota
New York
Wisconsin
• 134,000 beneficiaries enrolled - Medicare and Medicaid
• Can contract with Adult Day Services- supplemental benefit
Research Opportunities ADS
• 2012 National Study of Long-Term Care
Providers by the NCHS 65% response rate
• RTI conducting update of Regulatory Review
of Adult Day Services
Medicare ADS Act of 2013
• Introduced by Rep. Linda
Sanchez
• Creates a Medicare
Certified Adult Day Center
• Paid based on the Home
Health Prospective Payment
System
• Revised legislation from the
bill introduced in 2009
Increasing
Access
To
Home and Community-Based Services
Balancing Incentive Program
• 17 states participating
• 2% enhanced FMAP
• Increases Medicaid spending for HCBS
Money Follows the Person
• 46 states including the District of Columbia
• As of June 2013, a total of 35,050 older adults/
persons with disabilities transitioned to the
community since MFP began in January 2008.
Challenges:
• Lack of Affordable
housing
• Shortage of Medicaid
providers
Community First Choice
• 6% enhanced FMAP on personal attendant
care
• California and Maryland participating
• Conflict free case management
• Person-centered care
HCBS Spousal Impoverishment
Protections
• Eligibility for Medicaid for
HCBS will be the same as SNF
eligibility
• For couples, where one
spouse needs Medicaid
Starts 1/1/14 ?
services
in
the
community
Ends 12/31/19
Contact Information
Peter Notarstefano, Director of HCBS
LeadingAge
202 508-9406
pnotarstefano@leadingage.org