ARTICLES

April 2019 CMS Quarterly OASIS Q&A

April 2019 CMS Quarterly OASIS Q&As available here!

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Creative PDGM Therapy Strategies for Home Health Agencies

April 30, 2019 | Baily Bryant

When the Patient-Driven Groupings Model (PDGM) takes effect on Jan. 1, 2020, therapy-heavy home health agencies will have to get creative to ensure the new model doesn’t hurt their bottom line.

PDGM eliminates therapy-visit volume as a determining factor in calculating reimbursements, meaning therapy will no longer be a guaranteed revenue-driver for home health agencies. Rather than blindly cut back on services, providers should coordinate with therapists and capitalize on underutilized resources to ensure a smooth transition, experts say.

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Senior Housing will be too Pricey for 54% of Mid-Income Older Adults by 2029

April 23, 2019 | Baily Bryant

By 2029, nearly 8 million middle-income older Americans won’t be able to afford senior housing at today’s average market rates, new research shows. While the statistics have negative implications for the senior housing industry, they create opportunities for home-based care providers, whose services are often the least expensive option for seniors.

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CMS Proposes Cost Report Changes for Freestanding Home Health Agencies

April 16, 2019 | CMS.gov

On April 16, 2019, the Centers for Medicare & Medicaid Services (CMS) published notice in the Federal Register of plans to revise the existing home health freestanding cost reporting instructions and forms (1728-94) with revised forms and instructions (1728-19). CMS has also posted online several documents related to the proposed cost report revisions, including the proposed forms and instructions, a crosswalk of the proposed changes, and a document outlining CMS’ justification for making the proposed changes.

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Why Home Health Providers Should View PDGM as a Patient-Classification Model

April 14, 2019 | Robert Holly

Understandably, home health providers typically view the Patient-Driven Groupings Model (PDGM) first and foremost as a payment overhaul — the most significant in nearly two decades. But with the right perspective, PDGM can also be leveraged to help drive change, strengthen care planning and improve patient quality outcomes.

That’s something home health providers would be remiss to overlook, Anthony D’Alonzo, director of clinical strategy and innovation at Bayada Home Health Care, told Home Health Care News.

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CMS Finalizes In-Home Medicare Advantage Teleheath Policies

April 5, 2019 | Robert Holly

The Centers for Medicare & Medicaid Services (CMS) announced Friday that the agency has finalized a set of policies designed to expand the use of telehealth benefits under the Medicare Advantage program.

Originally proposed in October 2018 for the 2020 plan year, the new policies from CMS are meant to expand access to telehealth services by giving Medicare Advantage (MA) plans more flexibility to cover them in the home setting. Traditionally, CMS has largely restricted telehealth reimbursement to clinical settings in rural areas, apart from certain expectations in Alaska and Hawaii.

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Home Care Providers Look Ahead as Medicare Advantage Evolution Continues

April 7, 2019 | Robert Holly

Home care providers slow to chase Medicare Advantage business opportunities may now be motivated to speed up their pursuits.

Last week, the Centers for Medicare and Medicaid Services (CMS) announced it was broadening the range of supplemental benefits Medicare Advantage (MA) plans can offer in 2020. Starting next year, health care policymakers will allow MA plans to cover any benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions.

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Contract Year 2020 Medicare Advantage and Part D Flexibility Final Rule (CMS-4185-F)

April 5, 2019 | Legislation, Medicare Part C, Medicare Part D

On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefit (Part D) programs by promoting innovative plan designs, improved quality, and choices for patients.

CMS took significant action to increase MA plan choices for the 2019 plan year and aims to continue to expand opportunities so that patients have access to MA plans that meet their unique health needs.

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Fair Scheduling Trend Could Spell Trouble for At-Home Care Providers

April 3, 2019 | Baily Bryant

In recent years and months, rising minimum wage has been top of mind for home-based care providers, adding another level of difficulty to attracting and retaining workers. But fair scheduling legislation that’s gaining steam in cities and states across the country could soon take center stage — and potentially make matters worse.

Fair scheduling legislation varies across the country, but generally, the rules mandate employees must receive set work schedules a certain number of days in advance and a certain number of rest hours in between shifts.

The final rule can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-06822.pdf

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How Telehealth Can Solve HOme Health Agencies’ PDGM Therapy Problems

March 31, 2019 | Baily Bryant

One of the most anxiously awaited aspects of the Patient-Driven Groupings Model (PDGM) is the elimination of therapy visit volume as a determining factor in calculating reimbursements.

Despite reassurance from industry leaders that PDGM isn’t a ‘death knell’ for therapy services, therapy-heavy agencies will have to become more cost effective to ensure they don’t take a hit when the new payment model takes effect.

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