PDPM Aftermath Offers Glimpse of Home Health Therapy Changes to Come

Home health operators wondering how therapy utilization will change following the Jan. 1 implementation of the Patient-Driven Groupings Model (PDGM) need only look to their post-acute care brethren for answers. The beginning of October marked the official start of the Patient-Driven Payment Model (PDPM), another major payment overhaul from the Centers for Medicare & Medicaid […]

Top Roadblocks Impeding Home Care Providers’ Ability to Coordinate Services

As the health care system continues to move toward a value-based model, at-home care providers are eager to show their worth. Many hope to do that in part by coordinating with clinical and community partners to deliver holistic care and improved patient outcomes. But despite those ambitions, care coordination is easier said than done. “Projects […]

Crisis Averted: Court Strikes Down Rate Changes Set to Compound Caregiver Shortage

Regulatory changes that threatened to compound the caregiver crisis in one state have been reversed, after a judge declared them “null and void.” The news comes more than a month after a new rate structure took effect to govern the Consumer-Directed Personal Assistance Program (CDPAP) in New York. CDPAP allows seniors and people with disabilities […]

HIPAA Compliance, Domestic Workers Bill of Rights Emerging as Key Home Care Legal Issues

In order to avoid costly legal issues, in-home care providers need to stay on top of the constantly evolving legislation landscape. A major part of this is being proactive and getting in front of compliance before it becomes an issue, according to Angelo Spinola, attorney and shareholder at San Francisco-based legal firm Littler Mendelson. “The […]

NAHC’s Dombi: We’re Not Going To Be Bullied By Congress, CMS

There’s a flood of changes surging toward the U.S. home health care industry. But thanks to widespread recognition, improved quality and staunch advocacy efforts, providers have never been standing on higher ground. That was the key message delivered by the National Association for Home Care & Hospice (NAHC) leadership Sunday during the Washington, D.C.-based nonprofit […]

PDGM 101: Advice for Small-Scale Home Health Agencies

The Patient-Driven Groupings Model (PDGM) is less than three full months away. Among its biggest changes, PDGM halves the traditional 60-day billing period to 30 days and places greater emphasis on coding with a new 432-point case-mix mechanism. If those two changes weren’t enough, the overhaul also comes with a potential 8% behavioral adjustment cut […]

PDGM’s Lead Author Gets Candid About Pros, Cons of Revolutionary Model

Set to take effect on Jan. 1, the Patient-Driven Groupings Model (PDGM) is as controversial as it is revolutionary. The model’s therapy changes and behavioral assumptions are two reasons why. Home health operators worry their operations and patients will suffer as a result of those modifications, among others. Even PDGM’s lead author, Lisa Grabert, acknowledges […]

What ‘Significant’ AseraCare Ruling Means for Home Health Providers

A recent hospice-related court ruling may impact how federal watchdogs and whistleblowers go after home health agencies moving forward. Last month, the U.S. Court of Appeals for the Eleventh Circuit issued its long-anticipated decision in United States vs. AseraCare, a winding legal battle involving false claims allegations dating back to 2008. Hospice companies, other Medicare-reimbursed […]

New Trump Order Seeks Rate Equality Between Advantage Plans, Fee-for-Service Medicare

President Donald Trump signed a new executive order Thursday designed to bolster and expand Medicare Advantage (MA), the private Medicare insurance program for seniors that currently covers roughly 22 million individuals. While the executive order is relatively wide-ranging in scope, one major detail should immediately win the attention of home health providers. In the order, […]

CMS Pauses RCD in Two States Ahead of PDGM — But Moves Ahead in Texas

Good news for home health providers in North Carolina and Florida: The Centers for Medicare & Medicaid Services (CMS) will delay the implementation of Review Choice Demonstration (RCD) so agencies can adapt to the upcoming Patient-Driven Groupings Model (PDGM) first. Providers in Texas, however, won’t be as lucky. CMS announced Wednesday it is moving forward […]