BLOOMFIELD, CT — Gov. Ned Lamont signed a pair of bipartisan elder-care bills into law Tuesday, saying that Connecticut should be a home for everyone to live in dignity. 

 

Public Acts 24-39 and 24-141 — formerly House Bills 5001 and 5046 — were two of the Aging Committee’s priority bills for the short session, and will address some of the issues raised by advocates for the elderly population in the state, from the quality and availability of at-home care to the state of assisted living facilities.

 

Speaking from the Seabury Retirement Community in Bloomfield, Lamont said that he wants Connecticut to be a place where residents “can grow old with grace and dignity.”

 

Lamont said one of the important byproducts of the new act 24-39 is “transparency,” and giving more looks into the facilities in the state that he said need to be held accountable.

For more than 40 years, William A. Dombi has been one of home-based care’s fiercest advocates.

He became the National Association for Home Care & Hospice’s (NAHC) vice president for law in 1987, and has been a key player in many of the advancements and milestones that have moved the industry forward. Those include the growth of the home health benefit under Medicare, the implementation of the home health prospective payment system in 2000 and much, much more.

 

In 1987, Dombi spearheaded a notable lawsuit that changed the scope of coverage under the Medicare benefit.

 

In 2017, Dombi became NAHC’s interim president and was named the association’s permanent president the following year.

On Tuesday, May 28, NAHC submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) FY2025 hospice proposed rule (Fiscal Year (FY) 2025 Hospice Payment Rate Update Proposed Rule (CMS-1810-P) (Proposed rule text HERE; CMS Fact Sheet HERE; NAHC Report article on proposed rule HERE).

 

The proposals included updates to the hospice payment rates and wage index, hospice quality reporting program and two Requests for Information (RFI) — one related to a payment mechanism for high intensity palliative care services and the other related to the use of Social Determinants of Health (SDOH) in the Hospice Quality Reporting Program (HQRP).

On June 6, in response to concerns raised by NAHC and NHPCO, the Centers for Medicare & Medicaid Services (CMS) retracted its guidance indicating that any individual who elects to receive hospice services in a subsequent hospice election would need to be certified as if entering hospice in the initial benefit period.

 

As we reported yesterday, this guidance, published in a Hospice Certifying Enrollment Questions and Answers (Q & A) Document, contradicted Section 1814(a)(7) of the Social Security Act (SSA) and regulations at 42 C.F.R. § 418.22(c)(2). The SSA and regulations indicate that the attending physician must only certify a patient’s terminal illness for the initial hospice Medicare benefit period; and that only one physician, not both the attending and hospice physician, must provide this certification for subsequent benefit periods.

NAHC has been receiving questions about an article posted on the PalmettoGBA website, intended for participants in the Home Health Review Choice Demonstration (RCD), regarding a requirement that home health agencies must have a physician-signed statement of a “hand off” occurring when a physician recertifies home health. However, PalmettoGBA applied the requirement to all home health claims under review as did the other Medicare Administrative Contractors (MACs). 

 

There is no requirement for a physician-signed “hand off” under any circumstance in home health.  As soon as NAHC became aware of the situation we reached out to CMS (Center for Medicare & Medicaid Services).  Since then, the article has been taken down and, in a meeting earlier this week where PalmettoGBA and CGS representatives were present, they confirmed that they are not applying the “hand off” requirement as part of RCD or medical review of claims. We understand that the same is true for NGS, but we have reached out to them for confirmation.

 

CMS, as well as PalmettoGBA, have indicated that all MACs will be posting a revised article.  No expected timeline has been given.  Based upon discussion at the meeting earlier this week, we anticipate that any reference to a physician-signed “hand off” will be removed from the article. Home health agencies that have had claims denied due to the lack of a “hand off” should appeal those denials. Likewise, home health agencies participating in the pre-claim review option for RCD that have had non-affirmations for this reason, should submit the Document Control Number (DCN) to PalmettoGBA for correction.

In January 2024, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking input from the public regarding various aspects of Medicare Advantage (MA) data. Feedback from stakeholders over the past several years reflected a strong desire for more comprehensive high quality MA programmatic data to increase MA program transparency.

 

The National Association for Home Care & Hospice (NAHC) submitted comments (linked above) with its recommendations for greater data transparency for MA plans. 

With new regulations around alternatives to social workers in the hospice interdisciplinary group (IDG), CMS has offered new guidance to state surveyors in Appendix M.

 

The 2024 Physician Fee Schedule final rule, published Nov. 16, 2023, included an update to IDG requirements, adding marriage and family therapist (MFT) or mental health counselor (MHC) as alternatives to a social worker on the IDG.

 

The guidance is around citation code L541 for the make-up and involvement of the IDG. According to the Quality, Certification & Oversight Reports, there were 58 citations for L541 from October 2021 through August 2023 — the most recent data available. Generally, citations focused on a review of IDG documentation that suggested a lack of involvement from some IDG members.

 

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A successful QAPI program can minimize risk, enhance patient experience, improve agency outcomes, optimize operational efficiency, support growth, strengthen staff cohesion and achieve clinical excellence. However, many home health agencies struggle with developing, implementing, evaluating and maintaining an ongoing, agency-wide, data-driven QAPI program that is compliant, well-organized and effective.

 

This tool may be used as a guide to assist agencies in building the framework for a strong, compliant QAPI program.

 

Download tool here. 

 

The HCS Home Care and Hospice Salary & Benefits studies are now underway! This is the fifth year the Connecticut Association for Healthcare at Home (CAHCH)  has partnered with Hospital & Healthcare Compensation Service (HCS) on the studies. Both studies are also published in cooperation with the National Association for Home Care & Hospice.

 

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 1,018 home health agencies and included data from 16 Connecticut agencies. The Hospice Report had data from 704 hospice agencies and included data from 10 Connecticut agencies.

 

Both studies include questions on staffing issues, nursing vacancy + turnover rates, and sign-on bonuses 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 19 fringe benefits, planned salary increases, productivity, caseload, and shift differential data are also covered.