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NAHC and CMS Announcements Point to a Busy Fall in Home-based Care


To keep you informed on news, innovation, education and advocacy issues around home-based care, we’ve pulled together these important headlines.

COVID-10 Test Supplies

The U.S. Department of Health and Human Services announced that 10 million pieces of COVID-19 testing equipment will be shipped directly to hospice and home health providers. More tests will be needed for the home health and hospice sectors in order to keep up with demand as we prepare for a tough winter.

CMS Emergency Preparedness Testing Exercise Updates

CMS announced updates changing the requirements for reviewing and documenting emergency preparedness programs. View the memorandum from CMS here.

$20 Billion Added to Provider Relief Fund

Starting October 5th, the U.S. Department of Health and Human Services began accepting applications for additional funding to help cover losses tied to COVID-19. The new funding will also be available to businesses that launched between January and March of this year. William A. Dombi, President of NAHC is also pressing to expand funding to non-medicare-certified home care providers who serve highly vulnerable populations.

Medicare Loan Repayment Terms Restructured

Repayments for loans to healthcare providers due to COVID-19 were originally slated to start in August. The repayment terms for these loans have now been restructured to allow agencies more time to cope and potentially recover from the effects of COVID-19. Agencies now have one year to repay the loans. After a year has passed, Medicare will claim a portion of the agencies’ payments as a loan ​“repayments”.

Provider Relief Fund Updates

The Department of Health and Human Services has relaxed restrictions on the use of Provider Relief Fund money. PRF money can now be used ​“towards lost revenue that is potentially unrelated to COVID-19”.

The Importance of Data

Agencies seeking to break into narrow networks for new referral sources may find data a vital asset to gaining new business. One data point in the home health industry’s favor is the new patient adherence rate for 2020. More than 70% of patients with home health instructions adhered to their orders. This change marks a significant increase from the 54% adherence rate reported in 2016.

What’s Next for NAHC

NAHC President, William A. Dombi addressed the focus of future advocacy efforts at NAHC’s annual conference. Home-based care has reached new levels of awareness and support in Washington and inroads have been made to garner support during COVID-19, but there is still work to do. NAHC is pushing for expanded funding for Medicaid home and community-based services and revisions to fully recognize palliative care as one of the services provided by Medicare and create a new benefit for SNF-at-home.


Humana Speaks Out

The segment president of home solutions for Humana, Susan Diamond spoke in favor of the VBID demo at the Future event hosted by Home Health Care News. She stated that ​“the demo gives us the ability to provide additional support mechanisms for patients to really understand where the deficiencies in what hospices can do today, and where the opportunities are.”

Palliative Education Efforts

The importance of education within the Palliative Care and Hospice space was addressed in several articles by Hospice News this month. ​“A 2019 Journal of Palliative Medicine study found that as many as 71% of people in the United States have little to no understanding of what palliative care is, including many clinicians in a position to refer patients to palliative care or hospice.” It was also found that ​“Close to 60% of patients who would benefit from palliative care do not receive those services, despite the availability of community-based palliative care as well as hospital-based palliative care”.

Preparing for Audits

At a presentation at the National Hospice and Palliative Care Organization Interdisciplinary Conference, Kelly Murray stated ​“Auditing is the new norm. It is not ​‘if’ you get an audit, it is ​‘when’ will you get an audit”. A Hospice News article distilled her recommendations for preparing for an audit.

Updated CAHPS Survey

Hospice stakeholders have been working with CMS by offering suggestions to improve the CAHPS survey and CMS has announced that a new revised version of the CAHPS survey will be field tested in 2021. Catch the overview of the changes here.

MA Updates for Hospice Agencies

The number of MA plans offering home-based palliative care is expected to more than double in 2021 rising from 61 to over 130 plans.

Questions regarding payment structures are solidifying as well. For the first year of the Medicare Advantage carve-in, most participating hospices will receive a per diem payment similar to the reimbursement received through the current Medicare Hospice Benefit.


Are PDGM Changes on the Horizon?

A comprehensive analysis of PDGM in August showed that government spending on home health care is 21.6% lower than CMS’ projected costs going into 2020. PDGM is required to be budget neutral, so lawmakers including Congressman Vern Buchanan called on CMS to remove PDGM’s behavioral adjustment. The CMS final rule at the end of the month announced that the behavioral rate adjustment will remain until a full year of data is available. The rule did come with the announcement of a 1.9% rate increase and updates to the home health wage index.

New Telehealth Bill

A new bill, the HEAT Act, was introduced by Senators Susan Collins and Ben Cardin. The bill provides ​“Medicare reimbursement for audio and video telehealth series furnished by home health agencies during the COVID-19 emergency.”

Value-based Care is Here to Stay

Humana is seeing impressive savings from value-based care efforts reaching into home-based care. ​“Humana’s individual MA members in value-based models benefited from a greater frequency of preventative care….The company’s calculations suggested that an estimated $4 billion was saved due to value-based models in 2019.” Humana plans to use value-based care models to foster a better understanding of patient environments and leverage this knowledge to provide higher quality care.

Value-based care is not without its challenges however, CMS Administrator, Seema Verma shared that ​“The Center stands in need of a course correction in model design and portfolio selection if value-based care is to advance…Models must incorporate design elements that require participants to have skin the game. Models where providers have downside risks have actually performed better.”

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