Attendees at the National Association for Home Care & Hospice’s (NAHC) annual March on Washington conference discussed the regulatory burdens felt from face-to-face requirements and the issues they have with a proposed prior authorization demo. They expressed these concerns minutes after CMS presented a session focused primarily on care delivery models such as accountable care organizations (ACOs).
 
Sean Cavanaugh, deputy administrator for CMS and director for the Center for Medicare at CMS, told a group of roughly 50 attendees on April 4 that the federal Medicare agency is creating models to improve quality of care and outcomes. He talked about the growth of ACOs, the reduction in rehospitalization rates nationwide and the creation of value-based purchasing.
 
But little of the official’s presentation involved specifics about the home health and hospice industries. During a Q&A following the presentation, agencies  pointed to several regulatory issues they believe serve as an impediment to them providing the best possible care for patients.
 
The agencies contended that CMS’ proposal to require prior authorization for Medicare home health in five states will delay agencies’ ability to provide timely care and thus the best possible outcomes. And they argued CMS’ existing face-to-face requirement is hurting the industry and has nothing to do with providing high-quality care while leading to positive outcomes.
 
Cavanaugh noted that Congress criticizes CMS “quite strongly” for having a high error rate related to home health eligibility, and he wonders whether collectively improving the timeliness of getting prior authorization might ease concerns.
 
Meanwhile, Cavanaugh told agencies he understands their concerns about the face-to-face requirement. CMS is “trying hard to figure out a solution” to the face-to-face challenges agencies experience getting the necessary documentation from physicians, but CMS has not yet found it, Cavanaugh says.
 
One agency who attended the presentation said she was “struck by how irrelevant we must be” to CMS that there weren’t more slides about home health and hospice. “We have an awful lot of work to do to get on their radar at that level.”
 
NAHC prepares to lobby to Congress
 
During a morning session April 4, NAHC officials laid out some key issues the home health and hospice industries are facing and what agencies should say to Congress about it.
 
The face-to-face requirement remains one of home health’s top challenges. Despite the elimination of the narrative requirement as of Jan. 1, 2015, “We’re finding that it’s actually getting worse,” Mary Carr, NAHC’s vice president for regulatory affairs, told conference attendees.
 
Carr has heard stories that some people conducting medical reviews are “a little confused” about what the requirements entail.
 
And after Cavanaugh’s presentation, Carr said she found it interesting that “CMS is scratching their head on how to solve a problem they created.”
 
Congress will soon file a bipartisan bill in an attempt to simplify the face-to-face requirement, says Bill Dombi, NAHC’s vice president for law. He laid out three talking points about what agencies should say to get Congress to sign on to combat the existing face-to-face requirement:
  • This is not about fraud; this is all about documentation. The existing face-to-face requirement takes caregivers away from delivering care and turns them into paper pushers, he says.
  • Decisions are not being made based on the entire record. They are being made based on a limited amount of information within the doctor’s documentation, he says.
  • It’s not fair that CMS is holding home health agencies responsible — liable — for what’s in a physician’s file.
NAHC also addressed several other key issues during the morning session.
 
It wants Congress to reject efforts to include hospice as part of the Medicare Advantage benefit package.
 
It also wants agencies to reach out to Congress about the need to enact the bipartisan Home Health Care Planning Improvement Act (S. 578; H.R. 1342). The bill would allow nurse practitioners and physician assistants to certify and make changes to home health plans of treatment.
 
Another key issue: CMS’ proposal to require prior authorization for Medicare home health in Florida, Illinois, Massachusetts, Michigan and Texas. NAHC said agencies should indicate to Congress that such a measure should only be used in a targeted fashion in limited circumstances and that prior authorization could be a roadblock/barrier to care.