CMS Proposes New Rule Targeting Fiscal Integrity of Medicaid

In September, the owner and operator of an Atlanta-based in-home care provider pleaded guilty to defrauding Medicaid in a $1.2 million scheme. Shortly before that, a Boston-based in-home provider agreed to pay $1.95 million in a settlement to resolve allegations that it submitted Medicaid claims without physician authorization in August. These cases are both part […]

Aetna Medicare CMO: Home-Based Care Now Critical Part of Health Care Ecosystem

When Aetna, a CVS Health company (NYSE: CVS), announced 2020 Medicare Advantage (MA) offerings, the company set out to go beyond simply offering its members a list of benefits. Instead, the company wanted to take a more holistic approach to health, stressing that individuals’ social and personal needs play key roles in keeping them healthy.  […]

Why CMS’s New Home Infusion Benefit Falls Short — And How to Fix It

The recently finalized home infusion benefit from the Centers for Medicare & Medicaid Services (CMS) has created moderate excitement within the home health community, with some providers seeing newfound opportunities to expand their business offerings. Those who currently provide home infusion services, however, have called CMS’s new benefit “deeply flawed.” CMS finalized a permanent home […]

With RAP Phaseout Finalized, Writing Is on the Wall for Small Home Health Agencies

When the Centers for Medicare & Medicaid Services (CMS) released its final payment rule last week, the agency all but guaranteed a wave of home health industry consolidation in 2020. That guarantee comes despite CMS’s move to nearly halve the 8.01% behavioral adjustment included in the Patient-Driven Groupings Model (PDGM). But in addition to reducing […]

Post-Acute Care ‘Food Fight’ Brewing in Washington

There’s a political food fight brewing in the nation’s capital, health care policy insiders told Home Health Care News. And a possible overhaul to the entire post-acute care (PAC) sector is to blame. “One of the things I’m hearing out of Washington is that there are some stakeholders in the post-acute care space interested in […]

Encompass Health CEO: CMS Shouldn’t Risk Home Health Industry Destabilization

The Centers for Medicare & Medicaid Services (CMS) shouldn’t risk home health industry destabilization while pushing through its proposed version of the Patient-Driven Groupings Model (PDGM), especially when it comes to the overhaul’s looming 8.01% behavioral adjustment. That’s according to Encompass Health Corporation (NYSE: EHC) President and CEO Mark Tarr, who discussed PDGM and his […]

Home Health Providers: Beware of CMS’s PDGM Pendulum Swing

Home health providers looking to bet the farm that the Patient-Driven Groupings Model (PDGM) goes through in its current form should be warry, industry executives say. Although it’s important to adjust to the upcoming payment overhaul, the Centers for Medicare & Medicaid Services (CMS) has a history of changing its tune after regulatory actions trigger […]

Home Health Providers Skimping on Therapy Will Likely Pay Steep Price

As the Patient-Driven Groupings Model (PDGM) nears, providers are still trying to figure out how they will navigate 2020’s uncharted territory. For many, there’s a temptation to gain ground by sharply cutting therapy utilization. But that will likely hinder quality of care and cause some providers to pay a steep price. “The minute we saw […]

Trump Impeachment Investigation Stealing Spotlight From Home Health Industry’s PDGM Efforts

At first glance, it might be hard to spot a connection between the impeachment activity swirling around President Donald Trump and the home health industry. A deep dive into the current Washington, D.C.-landscape and national priorities, however, suggests the two are inevitably linked. With all eyes and ears tuned into impeachment talks on Capitol Hill, […]

Home Health Value-Based Purchasing Model Likely Headed to the Scrap Yard

The Home Health Value-Based Purchasing Model (HHVBPM) is likely headed for the scrap yard in the not-too-distant future. Implemented in 2016, HHVBPM was generally designed to pay home health providers in nine states based on outcomes and the value of services delivered. While many thought HHVBPM was fated for expansion, the initiative appears to be […]