GAO Recommends Extending Prior Authorization

The home health care industry rejoiced after the prior authorization demonstration from the Centers for Medicare & Medicaid Services (CMS) was put on hold indefinitely in 2017. However, the Government Accountability Office (GAO) is urging CMS to extend prior authorization across the general health care space, according to a recent report. The payment approach requires health […]

Home Care Providers Face Federal Lawsuits Over Labor Violations

Several home care providers are facing lawsuits from the Department of Labor (DOL) for allegedly failing to pay workers overtime or minimum hourly wages, according to Bloomberg BNA. The lawsuits come just a few years after the in-home care industry was hit with a new regulation that ensured workers were protected by minimum and overtime wages. […]

Agencies in Limbo as 13-Hour Rule Back in Legal Spotlight

New York’s “13-hour rule”—a term referring to the allowance of home care aides to be paid for just 13 hours of work instead of an entire 24-hour shift—is back in the spotlight after months of legal back-and-forth. Under current regulatory policy, live-in aides working in New York do not receive pay during hours slept or meals […]

Judge Overturns California Aid-in-Dying Law

Roughly two years later the End of Life Option Act went into effect in the state of California, a state judge overturned the law, declaring it unconstitutional. The Act enabled terminally ill patients to utilize medical aid in dying as a palliative care option to end suffering and peacefully end their lives. Six other states—Colorado, […]

CMS Launches Rural Health Strategy with Telehealth Aims

The Centers for Medicare & Medicaid Services (CMS) recently announced a new rural health strategy, targeting Medicare and Medicaid beneficiaries located in rural America. One of the strategy’s aims is to boost telehealth and telemedicine, a growing area of in-home based care. “For the first time, CMS is organizing and focusing our efforts to apply […]

Opioids, Star Ratings Among Top Regulatory Issues in Hospice

The hospice care space has become the hot acquisition target of the moment, in part because buyers see high margins and fewer regulatory hurdles when compared against home health care. However, that does not mean hospice is entirely spared from new and evolving hurdles and regulatory obligations. From opioid-related legislation to forthcoming Hospice Compare changes and […]

New Long-Term Care Medicare Benefit Proposed

A newly proposed Medicare benefit would extend services to eligible beneficiaries for long-term care. The proposal was within a discussion draft of a bill by Representative Frank Pallone (D-NJ), released at a Wednesday roundtable discussion with aging and disability advocates. The proposal, The Medicare Long-Term Care Services and Supports Act of 2018, would establish a […]

Humana to Address Social Determinants of Health in New MA Benefits

In the midst of two major takeovers in the home health and hospice space, insurance giant Humana (NYSE: HUM) is working on expanding its Medicare Advantage benefits. Just last month, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of supplemental benefits for MA plans in 2019, including the addition of non-skilled in-home […]

CMS Proposes $340 Million Increase in Hospice Payments for 2019

Hospice providers could be getting a 1.8%, or $340 million, bump in reimbursements in fiscal year 2019, the Centers for Medicare & Medicaid Services (CMS) proposed Friday afternoon. The proposal is higher than the 1% increase given to providers in 2018. The 1.8% payment update is based on an estimated 2.9% inpatient hospital market basket […]

Managed Care Plans Forced to Limit Home Care Contracts in New York

Managed care insurers in one of the largest states in the country are facing tough new limits on how many home care providers they can contract with. New regulations in New York will impact licensed home care services agencies (LHCSAs), placing some restrictions on the state’s managed care providers as the number of enrollees continues to […]