Medicare Trustees Warn of Long-term Financing Problems

The recently-released Medicare trustees annual report on the state of the Medicare program currently projects sufficient funds into 2028, two years longer than last year’s estimate. At that point revenues would be able to cover 90 percent of Medicare outlays.

The Medicare Part A program is funded by the Hospital Insurance (HI) trust fund, by way of payroll taxes.

Despite the extended solvency, the trustees warned of long-term financing challenges stating. “Social Security and Medicare both face long-term financing shortfalls under currently scheduled benefits and financing,” wrote the trustees, adding that “current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.”

As expected, COVID-19 had significant impact on the short-term financing of Medicare, but at this time the trustees do not expect it to hold negative long-term ramifications, likely attributable to vaccine and treatment availability.

For 2021 totals Medicare provided coverage for nearly 64 million people, 55.5 million of who are 65 or older and 8.3 million who are disabled.

Free Webinar on Forthcoming CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

The National Association for Home Care & Hospice (NAHC) and other stakeholder groups have been working with the National Council of Prescription Drug Plans (NCPDP) to improve coordination between hospice providers and Part D plans to ensure appropriate coverage for prescription drugs while patients are on hospice service.

A key issue believed to play a significant role in poor coordination is the length of time it takes for information about a patient’s hospice election to filter through the Centers for Medicare & Medicaid Services’ (CMS’) systems to the Part D prescription drug plans.

CMS is now set to launch a pilot study under which hospice EMR vendors, clearinghouses, and Part D plans will test whether hospice election information can be transmitted more timely from hospice EMR vendors/clearinghouses via an intermediary (called the Part D Transaction Facilitator) directly to the patient’s Part D plan.

In an effort to educate hospice providers, Part D plans, hospice EMR vendors/clearinghouses, and other interested parties, NCPDP is hosting a FREE WEBINAR on June 29 to describe the how the pilot will work. The pilot will utilize the Notice of Election (NOE) 837I Transaction Standard to provide information for the Part D Transaction Facilitator, who will create the NCPDP Telecommunication Standard Nx real-time Hospice enrollment transactions for submission to the Medicare Part D plans. The intent of this new process is to allow for timely Hospice election notification to Medicare Part D Plans.

ABOUT THE WEBINAR

Background:  Join this webinar to learn about a pilot initiative to solve for Hospice enrollment notification delays sent to the Medicare Part D plans that may result in inappropriate payments made by the Medicare Part D plans during a Hospice election period

Date/Time:  June 29, 2022, 1 p.m. EASTERN

Learning Objectives: 
After this educational session, attendees will be able to:

  • Understand the journey from delayed information to real-time information.
  • Describe the Hospice Election Status Nx Transactions and all they do.
  • Learn about becoming an NCPDP/CMS Hospice Election Status pilot participant.

Registration:  To register, go to the following link:  NCPDP – Webinars. Scroll down to Upcoming Webinars and click on Hospice Election Status NCPDP/CMS Pilot. Please note that while most NCPDP webinars require payment, this webinar is complimentary.

Vaccination Expectations for Surveyors

The Centers for Medicare & Medicaid Services (CMS) recently updated its vaccination expectations for surveyors.  In January of this year CMS issued a memo (QSO-22-10-ALL) requiring state agency surveyors and accrediting organization (AO) surveyors performing deemed status surveys to not participate in onsite surveys unless fully vaccinated (unless vaccination is medically contraindicated or the individual is legally entitled to a reasonable accommodation under federal civil rights laws because they have a disability or sincerely held religious beliefs, practices, or observances that conflict with the vaccination requirement).

That memo whas been rescinded.

With QSO-22-18-ALL CMS encourages surveyors conducting federal surveys to be vaccinated but does not require it (or an acceptable exemption).  It remains up to the survey entity to implement policies around COVID-19 vaccination (and exemptions).

Previous guidance for surveyors entering nursing homes was provided in QSO-20-39-NH and this guidance remains.  While it is not directly applicable to home health and hospice providers, it may be applicable to some hospice inpatient facilities. Additionally, some state survey agencies and AOs have incorporated this guidance into their policies and procedures. It is expect that home health and hospice providers will not request vaccination status of surveyors or restrict surveyor access based on vaccination status.

Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements

This is an update to a NAHC Report article published on June 15, 2022.

Previously, NAHC reported that the Centers for Medicare & Medicaid Services (CMS) posted memo QSO-22-17-ALL containing new instructions for surveys for compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements. CMS previously issued guidance and survey procedures to survey entities for assessing and maintaining compliance with the regulatory requirements for vaccination.

Under the previous guidance, federal, state and Accreditation Organization (AO) surveyors were to assess for compliance with the vaccination requirements at surveys for initial certification, standard recertification or reaccreditation, and complaint surveys.

Effective immediately, surveyors will continue to survey for compliance with the vaccination requirements during initial and recertification surveys, but will now only survey for compliance in response to complaints alleging non-compliance with this requirement (not all complaint surveys). NAHC received clarification from CMS that any complaint survey addressing infection control and not just the COVID-19 vaccination requirements specifically, will include a review of the provider’s compliance with the vaccination requirements.  Since these requirements became effective earlier this year, 95% of the nearly 12,000 providers that have been surveyed by states are in compliance with the requirements.

This most recent memo also instructs state survey agencies to reach out to their CMS Location if they are considering citing vaccine requirements at immediate jeopardy, Condition or actual harm levels. CMS is reviewing its previous interpretive guidance describing Immediate Jeopardy, Condition-level and actual harm determinations to ensure that deficiency citations recognize good faith efforts by providers/suppliers and to more fully evaluate harm or potential harm to patients/residents by considering trends in COVID-19 rates in the community.  Stay tuned to NAHC Report for more information on these updates as they become available.

FMC 2022 is for Thought Leaders and Innovators – People Like You!

“FMC is my favorite conference I attend all year. The NAHC staff does a fantastic job of running the 2.5-day program and the quality of the home health and hospice sessions are terrific. I would highly recommend any home health or hospice financial manager to attend this event! And the locations of the events are always Top Notch!”
Patrick Conole, Vice President of Finance & Management, Home Care Association of NYS

The 2022 Financial Management Conference from July 24-26 at Caesars Palace in Las Vegas, Nevada is going to be one of the best and most important industry events of the year. Excitement is running high for the conference, as demonstrated by the fact that every booth in the Expo has been sold! (Contact Christopher Adams at CTA@nahc.org if you’re interested in sponsorships or exhibiting at the Home Care and Hospice Conference and Expo in October.) The most important companies, innovators and thought leaders will be at FMC. If you fit that description, you should be at FMC. Register now to save money over on-site registration.

FMC is essential to those that manage, supervise, or collaborate with the financial arm of your organization. Attendees will walk away with new ideas, connections, and opportunities.

One of the best reasons to attend FMC every year are the general sessions, which feature a strong mix of legal, policy, and market information and analysis, along with insights from industry professionals and experts who have been ahead of the curve for decades. These sessions are when you get the big picture, as well as your specific questions answered by some of the smartest and most informed people in home care and hospice.

Washington Update: Congress, Regulators, Policymakers, and the Marketplace Landscape

Health care continues its bewildering spin under the pressures of COVID-19, workforce shortages, and cost inflation. At the same time, the accelerated learning triggered by the pandemic continues to provide new opportunities for the expansion and refinement for health care at home. No longer is the continuum of care a set of steps based on care setting as acute, pre- and post-acute, and end-of-life care are all now provided in the home setting.

This annual FMC opening general session brings attendees up-to-the-minute information on advocacy priorities, legislative and regulatory updates, and a forecast for upcoming action. The topics this year include PDGM in home health services, VBID and increased oversight activity in hospice, and workforce stresses in all care at home settings, as well as a multitude of opportunities and threats along the care spectrum.

This year, the session also includes a deep look at the national survey results from an unprecedented, unified collaborative in home care. You will not want to miss a minute of this program.

Home Care and Hospice Leadership Panel: A Practical View from Outside of Washington

One of the most popular events at FMC, the leadership panel, brings together a diverse group of leaders in health care, including providers of health care at home, managed care organizations, and investors, to explore the most pressing issues of the day. These business and thought leaders bring deep experiences and insights on the direction of health care and the place of health care at home.

There is a notable expansion of health care services in the home setting, combining patient-centered, holistic care approaches with advances in technologies and a new recognition of the value of care at home. growing opportunities for health care at home. While the pandemic may have accelerated the movement to the home, it is not the root cause, as these developments have been underway for years. Are they within our grasp today? The panel will provide their views on where we are headed in the broadening world of health care at home.

Panelists include Kenneth Albert, Marcylle Combs, Mary Myers, Billy Simione, and Rod Windley.

Financial Management Open Forum

The Open Forum is your chance to discuss your ideas and concerns with HHFMA experts and conference attendees. No subject within our world of health care at home is off limits! The 2022 Open Forum will focus on several primary topics: Medicare Advantage impact on home care; HHVBP, Medicare Home Health PDGM; changes within the home care community business landscape, workforce challenges, the outlook for hospice in Medicare and beyond. Anything else of interest to attendees is also fair game. Bring your ideas, concerns, advice, thought leadership to this special closing program.

FMC is centered on delivering value to your organization, focusing on efficiency, budgeting, benchmarking, operations, ROI, and more. Comprehensive educational sessions will cover the industry’s most pressing topics and issues, so you’ll leave equipped to contribute to your organization immediately. We’re bringing you the best experts and practitioners in the industry to present you with new insights that will answer your burning questions

This event is an investment for you and your organization. Make those valuable connections needed to take your career and organization to the next level.

We look forward to seeing you in Las Vegas this July!

ATTENTION Hospices! CMS Recruiting Additional Hospices for HOPE Beta Testing

As hospices should already be aware, the Centers for Medicare & Medicaid Services (CMS) and Abt Associates are currently beta testing a draft standardized hospice patient assessment instrument called Hospice Outcomes & Patient Evaluation (HOPE).  Additional hospice providers are needed to complete the testing.

Hospices must be Medicare-certified and training for this round of hospices is anticipated to occur mid-July 2022 with data collection slated to begin in August 2022 and continue through early fall 2022.

CMS is specifically seeking hospice providers with sufficient registered nurse, social worker, and chaplain staffing to conduct at least 1 – 2 joint visits per week. Hospices currently participating in the beta test may be finding this difficult amidst the workforce shortage causing CMS to recruit more hospices.

It appears that CMS is still aiming for completion of the beta testing in early fall of this year.  Should this occur, there may be time for CMS to analyze the results of the testing and formulate a proposal for use of the HOPE by all hospices in the FY2024 proposed rule.  This proposed rule would be posted in Spring 2023 for public review.

Joint visits are typical in beta testing standardized assessment instruments such as the HOPE for inter-rater reliability, but it is not expected that joint visits will be required when a HOPE tool is implemented in hospice. CMS includes the following additional information about the 1-2 joint visits per week that would occur as part of the HOPE testing:  For joint visits, two registered nurses visit one patient at the same time to complete the HOPE nurse assessment. Two social workers visit the patient at the same time to complete the HOPE social work assessment, and two chaplains visit the patient at the same time to complete the HOPE chaplain assessment. One of the two registered nurses, social workers and chaplains may attend their joint visit via video call, such as Zoom. HOPE assessments are completed at hospice admission, for symptom reassessment and at live discharge.

Recruitment will continue until CMS reaches the desired number of participants (number not specified). Those interested in participating should email HOPETesting@abtassoc.com by June 30, 2022.

If Hospice Revenue Matters to You then You Need to be at FMC 2022

The 2022 Financial Management Conference (FMC) is coming up in less than two months! Be sure to register before June 21, 2022 to secure early bird pricing. The hotel room block closes the next day! Registration is just a few easy steps and we don’t want you to miss the opportunity.

FMC 2022 is the premier learning experience for hospice decision-makers across the U.S. Join us for 2+ days of unmatched hospice education sessions and a dynamic marketplace

Believe the Hype. Past Attendees are Still Raving!

“My office coordinator and I went to the FMC in Chicago in 2019 and it was a fantastic experience! We attended the pre-conference and then went on to attend the entire conference. It was very robust, and the speakers were engaging and knowledgeable. We learned so much and have applied what we learned into practice and still do. We both will be attending in Vegas this and can’t wait!” – Barbie Long, Director, Community Healthcare and Hospice

View more testimonials for FMC.

Revenue is Vital. FMC Has You Covered

Check out these FMC 2022 sessions dedicated to improving your agency’s revenue!

The Secrets Hidden in Your Financial Statements

We discuss the hidden gems to look for in financial statements, what they mean, and how they might impact a buyer’s and seller’s acquisition or divestiture decisions. Learn more.

Revenue Cycle – Hospice

The Value-Based Insurance Design (VBID) Model offers new challenges in managing the revenue cycle as more Medicare Advantage plans participate and expand the reach of this demonstration project. You’ll get access to the latest information and best practices for optimizing cash flow and minimizing risk. Learn more.

Amplify your experience by adding one of our pre-conferences, including Hospice Summer Camp 2022. Getting back to the basics has never been more important, as hospice continues to grow and mature as a health care program. This preconference provides an updated and thorough overview of the financial aspects of hospice, including discussion of emerging national economic and policy changes which will impact hospice operations, regulatory issues, and revenue-enhancing strategies. Hospice Summer Camp 2022 is designed for Intermediate-Advanced hospice executives seeking to sharpen the skills and knowledge needed to improve management hospice financial operations in this changing environment. A separate registration is required. 

FMC is brought to you in part by the Home Care & Hospice Financial Managers Association (HHFMA). Learn more about the event and get full registration information here.

THANK YOU TO OUR SPONSORS

Platinum Sponsors
WellSky

Gold Sponsors
Forvis | MAC Legacy | MatrixCare

Silver
Axxess | Complia Health | Element5 | Homecare Homebase | Kantime | SimiTree

Bronze
BerryDunn | Healthcare Provider Solutions Inc | McKesson Medical-Surgical | Provident Healthcare Partners LLC

Networker
Arnall Golden Gregory, LLP | Careficient | Citus Health | Health Recovery Solutions | IntellaTriage

Media Sponsor 
HomeCare Magazine | McKnights Home Care

Version 3.3 of the HHS Security Risk Assessment Tool Now Available

The Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) have released version 3.3 of the popular HHS Security Risk Assessment (SRA) Tool (https://www.healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment-tool). This tool is designed to aid small and medium sized health care organizations in their efforts to assess security risks.

The latest version of the SRA Tool contains a variety of feature enhancements based on user feedback and public input. New features include the incorporation of Health Industry Cybersecurity Practices (HICP) references, file association in Windows, improved reports, and other bug fixes and stability improvements.

Also new this year is the SRA Tool Excel Workbook. This alternative version of the SRA Tool takes the same content from the Windows desktop application and presents it in a familiar spreadsheet format. The Excel Workbook contains conditional formatting and formulas to calculate and help identify risk in a similar fashion to the SRA Tool application.

This version of the SRA Tool is intended to replace the legacy “Paper Version” and may be a good option for users who do not have access to Microsoft Windows.

Free Webinar on Future CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

The National Association for Home Care & Hospice (NAHC) and other stakeholder groups have been working with the National Council of Prescription Drug Plans (NCPDP) to improve coordination between hospice providers and Part D plans to ensure appropriate coverage for prescription drugs while patients are on hospice service.

A key issue believed to play a significant role in poor coordination is the length of time it takes for information about a patient’s hospice election to filter through the Centers for Medicare & Medicaid Services’ (CMS’) systems to the Part D prescription drug plans.

CMS is now set to launch a pilot study under which hospice EMR vendors, clearinghouses, and Part D plans will test whether hospice election information can be transmitted more timely from hospice EMR vendors/clearinghouses via an intermediary (called the Part D Transaction Facilitator) directly to the patient’s Part D plan.

In an effort to educate hospice providers, Part D plans, hospice EMR vendors/clearinghouses, and other interested parties, NCPDP is hosting a FREE WEBINAR on June 29 to describe the how the pilot will work.   The pilot will utilize the Notice of Election (NOE) 837I Transaction Standard to provide information for the Part D Transaction Facilitator, who will create the NCPDP Telecommunication Standard Nx real-time Hospice enrollment transactions for submission to the Medicare Part D plans. The intent of this new process is to allow for timely Hospice election notification to Medicare Part D Plans.

ABOUT THE WEBINAR

Background:  Join this webinar to learn about a pilot initiative to solve for Hospice enrollment notification delays sent to the Medicare Part D plans that may result in inappropriate payments made by the Medicare Part D plans during a Hospice election period

Date/Time:  June 20, 2022, 1 p.m. EASTERN

Learning Objectives: 
After this educational session, attendees will be able to:

  • Understand the journey from delayed information to real-time information.
  • Describe the Hospice Election Status Nx Transactions and all they do.
  • Learn about becoming an NCPDP/CMS Hospice Election Status pilot participant.

Registration:  To register, go to the following link:  NCPDP – Webinars. Scroll down to Upcoming Webinars and click on Hospice Election Status NCPDP/CMS Pilot. Please note that while most NCPDP webinars require payment, this webinar is complimentary.

Participate in the Hospice Salary & Benefits Studies

Hospital & Healthcare Compensation Service (HCS) announced the 2022‑2023 Home Care and Hospice Salary & Benefits studies are now underway.  The studies are published by HCS in cooperation with the National Association for Home Care & Hospice (NAHC).

The Reports are recognized as the authoritative source for comprehensive marketplace data for home health + hospice agencies. Last year’s Home Care Report contained data from 1,011 home health agencies. The Hospice Report had data from 734 hospice agencies.

New to both studies–Questions on staffing issues, nursing vacancy + turnover rates, and how sign-on bonuses are being used by agencies to attract new employees. The results cover job data by salary, hourly, and per visit rates with job data breakouts by auspice, revenue size, region, state, and CBSA. Regional data for 21 fringe benefits, planned salary increases, productivity, caseload, and shift differential data are also covered.

Directions to Participate in the HCS Home Care or Hospice Salary & Benefits Study:

  1. Download the questionnaire from the HCS website: https://www.hhcsinc.com
  2. Select either the single site or multi-site questionnaire for the Home Care or Hospice study
  3. Email Rosanne Zabka, HCS, RZabka@hhcsinc.com to confirm your planned participation
  4. Email your completed questionnaire to HCS by August 8th

There is no cost to participate.  Participants save over 50% off the Report price.

Participant Pricing Home Care Hospice
Prepaid Price (due by 8/31/21) $185 $160
Billed Price $205 $180
Non-participant price $375 $325

As always, all individual data will be kept strictly confidential.  Study results are reported as aggregated percentiles per job–No information will be released to any person or organization which will identify individual participants.

The Home Care results cover marketplace data for 59 jobs; the Hospice results cover 62 jobs.  The 32nd annual Home Care Report will be published in October; the 31st annual Hospice Report will be published in November. HCS, founded in 1971, is recognized as the leader in national healthcare salary and benefits research.  HCS conducts national and custom marketplace studies, publishing more than ten specialized Reports each year.