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OIG Issues Criminal Background Check Study on HHAs

The Office of the Inspector General (OIG) has issued a report titled Home Health Agencies Conducted Background Checks Of Varying Types. The report is in response to a congressional request for the OIG to analyze the extent to which HHAs employed those with criminal convictions and whether those convictions should have disqualified them from HHA employment. The report is a companion to the May 2014 report entitled State Requirements for Conducting Background Checks on Home Health Agency Employees – a report that identified state background-check requirements for HHAs and identified the types of criminal convictions that disqualify individuals from HHA employment.

Speaking generally, there are two types of background checks that states may require HHAs to use: statewide and Federal Bureau of Investigation (FBI). Additionally, the ACA established a Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers called the National Background Check Program.

In the study, the OIG randomly selected a sample of 99 HHAs (six were ineligible). Responses to a survey about background check procedures and information on all employees were collected. The report found that all HHAs conducted background checks of varying types on employees and half also conducted periodic checks after date of hire.

Based on its findings, the OIG recommended that CMS promote minimum standards in background check procedures. CMS could promote minimum standards for HHA employee background checks by encouraging states to participate in the National Background Check Program. CMS agreed with the OIG’s recommendation.

Click here to read more.


CMS Releases Proposed Rule Intended To Modernize Medicaid Managed Care

CMS has released a proposed rule that updates its Medicaid managed care organization (MCO) regulations. The last time CMS updated MCO rules was in 2002.

In the rule, CMS calls for health plans to dedicate a minimum portion of the rates they receive toward medical services – a threshold known as a medical loss ration (MLR). Plans doing business with Medicaid and the Children’s Insurance Program are the only health plans that aren’t subjected to the MLR. The Obama administration is now proposing an 85% threshold for Medicaid managed-care plans.

Experts say the MLR that CMS has proposed for Medicaid plans is a suggestion and not an enforceable mandate. However, many plans will still be affected if states follow through on the agency’s suggestion. Over the past four years, Medicaid managed-care enrollment has increased by 48% to 46 million beneficiaries.

The rule would impose new standards to ensure beneficiaries have adequate provider networks. The new rule would require plans extend time and distance standards for specialists, such as OB/GYNs, behavorial health specialist and dentists. The rule also includes a provision that would require greater transparency in how states determine whether the rates they pay are sufficient to cover the services required under the contract.

Furthermore, the rule includes a section on managed Medicaid long-term care. In the rule, CMS would allow participants enrolled in Medicaid Long-Term Services and Supports (MLTSS), to switch plans or disenroll and switch to fee-for-service if their provider is not in-network for the managed care plan.

Click here to see the proposed rule.

Click here to the CMS press release.

Click here to read more.


Preventable Hospitalizations Down Among American Seniors

According to a new report by the United Health Foundation on the state of seniors’ health, preventable hospitalizations have dropped. The third edition of its annual America’s Health Rankings Senior Report show “encouraging news for senior health nationally,” but also indicates the setbacks seniors have faced compared to previous years.

Among the major gains is a 6.8 percent reduction in preventable hospitalizations, a measure that’s also dropped 11 percent since 2013. Reasons for the reduced hospital admissions and readmissions include the push for better population health management and the shift from fee-for-service model to value-based payments.

The report also found a 9.3 percent increase in the number of home health workers year over year, and a 38 percent increase in seniors who choose hospice care at the end of their lives. These findings are supported by a recent report that indicated nursing homes may replace hospitals as the major providers of senior care – a trend that is fueled by the increased interest in palliative care.

Click here to see the report.

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Outsource Training to Transfer Knowledge

Take a look at our latest TCG CHEX eLearning blog post – Outsource Training to Transfer Knowledge – to learn more about an article covering recent trends in the utilization of outside education for staff.

While you are there, don’t forget to use the calculator to estimate the financial savings your organization could see when you implement TCG CHEX eLearning for your staff education!


TCG Webinar: Home Health Billing Essentials

Date: Tuesday, June 14, 2011

Time: 10 am PT/12 pm CT/1 pm ET

Presented by:
M. Aaron Little, BS, CPA
Senior Managing Consultant
BKD National Health Care Group

Medicare home health PPS refinements have significantly complicated the billing process. Other issues such as the face-to-face encounter and therapy changes have influenced billing practices.
This webinar will provide strategies for drilling into the details of your billing processes, and participants will take away valuable insights on available industry resources and processes
that can be implemented to help optimize efficiencies.

Features and Benefits:

After attending this webinar, the participant will be able to:

  • List typical Medicare home health billing challenges.
  • Apply suggested key billing performance measures.
  • Identify effective and efficient process management tools.

CEs available!

Click Here to Learn More


TCG Webinar: Building a Manageable Corporate Compliance Program

Date: Tuesday, June 7, 2011

Time: 10 am PT/12 pm CT/1 pm ET

Presented by:
Deborah A. Randall, Esq.
Healthcare, Compliance and Telehealth Legal and Consulting Services

In 1998 for home health agencies and in 1999 for hospices, the OIG issued guidance for compliance programs. This webinar will discuss the OIG guidance and what an organization can do implement a “manageable” corporate compliance plan and make it a part of the corporate culture.

Features and Benefits:

After attending this webinar, the participant will be able to:

  • Identify the seven elements that should be included in a comprehensive compliance program
  • Understand the necessity of a risk assessment as part of the plan to identify agency vulnerabilities
  • Develop the required policies and procedures and communicate them to staff

CEs available!

Click Here to Learn More