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President Signs Legislation that Expands the Program of All-Inclusive Care for Elderly (PACE)

President Barack Obama signed into law legislation S.1362/H.R.3243, which expands the eligibility for PACE.  Previously, an individual had to be at least 55 years of age and eligible for nursing home care in order to be eligible for the program. The new legislation lowers the age restriction, allowing those 21 years of age and older who are nursing home eligible to participate.

Click here to read more from NAHC.

Telehealth Services for Veterans

Last week, the Senate Veterans’ Affairs Committee held a hearing to discuss the VETS Act, which would expand telehealth services provided by the VA. The legislation is being sent to the Senate for approval. This legislation would amend the current law in order to allow VA health professionals to practice telemedicine across state lines for patients in their home, whereas currently the VA health professionals are prevented from conducting telehealth across state lines.

Click here to read more.

CMS Issues New Payer-only Occurrence Code for Untimely Face-to-face Encounters

On November 6, 2015, the Centers for Medicare and Medicaid Services issued CR9385 (PDF), “Processing Hospice Denials When Face-to-Face Encounter is Not Received Timely.”

This Change Request will create a new payer-only occurrence code. The code will assist in processing medical review determinations that some hospice services have been denied because of an untimely face-to-face encounter. Also, this Change Request contains no new policy. It does, however, improve the implementation of existing policy per CMS.  The effective date is April 1, 2016 for claims medically reviewed on or after this date. There is an implementation date of April 4, 2016.

ZPICs Are Prominent – Article by Michael McGowan

There is a growing number of Florida Medicare home health agencies that are receiving notices from a Zone Program Integrity Contractor (ZPIC) stating that they are being investigated for a wide range of things, from waste, to abuse or even Medicare fraud.  They have been instructed that their patient records will be reviewed and their claims payments could be reversed, as well as fines will be assessed.  We are learning that this is becoming common-place across our nation.

In looking for a cause for this activity, it has been found that as high as 80% of agencies still have no understanding of Medicare’s Conditions of Payment.  For more information regarding this issue, click here.

CMS Implementing Home Health Value Based Purchase Program (HHVBP)

The Centers for Medicare & Medicaid Services (CMS) has scheduled January 1, 2016 as the implementation date of the Home Health Value Based Purchasing Program (HHVBP).  This is expected to be the most significant Medicare change since the 2000 implementation of prospective payment.  It is an important step in the revamping of how Medicare pays for health care services.

An important issue is when the affected agencies will receive information essential for providers to understand what the performance targets are.  Until the release of this information, providers cannot determine how their performance compares to those measures and which areas need the most improvement effort in order to gain a financial bonus in HHVBP or avoid a penalty. CMS officials have indicated that this information will not be available prior to April 2016. This will provide time to process the 2015 baseline data.

CMS officials have indicated that they will provide responses to all questions through their HHVBP website.  This will allow participants to have access to the information. Questions can be submitted to CMS through There is a webinar scheduled for December 2, 2015 that HHAs can access, along with a web portal, to see the performance records and enter new measures.

For more information, click here.



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