Congress Unlikely to Act as PDGM, Pre-Claim Loom

Washington, D.C., policymakers have hurled several challenging volleys toward the home health, personal care and hospice industries in 2018, including possible reincarnations of the Home Health Groupings Model (HHGM) and Pre-Claim Review Demonstration (PCRD). To parry those attacks, or at least make sure they’re not overly burdensome, stakeholders will likely need to band together in […]

CMS Proposes Stricter Payment Rule for Independent Home Care Workers

The Centers for Medicare & Medicaid Services (CMS) has taken action to tighten Medicaid payment rules related to independent home care providers. It announced the move in a proposed rule issued Tuesday. “The law provides that Medicaid providers must be paid directly and cannot have part of their payments diverted to third parties outside of […]

House Bill to Support Hospice Training Moves Closer to Vote

Legislation aimed at raising awareness and increasing the quality of hospice and palliative care is steadily finding its way through Capitol Hill. U.S. Rep. Tom Reed (R-New York) announced on Tuesday that the Palliative Care and Hospice Education and Training Act (PCHETA) has made it out of the House Energy and Commerce Health Subcommittee and […]

CMS Launches New Audit Initiatives for Medicaid

The Centers for Medicare & Medicaid Services (CMS) is stepping up its game when it comes to Medicaid oversight—and that may mean more red tape and audits for home care providers. CMS announced on Tuesday it plans to move forward with a series of wide-ranging transparency and accountability initiatives designed to improve Medicaid oversight and […]

LHC Group, Amedisys Execs Shrug Off Pre-Claim Proposal

The home health care industry was rocked when the Centers for Medicare & Medicaid Services (CMS) announced it was bringing back the pre-claim review demonstration at the end of May. The agency proposed reviving the model in the wake of a report urging more pre-claim, or prior authorization, demonstrations across the health care space from […]

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 […]