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11/05/2012

The Pulse: November 5, 2012

The Pulse: November 5, 2012

FEATURED NEWS

Statewide Poll Shows Majority of Ohioans Oppose Copayments for Medicare Home Healthcare Services

Washington, DC – A state poll of registered Ohio voters released today shows more than three out of four Ohioans think Congress should prevent cuts to Medicare home healthcare when making funding cuts during budget deficit reduction efforts this year.  Further, a strong majority of voters feel Congress should identify Medicare savings by targeting fraud and abuse over requiring seniors to pay out-of-pocket copayments.

“Ohio voters have made it clear that cutting Medicare funding for home healthcare or requiring seniors to pay expensive copayments to access skilled home healthcare services is not the right approach when addressing the nation’s financial future,” said Jeff Lycan, President and CEO of the MidwestCare Alliance.  “Alternative solutions, including targeting the $75 billion in Medicare fraud, are better for seniors and overwhelmingly preferred by Ohio voters.”  (See related article under Federal News, GAO Report).

Click here for the full news release. 
Click here to view the poll results.  

MCA PAC Debues with splash at Annual Conference

Individual support shined at the first PAC fundraising event at last week’s Annual Conference. Individuals contributing over $3,000, both in-kind and by bidding on the basket raffle, helped make the PAC event very successful!  Individual’s may contribute at anytime by writing a check to MCA PAC and sending to the Midwest Care Alliance’s office.  Please join us and consider making an individual contribution!

A Political Action Committee (PAC) is an important tool in an organization’s advocacy tool shed. Organizations like Midwest Care Alliance can use a PAC to help support political candidates who are leaders and supporters of home care, hospice, and palliative care issues in Ohio.

If you have any questions, please contact please contact Jeff Lycan at (614) 545-9016 or Jeff.Lycan@midwestcarealliance.org. Thank you for your support of home care, hospice, and palliative care advocacy!

Integrated Care Delivery System (ICDS) Meetings with Providers and Plans

On Friday, Oct. 26, Midwest Care Alliance (MCA) participated in a Central Ohio ICDS stakeholder meeting with Aetna and Buckeye, the two health plans that will serve the region. During the month of October, MCA participated in all seven regional meeting in collaboration with LeadingAge Ohio. Enrollment dates identified by Director McCarthy (bulleted below) have not changed however many of the health plans have commented in the regional sessions that it appears there will be some delay but the timeframe is not known. 

  • April 2013: Northwest, Northeast Central, East Central
  • May 2013: Northeast
  • June 2013: Central, West Central, Southwest

The state has announced that they will set up meetings by provider type to work through outstanding questions and issues.  Midwest Care Alliance will be part of these meetings. The state and health plans are still working with CMS on the Memorandium of Understanding and working to settle final details.  We do know that some plans are contacting providers now and seeking to establish relationships and contracts with final details to be ironed out at a later date.  We will continue to keep our members informed as new information about the ICDS demonstration is released. For more information regarding the ICDS proposal, please contact Jeff Lycan at (614) 545-9016 or Jeff.Lycan@midwestcarealliance.org.

Notice of Public Hearings Affecting Home Care & Hospice

The JCARR hearing on November 13, 2012, will review rules that were publically introduced by the Ohio Department of Health, affecting Ohio Home Care and Hospice providers, in October.  Amendments to Ohio Administrative Code (O.A.C.) rule 3701-13-01 pertaining to the definition of Direct Care Providers and Hospice Variances, waivers, 3701-19-28 will be heard.  JCARR will also review 3701-17-59, Personal care services; medication administration; resident medications; application/ of dressings; supervision of special diets.  At this point,  MCA has these rules under review.

Criminal Record Checks for Home Care Providers

New Criminal Record Checks (CRC) will affect home and community based care providers.  Agencies need to be aware of the proposed changes, which are expected to go into effect early in 2013:

  • Rules from DoDD, Department of Aging, Job and Family Services, and Department of Health will be updated to create more transparency between the department of all the CRC rules;
  • Home care providers will need to update all direct care employees CRC’s at least once every five years and perhaps every three years for those caring for patients served through DoDD waivers or services;
  • Individual Providers will need to complete a CRC at least once every year to be eligible to provide services;
  • Exclusions will be defined in a tiered system which will identify permanent exclusions, 10, 7, and 5 year exclusions as well as multiple offenses exclusions;
  • Updating of the definition of “Direct Care Provider” which focuses on a “direct hands on” employee; and
  • The rules will identify a number of free data base searches a provider must check prior to having the CRC completed.

As these changes solidify,  MCA will notify members.  Hospice providers will continue to process their employee’s CRCs as they have in the past as they were not included in the legislative changes.  For additional information contact Jeff Lycan at jeff.lycan@midwestcarealliance.org.

STATE NEWS

Kasich's Year End Agenda: Tax Reform, Fracking, Turnpike

Hannah News Services reported Gov. Kasich’s wish list for the General Assembly when legislators return following the election. Items not addressed will be pushed to next year -- potentially as part of his next biennial budget, the Youngstown Vindicator reports.  Click here to read the full article.

Can Medicaid Expansion Bolster Gov. Kasich Health Goals

Alan Weil, Executive Director of the National Academy for State Health Policy compliments Kasich’s vision for an improved health care system but identifies significant risk if the state forgoes setting up their own insurance exchanges as well as not expanding Medicaid as much as possible as allowed under the Affordable Care Act. 

Click here to read the full report.

CURRENT STATE LEGISLATION & STATEHOUSE NEWS

Click here for Month in Review

FEDERAL NEWS

Jimmo v. Sebelius Medicare Beneficiaries with Disabilities and Chronic Conditions

The U.S. Secretary of Health and Human Services and the Center for Medicare Advocacy announced yesterday a proposed settlement of a nationwide class-action lawsuit that is expected to significantly expand coverage of therapy and skilled nursing services for Medicare beneficiaries with chronic conditions or disabilities. It also would make more limited changes to coverage of inpatient rehabilitation hospital/unit (“IRH/U” or “IRF”) care. The settlement must first be approved by the court, a process which could take several weeks.  Click here to read the full article.

Health Care Fraud Report Released

James C. Pyles, Principal of VAHC Washington Counsel for POWERS PYLES SUTTER & VERVILLE PC summarizes the Government Accountability Office (GAO) report on the types and outcomes of health care fraud investigations conducted by federal and state enforcement agencies. See “Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, and the Children’s Health Insurance Program Cases”, GAO (Sept. 7, 2012)  Read more...

Note the types of entities and individuals investigated and charged by federal agencies.  The largest percentage (18.7%) of entities found guilty of health care fraud were medical facilities (medical centers, clinics, and medical practices). Home health agencies accounted for only 4.5% of those found guilty while DME suppliers accounted for 18.5%. GAO report at p. 22.

The largest percentage of subjects with judgment or settlements in civil fraud cases were hospitals at 27.4% with medical facilities coming in second at 16.6%.  Home health agencies comprised 5.6% of this group. DME suppliers comprised 4.2% of this group.  GAO Report at 30.  

The number of individuals and entities excluded from Medicare participation for fraud were members of the nursing profession with an unknown affiliation (58.5%), home health agencies (2.3%), and DME suppliers (3.9%).  GAO Report at 32.

Home health providers constituted the largest percentage of subjects investigated by the state Medicaid fraud control units (MFCUs) at 26.6% while DME suppliers constituted 7.8%. GAO report at p. 35. However, home health agencies and home health aides constituted nearly 40% of those indicted or charged in criminal health fraud cases by MFCUs.  GAO Report at 36. Interestingly, home health providers only accounted for 9.6% of the total monetary penalties assessed by MFCUs.  DME suppliers were assessed the highest percentage at 33% while health care practitioners came in second at 21.6%. GAO Report at 38. When pharmaceutical manufacturers were included in the comparison, they accounted for 62% of all fraud judgments and settlements by MFCUs. Judgments and settlements assessed on pharmaceutical manufactures in 2010 amounted to $509,372,944 while home health providers were assessed only $1,347,230. So even though home health constituted nearly 40% of those indicted or charged in criminal fraud cases by MFCUs, they were ordered to pay less than 1% of the total fines and settlements. GAO Report at p. 40.

Looked at another way, the average fine or settlement levied by MFCUs against 43 home health agencies was $31,330 while the average fine or settlement levied by MFCUs against 111 pharmaceutical manufacturers was approximately $5 million.

What it means: No one supports health care fraud by any group of providers and practitioners. The GAO report, however, shows that home health actually accounts for a far smaller percentage of fraud and penalties than other types of health care entities, federal and state governments could achieve a greater return on investment if they directed their anti-fraud dollars to the areas representing the greatest potential loss. This information should be helpful in restoring some perspective in Congress about where to allocate anti-fraud efforts and investments.


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