HHS Expands HCBS for Elderly, People with Disabilities

More than 40 states and territories will now participate in Medicaid’s Money Follows the Person demonstration program, which has provided billions to help seniors and people with disabilities safely transition from institutional care to their homes and communities On August 23, 2022, the U.S. Department of Health and Human Services (HHS), through the Centers for…

HHS Proposes to Reinstate Non-Discrimination Rules

The U.S. Department of Health and Human Services (HHS) announced a proposed rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.

The proposed rule reinstates several provisions undone by the Trump administration in a 2020 Rule (see NAHC Report for more information). In that rule several provisions around non-discrimination from a 2016 Rule issued by the Obama administration were rescinded by the Trump administration. The most notable provision rescinded was the definition of “on the basis of sex” along with other significant portions of the 2016 Rule that were considered overly burdensome.

In the proposed rule HHS seeks to address gaps identified in prior regulations in order to advance protections against discrimination in health care programs.

  • Reinstates the scope of Section 1557 to cover HHS’ health programs and activities.
  • Clarifies the application of Section 1557 nondiscrimination requirements to health insurance issuers that receive federal financial assistance.
  • Aligns regulatory requirements with Federal court opinions to prohibit discrimination on the basis of sex including sexual orientation and gender identity.
  • Makes clear that discrimination on the basis of sex includes discrimination on the basis of pregnancy or related conditions, including “pregnancy termination.”
  • Ensures requirements to prevent and combat discrimination are operationalized by entities receiving federal funding by requiring civil rights policies and procedures.
  • Requires entities to give staff training on the provision of language assistance services for individuals with limited English proficiency (LEP), and effective communication and reasonable modifications to policies and procedures for people with disabilities.
  • Requires covered entities to provide a notice of nondiscrimination along with a notice of the availability of language assistance services and auxiliary aids and services.
  • Explicitly prohibits discrimination in the use of clinical algorithms to support decision-making in covered health programs and activities.
  • Clarifies that nondiscrimination requirements applicable to health programs and activities include those services offered via telehealth, which must be accessible to LEP individuals and individuals with disabilities.
  • Interprets Medicare Part B as federal financial assistance.
  • Refines and strengthens the process for raising conscience and religious freedom objections.

The proposed rule applies to:

  • Every health program or activity, any part of which receives federal financial assistance,
    directly or indirectly, from the Department;
  • Every health program or activity administered by the Department; and
  • Every program or activity administered by a Title I entity of the ACA

Public comments are due 60 days after publication of the proposed rule in the Federal Register.

HHS Proposes to Reinstate Non-Discrimination Rules

The U.S. Department of Health and Human Services (HHS) announced a proposed rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.

The proposed rule reinstates several provisions undone by the Trump administration in a 2020 Rule (see NAHC Report for more information). In that rule several provisions around non-discrimination from a 2016 Rule issued by the Obama administration were rescinded by the Trump administration. The most notable provision rescinded was the definition of “on the basis of sex” along with other significant portions of the 2016 Rule that were considered overly burdensome.

In the proposed rule HHS seeks to address gaps identified in prior regulations in order to advance protections against discrimination in health care programs.

Continue reading “HHS Proposes to Reinstate Non-Discrimination Rules”

HHS Proposes to Reinstate Non-Discrimination Rules

The U.S. Department of Health and Human Services (HHS) announced a proposed rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. The proposed rule reinstates several provisions undone by the Trump administration in…

Hospices Urged to Participate in CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

For more than a decade, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Office of the Inspector General (OIG), and other policymakers have noted with concern the growth in Medicare spending outside of the hospice benefit, while patients are on hospice care. One area of particular concern is spending for Part D drugs while patients are on hospice care, which totaled nearly $500 million in 2019.

The National Association for Home Care & Hospice (NAHC) and other stakeholder groups have been working as part of the National Council of Prescription Drug Plans (NCPDP) Hospice Task Group to improve coordination between hospice providers and Part D plans to ensure appropriate coverage for prescription drugs while patients are on hospice service. Through those efforts, it has been discovered that a key problem area contributing to poor coordination between hospice providers and Part D plans is the length of time it takes for information about a patient’s hospice election to filter through CMS’ systems to Part D prescription drug plans. While it is estimated that it takes an average of 22 days for hospice election information to reach a Part D plan, it frequently takes much longer. As a result, it is believed that Part D plans may, without their knowledge or the knowledge of the hospice provider, be covering drugs that are related to the hospice terminal diagnosis or a related condition.

To address the delay in transmission of hospice election status information to Part D plans, the NCPDP Hospice Task Group has provided support to RelayHealth (CMS’ Part D Transaction Facilitator) and CMS in developing a pilot program under which copies of the hospice Notice of Election (NOE) and other notices related to hospice election status are transmitted via RelayHealth to the Part D plans. The pilot utilizes the 837I NOE transaction for communication of election information. RelayHealth estimates that under the pilot this information would be transmitted within two days (and potentially much less time) from the hospice to the Part D plan.

If the pilot is successful in its goal of reducing the time frame for transmission of hospice election status information to the Part D plans, future work may be initiated to explore the potential for transmission of hospice election status information using Direct Data Entry NOE transactions, as well as additional information between hospices and Part D plans, such as information regarding what drugs are the responsibility of the hospice under Medicare Part A.

Currently transmission of drug coverage information between hospices and Part D plans is conducted via fax and is an unwieldy process.

During the planning phases of the pilot RelayHealth worked with hospice EMR vendors (Axxess, MatrixCare, and Netsmart) and hospice clearinghouses (Axxess and Waystar) to develop mechanisms that support transmission of the 837I to RelayHealth. Now that the pilot is close to going live (scheduled to begin August 1), RelayHealth is also directly recruiting hospice providers interested in participating in the pilot. If your hospice is interested in participating, you must:

  • Have the capability to generate Notice of Election (NOE, NOC, NOTR) Transactions in the electronic 837I format
  • Have the ability to submit a copy of 837I transactions to RelayHealth
  • Have the willingness to provide resources to assist during the pilot test initiative (per timeline)
  • Provide contact and other agency information to RelayHealth
  • Complete and return a Business Associate Agreement (BAA) and implementation form

RelayHealth has requested that hospices wanting to participate in the pilot take the following steps:

  • Confirm with your EMR vendor that you have the capability to generate electronic NOE 837I file
  • Submit the following information along with a BAA which can be found here: https://medifacd.mckesson.com/Hospice/Hospice-Providers/
    • Agency NPI
    • Organization Name
    • Primary Contact First and Last Name
    • Phone number
    • Email address
    • Method of NOE Electronic Submission (Clearinghouse or Direct)
    • If you submit electronic NOEs through a Clearinghouse, provide the name of your clearinghouse
  • Submit information to: hospicesupport@relayhealth.com

In late June, NCPDP conducted a webinar about the Hospice Election Status NCPDP/CMS Pilot that outlined the pilot program.  NAHC encourages hospice providers and other interested stakeholders to view the webinar to familiarize themselves with details of the pilot program.  The webinar and slides are available at the following links:

Hospice Election Status NCPDP/CMS Pilot Webinar

Hospice Election Status NCPDP/CMS Pilot Slides

Hospices Urged to Participate in CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

For more than a decade, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Office of the Inspector General (OIG), and other policymakers have noted with concern the growth in Medicare spending outside of the hospice benefit, while patients are on hospice care. One area of particular concern is…

Hospices Urged to Participate in CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

For more than a decade, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Office of the Inspector General (OIG), and other policymakers have noted with concern the growth in Medicare spending outside of the hospice benefit, while patients are on hospice care. One area of particular concern is spending for Part D drugs while patients are on hospice care, which totaled nearly $500 million in 2019.

The National Association for Home Care & Hospice (NAHC) and other stakeholder groups have been working as part of the National Council of Prescription Drug Plans (NCPDP) Hospice Task Group to improve coordination between hospice providers and Part D plans to ensure appropriate coverage for prescription drugs while patients are on hospice service. Through those efforts, it has been discovered that a key problem area contributing to poor coordination between hospice providers and Part D plans is the length of time it takes for information about a patient’s hospice election to filter through CMS’ systems to Part D prescription drug plans. While it is estimated that it takes an average of 22 days for hospice election information to reach a Part D plan, it frequently takes much longer. As a result, it is believed that Part D plans may, without their knowledge or the knowledge of the hospice provider, be covering drugs that are related to the hospice terminal diagnosis or a related condition.

To address the delay in transmission of hospice election status information to Part D plans, the NCPDP Hospice Task Group has provided support to RelayHealth (CMS’ Part D Transaction Facilitator) and CMS in developing a pilot program under which copies of the hospice Notice of Election (NOE) and other notices related to hospice election status are transmitted via RelayHealth to the Part D plans. The pilot utilizes the 837I NOE transaction for communication of election information. RelayHealth estimates that under the pilot this information would be transmitted within two days (and potentially much less time) from the hospice to the Part D plan.

If the pilot is successful in its goal of reducing the time frame for transmission of hospice election status information to the Part D plans, future work may be initiated to explore the potential for transmission of hospice election status information using Direct Data Entry NOE transactions, as well as additional information between hospices and Part D plans, such as information regarding what drugs are the responsibility of the hospice under Medicare Part A.

Currently transmission of drug coverage information between hospices and Part D plans is conducted via fax and is an unwieldy process.

During the planning phases of the pilot RelayHealth worked with hospice EMR vendors (Axxess, MatrixCare, and Netsmart) and hospice clearinghouses (Axxess and Waystar) to develop mechanisms that support transmission of the 837I to RelayHealth. Now that the pilot is close to going live (scheduled to begin August 1), RelayHealth is also directly recruiting hospice providers interested in participating in the pilot. If your hospice is interested in participating, you must:

  • Have the capability to generate Notice of Election (NOE, NOC, NOTR) Transactions in the electronic 837I format
  • Have the ability to submit a copy of 837I transactions to RelayHealth
  • Have the willingness to provide resources to assist during the pilot test initiative (per timeline)
  • Provide contact and other agency information to RelayHealth
  • Complete and return a Business Associate Agreement (BAA) and implementation form

RelayHealth has requested that hospices wanting to participate in the pilot take the following steps:

  • Confirm with your EMR vendor that you have the capability to generate electronic NOE 837I file
  • Submit the following information along with a BAA which can be found here: https://medifacd.mckesson.com/Hospice/Hospice-Providers/
    • Agency NPI
    • Organization Name
    • Primary Contact First and Last Name
    • Phone number
    • Email address
    • Method of NOE Electronic Submission (Clearinghouse or Direct)
    • If you submit electronic NOEs through a Clearinghouse, provide the name of your clearinghouse
  • Submit information to: hospicesupport@relayhealth.com

In late June, NCPDP conducted a webinar about the Hospice Election Status NCPDP/CMS Pilot that outlined the pilot program.  NAHC encourages hospice providers and other interested stakeholders to view the webinar to familiarize themselves with details of the pilot program.  The webinar and slides are available at the following links:

Hospice Election Status NCPDP/CMS Pilot Webinar

Hospice Election Status NCPDP/CMS Pilot Slides

Hospice Notes for July 13, 2022

Congress is facing a packed few weeks in the lead-up to the monthslong August recess. The potential revival of a slimmed-down reconciliation package sought by Senate Democrats remains top-of-mind for many DC watchers. While nothing is concrete at this point, it unfortunately appears likely that any smaller party-line reconciliation bill will omit major funding investments in Medicaid home-and-community-based services (HCBS). Last year’s House-passed Build Back Better Act included $150 billion for HCBS, seen as a transformative injection of resources that would increase access and better support the frontline home care workforce.

NAHC continues to work with other diverse coalitions to push for the inclusion of HCBS funding in any emerging deal.

Elsewhere on Capitol Hill, the House Appropriations committee recently approved a number of FY2023 government funding bills, including the Labor, Health and Human Services, Education, and Related Agencies (LHHS) package that contains discretionary spending for federal health programs. While it is certain that future Senate-side bipartisan negotiations will ensure any final government funding package that will ultimately become law will differ from what the House Appropriations committee has cleared, it is still instructive to keep track of the Democrat-led House deal, as it provides insight into that group’s policy priorities. A few provisions relevant to home-based care providers, detailed in the bill’s accompany report, include the following (note -many of these are merely signaling in nature, as opposed to explicitly directive):

  • Medicare Coverage of Home-based Extended Care Services.—The Committee encourages CMS to consider options to improve extended care services for Medicare beneficiaries, such as through home-based extended care by home health agencies (bottom of pg 184)
  • Patient Access to Home Health Care.—The Committee supports the intent of the network adequacy rules of CMS for Medicare Advantage organizations and for Medicaid managed care organizations under 42 C.F.R. 438 and 457 to maintain a network of qualified providers sufficient to provide adequate access for covered services to meet the health care needs of the patient population served. The Committee requests a report within 180 days of the date of enactment of this Act on regulatory actions related to network adequacy (bottom of pg. 186)
  • Home Health Aides.—The Committee recognizes that home health aides (HHAs) are the foundation of professional home-based caregiving, and that the growing population of disabled, chronically ill, and elderly Americans receiving home-based care requires a skilled and highly trained HHA workforce prepared to manage complex care needs. The Committee encourages HHS to explore how HHAs are meeting clinical competencies necessary to provide high-quality home-based care (pg. 221)
  • Direct Care Workforce Demonstration.—The Committee provides $3,000,000 for a Direct Care Workforce Demonstration project, to reduce barriers to entry for a diverse and high-quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract or retain direct care workers. (pg. 211)
  • Dementia Care Management Model.—The Committee urges the Center for Medicare & Medicaid Innovation (CMMI) consider how best to test a Medicare dementia care management model. The Committee encourages CMMI to continue working with stakeholders to find a way to test a value-based dementia care management model that could reach dementia patients across the stages and include coordinated care management and caregivers. The Committee requests an update not later than one year after the date of enactment of this Act on the progress for this model. (pg. 180)

The bill also includes several provisions that would help to increase the health care workforce. Among other things, the bill includes: nearly $2 billion in new money for the Department of Labor, including for apprenticeship programs, Workforce Innovation and Opportunity state grants, and Senior Community Service Employment; $15,6 billion in new money for HHS to enhance nursing workforce development and other health care programs; and enhanced funding for targeted programs of the Administration on Community Living.

The Committee also adopted a manager’s amendment from House Appropriations Committee Chairwoman Rosa DeLauro (D-CT), that added language to the committee report that urges the Health Resources and Services Administration  (HRSA) to “address the skilled care workforce needs of seniors through existing workforce education and training programs.”

The most hospice and palliative care-specific bills in Congress right now include the Palliative Care and Hospice Education and Training Act (PCHETA) (S.4260) and the Expanding Access to Palliative Care Act (S. 2565). PCHETA would bolster the serious illness professional workforce and boost palliative and hospice research funding, while S.2565 would require CMMI to test a dedicated community-based palliative care demonstration informed by the recently-ended, hospice-only Medicare Care Choices Model (MCCM). Both bills are currently Senate-only at this point, and we need your continued advocacy and outreach to continue to garner co-sponsors for these important policies. Use NAHC’s grassroots outreach campaigns to ask your Senators to support these bills.

Elsewhere in DC, much of the policy conversation on palliative care in particular is occurring within CMMI. In light of the Innovation Center’s strategic refresh late last year, it has become apparent that leadership there is focused on streamlining their demonstration portfolio and developing ways to better integrate specialty care (which is how they conceptualize palliative care) into broader, population health-style models, primarily the ACO programs.

Recently, CMMI posted a blog that broadly spells out their early vision for this kind of integration. In the piece, they specifically write: “Until more ACOs can assume full risk, collaborative care codes, as currently used in behavioral health, could support integration and co-location of some specialty care, such as palliative care.”

NAHC, in tandem with other members of the National Association of Hospice & Palliative Care, continues to work with CMMI to explore how best to support and scale home and community-based palliative care.

HHS Issues Guidance on HIPAA and Audio-Only Telehealth

On Monday, June 13, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), is issuing guidance on how covered health care providers and health plans can use remote communication technologies to provide audio-only telehealth services when such communications are conducted in a manner that is consistent with the applicable requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules, including when OCR’s Notification of Enforcement Discretion for Telehealth – PDF is no longer in effect.

This guidance will help individuals to continue to benefit from audio-only telehealth by clarifying how covered entities can provide these services in compliance with the HIPAA Rules and by improving public confidence that covered entities are protecting the privacy and security of their health information.

While telehealth can significantly expand access to health care, certain populations may have difficulty accessing or be unable to access technologies used for audio-video telehealth because of various factors, including financial resources, limited English proficiency, disability, internet access, availability of sufficient broadband, and cell coverage in the geographic area.  Audio-only telehealth, especially using technologies that do not require broadband availability, can help address the needs of some of these individuals.

“Audio telehealth is an important tool to reach patients in rural communities, individuals with disabilities, and others seeking the convenience of remote options. This guidance explains how the HIPAA Rules permit health care providers and plans to offer audio telehealth while protecting the privacy and security of individuals’ health information,” said OCR Director Lisa J. Pino.

The Guidance on How the HIPAA Rules Permit Health Plans and Covered Health Care Providers to Use Remote Communication Technologies for Audio-Only Telehealth may be found at: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-audio-telehealth/index.html.

HHS Issues Guidance on HIPAA and Audio-Only Telehealth

On Monday, June 13, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), is issuing guidance on how covered health care providers and health plans can use remote communication technologies to provide audio-only telehealth services when such communications are conducted in a manner that is consistent with the applicable requirements…