House Approves Health Care Reform Bill

CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

Volume 26, Number 03MARCH 2010

IN THIS ISSUE

Are You CAHSAH

Certified? P. 7

FEATURES:Texas Rules on

Hospice Caps P. 10

2010 CAHSAH Conference

P. 3, 14

Marketing Hospice Services

P. 11

On Tuesday, March 16th, the home care industry took center stage at the State Capitol, hosting CAHSAH’s 2010 Lobby Day event. The event provided policy briefing and lobbying insights from CAHSAH Policy Director, Jordan Lindsey, CAHSAH Lobbyist, Peter Kellison, and CAHSAH PAPA Chair, Lucy Andrews. More than 60 CAHSAH members attended the event, taking time out of their day to go over to the capitol to ensure the success of CAHSAH’s advocacy efforts.

“This is one of the important things we do,” shared Andrews, in her welcome address of the 2010

2010 Lobby Day: Voting Voices and Voting Faces Making Direct Connection

Lobby Day. “We do it for our association. We do it for our constituents. And most importantly we do it for our clients because we are here to speak for those who can not speak for themselves.”

Kellison provided the attendees with the basics of the state government and insights on current budget issues. He encouraged the attendees to deliver an effective message, a message that is simple and to the point.

Lindsey provided an in-depth presentation on lobbying strategies and highlighted the

CAHSAH Bulletin

On Sunday, March 21 the House of Representatives gave federal approval to legislation passed by the Senate on Christmas Eve to provide medical coverage to millions of uninsured. The final vote was 219 to 212 with 34 Democrats joining all Republicans in voting against the bill.

After approving the bill, the House adopted a package of changes to the legislation by a vote of 220 to 211. That package then was passed by the Senate on March 25, and the House of Representatives. While Democrats hailed the legislation as historic and compared it to the enactment of Medicare and Social Security, Republicans decried it as saddling the nation with unaffordable levels of debt, leaving states with expensive new responsibilities, weakening Medicare and giving the

government a huge new role in the nation’s health care system.

The health care bill would require most Americans to have health insurance, would add 16 million people to the Medicaid rolls and would subsidize private insurance for low and middle-income people at an estimated cost to the government of $938 billion over ten years, according to the Congressional Budget Office (CBO).

Pictured:Michelle Hofhine, Jordan Lindsey, Senator Tony Strickland and Barry Berger.

Photo by:Rob Mikitarian

>REFORM BILL: continued on p.5

The CAHSAH Bulletin is brought to you by

McKesson Corporation.

Learn more by going towww.mckesson.com

>LOBBY DAY: continued on p.4

D e c k s o f F u n , D o u b l e D o w n o n P r i z e s !A l l i n S u p p o r t o f t h e H o m e C a r e I n d u s t r y

2010 PAC EVENT

SAVE THE DATE: WEDNESDAY, MAY 5, 2010, 7:30PM - 11PM TICKETS: $50

Join us for the most widely attended party at CAHSAH’s Annual Conference. CAHSAH’s Political Action Committee Event is the biggest PAC fundraiser of the year and an excellent opportunity to meet new colleagues and celebrate our success together. Your financial support of the PAC is needed more than ever this year as we continue our “PAC Partner” program and build relationships with legislative champions of home care.

The event is open to all, includes dinner and a night packed with entertainment and great prizes! Tickets and Sponsorships may be purchased in advance by contacting Mary Adorno at (916) 641-5795 ext: 124 or madorno@cahsah.org. You may also get your tickets at the PAC Event Registration table at the conference.

SPONSORSHIP LEVELS

*BE RECOGNIZED*

Royal Flush $1,500Food Sponsor10 tickets to the event Dealer’s Choice $1,200Entertainment Sponsor8 tickets to the event

Sure Bet $1,000Black Jack Table Sponsor6 tickets to the event

Four of Kind $750 4 tickets to the event

Card Shark $500 2 tickets to the event

Up the Ante $2501 ticket to the event

Assembly Member Dave Jones (Chair- Assembly Health Committee)Assemblyman Anthony Portantino (D-Pasadena)Assemblyman Jerry Hill (Chair of the Budget Sub-Committee on Health and Human Services)Senator Tony Strickland, (Assistant Senate Minority Leader & Vice-Chair of the Senate Health Committee)

Place your sure bet now by investing in CAHSAH’s Political Action Committee and don’t miss out on this exceptional party!

Your PAC Dollars at Work! Members of CAHSAH Board and CAHSAH PAC Partners hosted the following private dinners for the following legislators:

Increase your chances of winning the grand conference prize by purchasing a PAC event ticket!

B l a c k J a c k N i g h t

R

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Education Resources, P & P Manuals, Toolkits and More!

Contact us to learn how we can provide expert solutions to drive your success.

Looking for the best solution?TCG has the answer.

Join us at the largest home care conference in the West. Each spring, CAHSAH’s Annual Conference & Home Care Expo brings together more than 480 providers and vendors for cutting-edge training; engaging and enlightening speakers; and endless networking. The Conference will take place from May 4-7 at the Convention Center in Sacramento, California.

Room blocks are limited. Make your reservations by calling: (888) 421-1442. Ask for the CAHSAH rate of $178 Single/Double (plus tax). Hotel Room Reservation Deadline: April 5, 2010.

To download the conference brochure, visit http://www.cahsah.org/?p=registrati.

For more information or to register by phone, please contact CAHSAH at (916) 641-5795, ext. 113

M a k e y o u r C o n f e r e n c e

T r av e l P l a n s N o w !

CAHSAH’s Annual Conference & Home Care Expo

www.cahsah.org

4

UPDATE

P OL

I CY

Question: If an employee does not turn in their timesheet according to company policies and procedures, can we pay them when the time sheet is submitted?Answer: CA Labor Code requires employees to be paid in a timely manner regardless of submission of a time sheet. Employers should estimate hours worked based on staff schedules and make corrections when the official time sheet is submitted.

Question: Does an employer have to pay COBRA benefits if the employee voluntary leaves?Answer: Yes, Cal-COBRA is a California law that is like Federal COBRA. Cal-COBRA applies to employers and group health plans that cover from 2 to 19 employees. More detailed information is available herehttp://www.dmhc.ca.gov/dmhc_consumer/hp/hp_cobra.aspx#who

Question: Does OASIS C require a date be input when there is exacerbation of a prognosis? I know that OASIS B did and I’m confused because form 485 requires us to enter a date?

Answer: Form 485 continues to require a date of occurrence or exacerbation; however, OASIS-C diagnosis list does NOT require an exacerbation date.The bill would require many employers to offer coverage to employees or pay a penalty. In one of the changes to the legislation in the second House bill, the employer penalty was raised from $750 to $2000 per full-time equivalent employee for employers with 50 or more FTEs. Since the first 30 full-time employees are exempt from the penalty, when an employer hits 51 FTEs they pay the penalty on 21. The CBO estimates the bill would provide coverage to 32 million uninsured people but still leave 23 million uninsured in 2019. It is estimated that one-third of the remaining uninsured would be illegal immigrants.

The new costs of covering the uninsured would be more than offset by approximately $500 billion in Medicare savings (including $40 billion in home health cuts) and by new taxes and fees, including a tax on high-cost employer sponsored health plans and a tax on investment income of the most affluent Americans.

Because of the partisan process used in passage of the bill and phasing in many of its provisions over the next four years, the health care reform legislation is likely to remain controversial up to the mid-term elections in November and beyond.

5www.cahsah.org

March WNU HeadlinesMarch 1st: HHS Posts List of Covered Entities Reporting

Breaches of Protected Health Information

Office of Civil Rights (OCR) has posted a list of the covered entities that have reported breaches of unsecured protected health information affecting more than 500 individuals. HITECH Act, which became effective September 23, 2009, requires covered entities to provide notification of breaches of unsecured protected health information directly to the Secretary of HHS. Breaches that affected 500 or more individuals must be reported to HHS within 60 days, and covered entities must provide this notification via the online form on the OCR website which will be continuously updated. For more information, visit the OCR website at http://www.hhs.gov/ocr/hipaa/.

March 8th: CA Lags in Registrants for Home Health Quality Improvement Campaign

CAHSAH President Joe Hafkenschiel participated in a March 4th teleconference for the Home Health Quality Improvement (HHQI) National Campaign. Over 4,000 agencies across the country have registered for the campaign which provides registered agencies with free data reports and best practice information packets. A new best practice package for oral medication management will be available April 28. On the teleconference, Hafkenschiel learned that California has the lowest registration rate for the HHQI campaign at 16 percent. He urges agencies to register for the campaign and take advantage of the free resources to improve home health quality. Agencies can register at http://www.cahsah.org/www.

homehealthquality.org/hh.

March 15th: NGS Offers Free Hospice Benefit-Billing and

Payment Teleconference

The National Government Services Provider Outreach and Education department will conduct the Hospice Benefit-Billing and Payment teleconference on April 15, 2010 to educate the hospice community on the billing requirements under the Medicare Hospice benefit. Claim submission steps as well as the billing transactions that are used to report situations to Medicare such as; elections, revocations, and transfers will be reviewed during this free teleconference. Click here to register.

March 29th: CMS Plans Login Changes to the OASIS

Submission System & CASPER Reports

CMS is changing the way home health agencies login to the OASIS Submission System and CASPER Reports. A conversion will take place to move from state-assigned shared agency login IDs to personal login IDs. Agency users will be required to register for personal login IDs, and will no longer be able to use the shared agency ID to login to the OASIS Submissions Systems and CASPER Reports. The new security system allows two individuals from your facility to obtain an individual user ID. Information and forms are available on the QIES web site at http://www.qtso.com/ . If you have any questions or concerns please contact the MDSOASIS helpdesk at mdsoasis@cdph.ca.gov .

Better Outcomes Through Standardized Patient CareNEW Automated Rules Management Feature

McKesson Supply Management Online now offers Automated Rules Management to help control costs while increasing efficiency.

The technology you already use, Supply Management Online, makes rules management easy for you. With this new feature, you can now enhance quality of care while monitoring and reducing unnecessary costs, all with a simple set-up.

Rules management is a tool for you to:

Supply Management Online helps you to execute your strategies and comply with Prospective Payment System (PPS) requirements simply while reducing waste and controlling costs.

To learn more about how to streamline patient care and simplify staff use of supplies, contact McKesson Medical-Surgical today at 888.822.8111.

McKesson Medical-Surgical8741 Landmark RoadRichmond, VA 23228888.822.8111

www.mckesson.com

©2008 McKesson Medical-Surgical Inc.2008-0077

Supply Management Online’s new rules management feature helps you:

Manage protocols according –to your pre-established guidelines Monitor appropriateness of –product use Track adherence to protocol –guidelinesAchieve cost savings –

Manage supply costs for patients – Control products purchased by clinicians –Avoid over-utilization of products –

Limit products purchased to –approved formulary Reduce chances of non-reimbursement –

http://www.hhs.gov/ocr/hipaa/http://www.hhs.gov/ocr/hipaa/http://www.homehealthquality.org/hhhttp://www.homehealthquality.org/hhhttp://www.NGSMedicare.comhttp://www.qtso.com/mailto:mdsoasis@cdph.ca.gov

6

THE COUNTDOWN HAS BEGUN!!!

UPDATE

Nowadays, we all understand “Getting the Best Bang for Your Buck”. So, when someone asks why they should join CAHSAH instead of another association or organization, don’t get caught off guard. Turn the tables; provide them with a list of questions that anyone who is considering joining any organization should ask themselves:

ASK YOURSELF

Once asked, the answer will be obvious: CAHSAH is by far the best choice!

This tool is a low key recruiting tool – it does the work for you and makes a strong impact.

Try it and let us know how it works.

Introducing: A New Recruiting Tool

Wanted: Best Practices, New Ideas, New Processes, New Procedures

M E MB

ER

SH

IP

Use CAHSAH’s Tip Line 916-641-5795, ext 111 or sbertoux@cahsah.org

“Share the Wealth” is a CAHSAH sponsored program, allowing an open exchange of member ideas. Just jot down a couple of paragraphs describing the situation, the new process/procedure, and the outcome. Then send us your story OR, for your convenience, call and we will arrange for a phone interview and will prepare the submission on your behalf. The most notable will be published in the Bulletin each month; the winner will be announced at Conference and will receive a FREE WORKSHOP. So take a few moments while it’s fresh in your mind. The prize could be yours.

Here are some topics that might trigger an idea:

CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

Here is a list of other tools available for your use:

Key Membership Benefits

Section Specific Benefits

CAHSAH’s Estimate of Value

2009 CAHSAH Report Card

Ask Yourself

Overcoming Objections

Making the CAHSAH Connection

Referral/Intake

Assignment/Scheduling

Patient Care Practice Supervision

Documentation System

Documentation Review

Quality Improvement

Information System

Coding & Billing

10987

There are only a handful of expo booths available for CAHSAH’s 2010 Annual Home Care Expo. If you wish to exhibit at this year’s trade show, place your reservation now. You’re going to like this event -- great location, great facility, great weather, great opportunity!!

Contact mlander@cahsah.org or go online to view the interactive floorplan and to access the prospectus and details of the show.

See you in MAY!

http://www.cahsah.org/documents/774_ask_yourself.pdfmailto:sbertoux@cahsah.orghttp://www.cahsah.org/index.php?p=recruitinghttp://www.cahsah.org/index.php?p=recruitinghttp://www.cahsah.org/index.php?p=recruitinghttp://www.cahsah.org/index.php?p=recruitinghttp://www.cahsah.org/index.php?p=recruitinghttp://www.cahsah.org/index.php?p=recruitinghttp://www.cahsah.org/index.php?p=recruitingmailto:mlander@cahsah.orghttp://www.cahsah.org/ASP/Expo2009/ExpoHall10.asphttp://www.cahsah.org/documents/710_2010_exhibitor_prospectus.pdf

7www.cahsah.org

CAHSAH Welcomes

New Members!

NEW – Making the CAHSAH Connection?

We have just completed the design of a powerpoint presentation to send to new members as a get acquainted tool and guide. The intent is to not only answer the key questions but to provide the information in a format that can be viewed at their convenience and stored electronically for future reference. Perhaps you’d like to take a look – it’s a good refresher document. Please feel free to forward to friends and peers.

REFERRALS, REFERRALS, REFERRALS!

GAIN the necessary tools as well as INCREASE your competitive edge in the marketplace that is expanding ever so quickly!

If you provide home care aide services, then you are ELIGIBLE to participate in CAHSAH’s Home Care Aide Organization Certification Program.

CAHSAH kicks off the year with two key marketing initiatives to GROW YOUR BUSINESS:

The state has been organized into 11 regions where REGIONAL COORDINATORS are promoting the Certification Program to local referral sources. These people are CAHSAH members who have volunteered to lead efforts in their local communities.

Key Priorities:

Schedule presentations with local referral sources•Encourage other Home Care Aide CAHSAH members to become •CertifiedEncourage nonmembers to become Certified•Share information and address issues•Participate in community events•Advertise in local home care publications•Build a network to facilitate communication•Be a contact person for CAHSAH and work to support the growth of •CAHSAH’s Home Care Aide Organization Certification ProgramParticipate on CAHSAH’s Home Care Aide Organization Certification •Program Subcommittee

CERTIFICATION shows referral sources and clients that your caregivers are employees and that you carry workers’ compensation, liability insurance, and an employee dishonesty bond.

Contact the local regional coordinator in your community to learn more.

If you have questions about our Home Care Aide Certification Program, please contact Michele Lander at (916) 641-5795 x 129 or mlander@cahsah.org.

What are you waiting for? Apply Now!

MARCH ON WASHINGTON & LAW SYMPOSIUM

2010 Home Care & Hospice

C O N F E R E N C E & E X P O S I T I O N

Make a Di�erence March on Washin

gton!

Instant

Rebate

Use Cod

e HC4379!

Register Online Now and Receive a $25 Instant Rebate on your Registration! www.nahc.org/meetings/mow/10

$25

Please help us extend a warm welcome to those new members who have recently joined CAHSAH between

February 20, 2010 and March 19, 2010.

ProvidersCompatible Home Care, Chula Vista, CA

Plexus Health Care, Inc., Upland, CASerenity Hospice, Claremont, CASheridan Care, Los Angeles, CA

AffiliatesEdna Guanio, Oxnard, CA

Eng Hoe Soon, San Diego, CALegacy Home Health & Hospice,

Meridian, IDTimothy Tang, San Diego, CAToshihiko Kii, San Diego, CA

http://www.cahsah.org/documents/780_cahsah_connection_pdf_website.pdfhttp://www.cahsah.org/documents/782_list_of_regional_coordinators_(2)_(2).pdfmailto:mlander@cahsah.orghttp://www.cahsah.org/index.php?p=hca_organization_certification

8 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

UPDATE How to Get More Referrals for your Homecare or Hospice Agency?

E D UC

AT

ION

There are so many factors to consider when referral sources place patients in a home care or hospice agency. But one factor that impacts the distinction of one agency from another is the successful management of that agency. Great management leads to great results, creating a cycle of success in providing quality care to patients - a key decision factor when referrals are made. Make sure your Administrators are well educated in all areas of their responsibility to ensure success. The investment you make today in attending these upcoming certificate programs will long last this slowing economy.

All certificate programs are brought to you by: CAHSAH with the support of TCG, NAHC

HOSPICE ADMINISTRATOR CERTIFICATE PROGRAM Sponsored by: HospiScript and Care West Insurance Risk ManagementJuly 20-22, 2010 – Las Vegas, NV

HOME CARE ADMINISTRATOR CERTIFICATE PROGRAM Sponsored by: Care West Insurance Risk ManagementJuly 21-23, 2010 – Las Vegas, NV

HOSPICE EXECUTIVE CERTIFICATE PROGRAM Sponsored by: HospiScript and Care West Insurance Risk ManagementNovember 2-4, 2010 – New York, NY

HOME CARE EXECUTIVE CERTIFICATE PROGRAM Sponsored by: Care West Insurance Risk ManagementNovember 3-5, 2010 – New York, NY

Save an extra $25 when registering two or more people from the same agency online.For more information or to register, please visit: http://www.cahsah.org/?p=certificate_programs

In February, CAHSAH offered a PPS Billing workshop presented by billing expert, Melinda Gaboury. Melinda and attendees spent the day reviewing the calculation of the HHRG & HIPPS code, Episode Exceptions LUPA, PEP, Outlier & Therapy and Medicare verifications on patient’s using HIQH screen examples, and claim forms. The workshop also included a review process of auditing a prebill for final claim purposes and both Medicare and Non-Medicare payers and the Medicare Secondary Payer Billing Requirements.

At lunch, attendees were able to network with one another and were treated to a special demonstration on the latest software technology by CAHSAH’s new workshop sponsor Kinnser Software.

After lunch, Melinda wrapped up with a discussion on Electronic Remittance Advices & Codes. The class spent time working through numerous billing scenarios for both Medicare

Medicare Billing Under PPS ReformSponsored by Kinnser Software

and Non-Medicare payers. Attendee handouts included claim forms, audit tools and DDE screens for attendees to take back to their agencies and study.

If you missed this program, CAHSAH has partnered with HPS to provide an on-demand video training of this class for purchase. Check our website for availability.

http://www.cahsah.org/?p=certificate_programs

9www.cahsah.org

This March, over 150 people gathered together to learn of the new changes in OASIS-C. Melinda Gaboury not only covered the necessities of surviving but thriving under CMS’ new requirements.

The workshop began with a brief overview of OASIS-C timelines, and its affect on home health agencies including training and intake. She then reviewed the crosswalk of OASIS-B1 to OASIS-C and the Guidance Manual; including discussions on data accuracy, encoding, and transmission requirements. After a brief morning coffee break to re-stimulate the masses, Melinda took on the big items! It was time to discuss the new M item instructions from Chapter 3 of OASIS-C Guidance Manual. This topic took over the conversation for the rest of the day. Attendees specifically learned new changes regarding; Clinical Record Items, Patient History & Diagnoses, Living Arrangements, Sensory Status, Integumentary Section, Respiratory Status, Cardiac Status, Elimination Status, Neuro/Emotional/Behavioral Status, ADL/IADLs, Medications, Care Management, Therapy Need & Plan of Care, and Emergent Care & Discharge.

On the second day, after a quick review of what was discussed the previous day, attendees dove right back into learning new information. This time the focus was more on OASIS-C’s affect on billing. Topics discussed included: calculation of the HHRG & HIPPS code, Episode Exceptions including LUPA, PEP, SCIC, Outlier & Therapy, reimbursement calculation and the affect that OASIS-C documentation has on reimbursement, and casemix weights before & after OASIS-C. Again questions and answers were always included in the presentation time, and Melinda made sure attendees had plenty of scenarios to use for practice.

For most attendees the day was finished at about noon, but for those brave over-achievers CAHSAH offered the COS-C OASIS certification exam.

If you were unable to attend, CAHSAH has partnered with HPS to provide a video recording of this class for purchase. Keep checking our website for availability.

OASIS-C: Don’t Just Survive – Thrive!

New to the game? Become a “Power Player” by attending the upcoming workshop. From learning the rules to knowing the key players, you too can be successful in the home care business. The stakes are too high to risk going into the business blindly.

This two-day program will review everything from the 855A application process to licensing & certification to surveys, operations, marketing, intake and supervision and management structure. The program will cover applicable local, state and federal

regulations governing Medicare certified home health providers in California and Nevada.

Each agency will receive the “HHA Start Up Manual” a CAHSAH resource valued at $400 when attending this workshop.

June 24-25, 2010 - Las Vegas, NVFor more information or to register, please visit: http://www.cahsah.org/educational_events/10StartUpHHA.asp

Sponsored by: Kinnser Software THE STAKES ARE HIGH: Ensure your New Home Health Agency’s Success!

The Art of ICD-9 Coding for Home Health

Sponsored by: Kinnser Software

Coding is an important process impacting reimbursement rates. In this economy, you cannot afford to make mistakes. Join expert coder and attendee favorite, Sparkle Sparks as she navigates through the coding guidelines in the quest for accuracy. From novice to expert, with three different courses you have the option of choosing a course appropriate for your experience level.

Basic LevelJune 7, 2010 – Ontario, CA

Intermediate LevelJune 8, 2010 – Ontario, CA

June 10, 2010 – Sacramento, CA

Advanced LevelJune 11, 2010 – Sacramento, CA

For more information, please visit our website.

The two most common issues found with ADR audits are:

The documentation does not support the need for the level of 1. services. The documentation does not support eligibility for hospice 2. care.

Do you know what to do to fix this? Better yet, is your agency up-to-date on the rules so this doesn’t happen to you? Join ADR experts Annette Lee and Corrinne Ball as they walk you through the Medicare review process. You will learn about Local Coverage Determinations (LCDs), RAC, claim denials, ADR’s, and the appeal process. Additionally, the program will review top medical review denials, and documentation tips on avoiding those denials.

May 24, 2010 -Sacramento, CAMay 25, 2010 – Ontario, CA

For more information about CAHSAH’s Hospice ADR’s: Behind the Magic Curtain workshop, please visit our website.

How to Fix Common ADR Issues that Will Save your Agency Time & Money

Sponsored by: Kinnser

10 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

UPDATE Elizabeth E. Hogue, Esq.

On February 22, 2010, a federal court in Texas ruled that regulations of the U.S. Department of Health and Human Services (DHHS) imposing a statutory cap on Medicare payments for hospice care are arbitrary and capricious and cannot be implemented. The judge granted summary judgment to the hospice, which means that the Court decided that both the

law and the facts are in favor of the hospice or plaintiff [Lion Health Services, Inc. v. Sebelius, No. 4:09-CV-493-A (N.D. Tex. Feb. 22, 2010)].

Previously, on July 13, 2009, a federal court in California ruled in favor of Los Angeles Haven Hospice, Inc. and said that the statutory cap on Medicare payments for hospice payments is invalid [Los Angeles Haven Hospice, Inc. v. Sebelius, No. CV-08-4469 (C.D. Cal. July 13, 2009)]. The U.S. District Court for the Western District of Oklahoma also previously decided on July 10, 2009 that Compassionate Care Hospice could challenge statutory caps on Medicare payments [Compassionate Care Hospice v. Sebelius, No. 5:09-cv-00028-C (W.D. Okla. July 10, 2009)]. Like the Court in California, the U.S. District Court for the Northern District of Texas decided that caps on payments to hospices under the Medicare hospice benefit conflict with a clear Congressional directive for calculating the annual provider cap. Consequently, the Court ruled that DHHS cannot collect overpayments from the hospice that initiated the suit. The Court also decided that DHHS cannot use the regulation to calculate the hospice’s payment cap for past, present, or future accounting years. The Court further ordered DHHS to refund all monies repaid to the Medicare Program by the hospice for the accounting years 2006 and 2007 in the amounts of $1,137,113 and $1,124,637, respectively.

After the Provider Reimbursement Review Board decided it did not have the authority to decide the legal question of whether Section 418.209(b) is valid, the hospice filed suit claiming that the regulation is contrary to the

Court in Texas Rules on Hospice Caps

F E AT

UR

ES

language of the governing statute. According to the statute, the amount paid for hospice care for an accounting year is limited to a “cap amount” for the year “multiplied by the number of Medicare beneficiaries in the hospice program in that year.” The statute provides that the number of Medicare beneficiaries for purposes of this calculation should be “reduced to reflect the proportion of hospice care that each such individual was provided in a previous or subsequent accounting year…”

The implementing regulation, Section 418.309(b), however, calculates each hospice’s cap amount using “the number of Medicare beneficiaries who elected to receive hospice care during the cap period.” The hospice argued that the regulation was invalid because it includes an individual in a single accounting year depending on when the individual filed an election to receive hospice care, rather than requiring a proportional adjustment as specified by the statute.

The Court stated that Congress clearly indicated in the statute how the number of beneficiaries should be calculated. By its plain language, the statutory requirement that the number be ‘reduced to reflect the proportion of hospice care that each such individual was provided in a previous or subsequent accounting year’ can only be accomplished in one way: each such individual who was also provided care in other accounting years must be counted toward the ‘number of beneficiaries’ in that year as a fraction…

Section 418.309(b)(1) clearly does not follow the method described in §1395f(i)(2)(C)…rather than merely to ‘reduce’ the number of individuals who were provided care in a particular accounting year, the regulation completely excludes individuals who did not elect benefits in that accounting year…

Hospice providers will surely want to stay up-to-date on developments in these cases.

©2010. Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material

may be reproduced in any form without the advance written permission of the author.

Elizabeth E. Hogue, Esq.

Management at assisted living facilities (ALF’s) and retirement communities are often committed to keeping residents in their facilities for as long as possible. There are, of course, costs associated with filling vacancies. In addition, if residences remain empty for any length of time, the profitability of these types of entities can be severely adversely affected. Consequently, to the extent that hospices can assist residents to remain in their homes, ALF’s and retirement communities may be extremely interested in establishing on-going relationships with these types of providers.

ALF’s and retirement communities can be valuable referral sources for hospices, both in terms of the volume of patients and the types of patients referred. Management at ALF’s and retirement communities may wish to make referrals to a single company or to limit referrals to a few providers. The perception among managers of these types of facilities, whether true or not, seems to be that providers are more likely to help them to meet the goal of limited resident turnover if they have preferred provider relationships with them.

So, providers may wish to approach ALF’s and retirement communities to see if they are interested in these types of arrangements. If they are, management of ALF’s and retirement communities may want to sign a Preferred Provider Agreement in order to cement relationships with providers.

The anti-kickback statute may apply if providers, ALF’s, or retirement communities involved in referral arrangements receive any type of federal or state funds, including, but not limited to; payment for services provided from Medicaid waiver programs, managed Medicaid programs, the Tri-Care Program, or any other state or federal programs. The anti-kickback statute generally says that anyone who either offers to give or actually gives anyone anything in order to induce referrals has engaged in criminal conduct. There are, however, a number of exceptions to this statute that may be applicable.

Providers need to ask themselves two crucial questions regarding the application of the anti-kickback statute to referral arrangements:

1) Is there a kickback or rebate?

2) If so, is there an exception or “safe harbor” which permits the arrangement even though it would otherwise violate the statute?

A kickback or rebate occurs when a provider receives referrals from another provider and something flows back to the referral source from the provider who received referrals. If there is a kickback or rebate, providers must automatically ask the second question described earlier. If they fail to utilize applicable exceptions, they may miss out on useful marketing strategies

that are likely to result in numerous referrals.

With regard to Preferred Provider Agreements, however, it is important

to note that no money or anything of value changes hands between

providers and the other party involved. Consequently, there is no kickback or rebate. Providers can, therefore, enter into Preferred Provider Agreements and avoid violations of the anti-kickback and rebate statute so long as no money

or anything else of value is given to ALF’s and retirement communities in

exchange for referrals.

The parties to Preferred Provider Agreements must also make certain that they

honor patients’ choices of providers. There are a number of sources of patients’ right to freedom of choice

of providers applicable to arrangements between providers and ALF’s and retirement communities:

1) Court decisions or the common law says that all patients; regardless of payor source, type of care rendered, or types of providers involved; have the right to control the care they receive and who provides it.

2) A federal statute that guarantees all Medicaid patients the right to freedom of choice of providers. This statute may be applicable if either party receives reimbursement from the Medicaid Program.

There is, however, no requirement that ALF’s and retirement communities must present lists of providers from which residents may choose in order to comply with the above. When patients express preferences for certain providers, however, their choices must be honored despite the existence of Preferred Provider Agreements. The agreement of the parties to a Preferred Provider Agreement to honor patients’ choices should be included in such Agreements.

The market for hospice services is expanding, but the competition for referrals among providers seems to be extremely fierce. Providers are well-advised to utilize Preferred Provider Agreements to assist them with increasing and/or maintaining referrals in order to help ensure profitability.

For assistance with preparation of Preferred Provider Agreements, contact Elizabeth Hogue, Esq. ©2010. Elizabeth E. Hogue, Esq.

All rights reserved.

Part VII: Marketing Hospice Services Preferred Provider Arrangements between Hospices and Assisted

Living Facilities/Retirement Communities

www.cahsah.org 11

12 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

CAHSAH State Bill Tracking Priority A LegislationSTATE BILL WATCH PRIORITY A BILLSBill # Description Position Status

General BusinessAB 1735 (Harkey)

Would allow a tax credit in an amount equal to 50 percent of the amount of costs paid or incurred in connection with additional education and training for purposes of career advancement or retention, as specified.

Support Pending hearing in Revenue and Taxation Committee

AB 2334 (Salas)

Would prohibit a medical care provider, or health facility from charging, assessing, or collecting, directly or through a collection agency or other intermediary, or pursuant to any judgment, any interest on, or late fees or charges out of, any unpaid balance on a bill for medical services rendered. Also require those providers and facilities to include in a bill for medical services a notice to this effect, in at least 12-point type.

Oppose Pending hearing in Health Committee

Health Care CoverageAB 2586 (Chesbro)

Would require a plan or an insurer that contracts with providers to obtain approval from its regulating dept. prior to implementing a network modification. Would require the plan or insurer, in order to obtain approval, to demonstrate that the modified network meets certain access requirements.

Support Pending hearing in Health Committee

HospiceAB 950 (Hernandez)

Would allow in-patient beds as part of a hospice’s current license and not require the hospice to have a separate facility license.

Support Hearing canceled at the request of author.

LaborAB 179 (Portantino)

CAHSAH sponsored bill to remove the weekly pay requirement. Would permit employees of temporary services employers of health care services to be paid semimonthly.

Support Labor and Industrial Relations Committee

AB 1603 (Solorio)

Would require that an employee be deemed to be temporarily partially disabled during the period when the employee's disability is permanent and stationary, no more than 60 days have elapsed after the date the employee was informed that his or her disability is permanent and stationary, the employer has not offered the employee regular, modified, or alternative work, and the employer has not informed the employee that it will not offer the employee regular, modified, or alternative work.

Oppose Referred to Insurance Committee

AB 1994 (Skinner)

Would provide, with respect to hospital employees, that the term "injury" includes a blood-borne infectious disease, neck or back impairment, methicillin-resistant Staphylococcus aureus (MRSA), or H1N1 influenza virus that develops or manifests itself during the period of the person's employment with the hospital. This bill could establish a precedent and open the door for home health to be included.

Oppose Referred to Insurance Committee

AB 2187 (Arambula)

Creates a separate prohibition against a person or an employer who, willfully fails to pay all wages due to an employee who has been discharged or who has quit within 90 days of the date of the wages becoming due and would impose additional criminal penalties for such conduct. Also requires those who violate these provisions to pay restitution equal to the amount of unpaid wages to the aggrieved employee and prosecution costs, upon conviction becoming final.

Oppose Referred to Labor & Employment Committee

SBX8 64 (Hollingsworth)

Repeals the existing Labor Code Private Attorneys General Act of 2004 that provides aggrieved employees with a nonexclusive remedy acting as private attorneys general to seek civil penalties for violations of the Labor Code on their own behalf or on behalf of other employees, which penalties previously could be assessed and collected only by the Labor and Workforce Development Agency or its subordinate entities.

Support From Committee without further action.

SBX8 70 (Dutton)

Would specify conditions under which on-duty meal periods are permitted rather than meal periods in which the employee is relieved of all duty.

Support Returned to Secretary of Senate.

NursingSB 182 (Ashburn)

Would delete the limitation that temporary clinical nursing faculty be employed for not more than 4 semesters or 6 quarters.

Support Hearing cancelled at request of author.

State Funded ProgramsAB 1260 (Huffman)

CAHSAH sponsored bill to achieve the budget objective of $5.3 million in savings associated with cuts to respite services without applying an arbitrary and excessively restrictive cap.

Support Re-referred to Rules Committee

AB 1506 (Anderson)

Would require a state agency to accept, from any person or entity, a registered warrant or other similar evidence of indebtedness issued by the Controller endorsed by that payee, at full face value, for the payment of any obligations owed by that payee to that state agency.

Support Referred to Governmental Organization Committee

AB 1864 (Strickland, Audra)

Would provide that Medi-Cal providers be paid even when the state has not passed a budget for the current fiscal year.

Support Re-referred to Health Committee

SB 886 (Florez)

Would authorize the providers of specified in-home services to use electronic timekeeping for verifying tasks completed and ensuring quality home care for in-home recipients, as defined.

Support Amended and re-referred to Human Services Committee

http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 1735http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 2334http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 2586http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 950http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 179http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 1603http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 1994http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 2187http://ct2k2.capitoltrack.com/BillInfo.asp?measure=SBX8 64http://ct2k2.capitoltrack.com/BillInfo.asp?measure=SBX8 70http://ct2k2.capitoltrack.com/BillInfo.asp?measure=SB 182http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 1260http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 1506http://ct2k2.capitoltrack.com/BillInfo.asp?measure=AB 1864http://ct2k2.capitoltrack.com/BillInfo.asp?measure=SB 886

13www.cahsah.org

Federal Bill ListBill Number Description Position Location

AbuseS 795

(Hatch)Creates an Elder Justice Coordinating Council and an Advisory Board on elder abuse, neglect and exploitation which will be responsible for coordinating public and private activities and programs related to elder abuse

Watch Referred to Finance Committee

Health Care CoverageH.R. 3590(Rangel)

Senate version of health care reform. Watch Signed by the President

HR 4872(Spatt)

Health Care Reform Reconciliation corrections bill. Watch Referred to Senate Finance Committee.

H.R.3200(Dingell)

House version of health care reform. Watch Placed on Union Calendar

Health Care WorkforceH.R.468 (Schakowsky)Companion Bill: S.245

(Kohl)

Expands training and support to all sectors of the health care workforce to care for the growing population of older individuals in the United States.

Watch Referred to House Education and Labor Committee

Home HealthHR 1094(Lewis)

Permits a home health agency to determine the most appropriate skilled service to make the initial assessment visit for an individual who is eligible for home health services under Medicare but does not require skilled nursing care as long as that skilled service is included as part of the plan of care for such services.

Watch Referred to House Energy & Commerce Committee

H.R.1765 (Matsui)

Amends Title XVIII of the Social Security Act for payment of furnishing intravenous immune globulin in a patient's home for the treatment of primary immune deficiency diseases and covers certain disposable pumps as durable medical equipment under the Medicare.

Watch Referred to House Ways & Means Committee

S. 1123(Collins)

Would restore the 5 percent add-on for Medicare home health services delivered in rural areas. The most recent iteration of the rural add-on expired at the end of 2006, and this bill seeks to reinstate the add-on payment for five years beginning Jan. 1, 2010.

Support Referred to Senate Finance Committee.

S. 1157(Conrad)

Would protect and preserve access for Medicare beneficiaries in rural areas to health care providers under the Medicare program and reinstate the 5 percent Medicare home health rural add-on for calendar year 2010.

Support Referred to Senate Finance Committee

H.R. 3030(Waltz)

Would set up pilot projects through the Department of Health and Human Services to provide incentives for home health agencies to use remote monitoring technologies and identifies various performance targets for participating home health agencies to meet and mandates that incentive payments be given to participating home health agencies based on having met performance targets.

Support Referred to House Energy and Commerce Committee

Home InfusionHR 574(Engel)

Companion Bill:S.254 (Lincoln)

Amends title XVIII of the Social Security Act to provide for the coverage of home infusion therapy under the Medicare Program.

Support Referred to House Ways & Means Committee

HospiceS.421

(Specter) Imposes a temporary moratorium on the phase out of the Medicare hospice budget neutrality adjustment factor.

Watch Referred to Senate Finance Committee

S.1150 (Rockefeller)

Would make hospice a required benefit under Medicaid and the Children's Health Insurance Program (CHIP), and for children, requiring concurrent coverage of both hospice and curative treatment.

Support Referred to Senate Finance Committee

Information Technology/TelemedicineS.264

(Stabenow)Amends title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid program and the Children's Health Insurance Program.

Watch Referred to Senate Finance Committee

S.457 (Thune)

Establishes pilot projects under the Medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies.

Support Referred to Senate Finance Committee

Long Term Care InsuranceS 697

(Pallone)Would create a new national insurance program to help adults who have severe functional impairments to remain independent, employed, and stay a part of their community. Financed through modest voluntary payroll deductions

Watch Referred to House Budget Committee

MedicareH.R.27

(Biggert)Amends title XVIII of the Social Security Act establishing additional provisions to combat waste, fraud, and abuse within the Medicare Program.

Watch Referred to House Judiciary

H.R.902 (Smith, A.)

Companion Bill:S.712(Feingold)

Amends title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in rural areas.

Watch Referred to House Energy & Commerce Committee

H.R.1670 (Davis, D.)

Amends title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports.

Watch Referred to House Energy & Commerce Committee

UnionizationHR 1409(Miller)

Companion Bill:S. 560(Kennedy)

Amends the National Labor Relations Act to establish a check card system to enable employees to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor practices during organizing efforts.

Oppose Referred to Subcommittee on Health, Employment, Labor and Pensions

CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME14

ANNUALCONFERENCEAre You Registered?

May 4-7, 2010Sacramento, CA

From branding yourself from others to preparing for changes in the industry or surviving OASIS-C, and understanding HR – you’ll �nd a session speci�c to your education needs. Here’s a glimpse at what your education dollars can buy you.

Money matters – invest in your future today!

L7 - YOUR BRAND. WHAT BRAND? EASY WAYS TO BUILD IDENTITY IN A CROWDED MARKETPLACE Friday, May 7, 2010, 10:15 AM - 11:45 AM

As competition heats up, it becomes increasingly important that your agency is di�erentiated from your competitors. Just talking about your programs and services simply doesn’t cut it anymore. This program provides practical tips on how to enhance your visibility in the communities you serve so that referral sources and consumers won’t just choose home care and hospice… they’ll choose YOUR home care and hospice!

M13 - PREPARING FOR THE CHANGING FACE OF HOME CARE Thursday, May 6, 2010, 3:30 PM - 5:00 PM

This presentation will discuss key topics impacting the �nancial stability of home care organizations in a time of de-creasing reimbursement and regulatory changes. Topics will include: RAC audit preparation; increasing case mix through improved diagnosis coding and therapy management; and reducing write o�s through enhanced receivables management..

M8 - OASIS-C: ARE YOU JUST SURVIVING OR ARE YOU THRIVING? Wednesday, May 5, 2010, 10:15 AM - 11:45 AM

This session is ideal for any home health agency employee that has to complete, review, input or audit an OASIS docu-ment. This session will also be for the administrators/directors that are making decisions based on OASIS data. The OASIS changes will be reviewed and reimbursement implications will be outlined. In addition to documentation issues that will be discussed the reimbursement calculations utilizing OASIS data will be reviewed and calculations made. Process Improvement tools that are essential to successful documentation with OASIS-C will be reviewed and samples provided.

P4 - NAVIGATING THE WAGE ORDERS: PERSONAL ATTENDANT EXEMPTIONS, RECORDKEEPING REQUIREMENTS, AND PAY STUBS FOR HOME HEALTH CARE EMPLOYERS

Thursday, May 6, 2010, 9:45 AM - 11:15 AMIn this session, attendees will learn how to read Wage Orders 4 (o�ce workers), 15 (in-home workers), and 5 (hospital workers). It is these three Wage Orders that govern recordkeeping requirements, meal and rest period requirements, meal and lodging credits, applicability of the personal attendant exemption, and requirements for live-ins, as these re-quirements apply in the home health industry. We will go through each of these requirements, and work through prob-lems aimed at helping attendees understand how to apply these requirements correctly in order to avoid liability. We will also discuss in detail the speci�c requirements for pay stubs - what information has to be stated on employee pay stubs, so that attendees will be able to review their own pay stub practices to ensure that they are in compliance. As always, we will engage in questions and answers, and hopefully a lively group discussion of these topics.

For more information or to view other education sessions, go to: http://www.cahsah.org/index.php?p=annual_conferences

To register, visit our website at cahsah.org or call (916) 641-5795 ext 113.Full brochure online at cahsah.org. Advanced deadline rate is April 2.

CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME 15

MONOPOLY: CAHSAH EditionRAFFLE GAME

LOOKING TO WIN SOME CASH?Participate in this year’s conference game Monopoly: CAHSAH Edition for your chance at cash prizes! Collect CAHSAH Bucks throughout the conference for a cash prize ra�e drawing held during Thursday’s Luncheon.

We’ll even include a CAHSAH Buck in your registration packet to get you started!

Where Can You Earn CAHSAH Bucks?

BEFORE CONFERENCE

Facebook posts & Tweets leading up to the conference

DURING CONFERENCE

Facebook and follow CAHSAH Education on Twitter

WHAT PAST ATTENDEEShad to say...“Every conference, I gain some valuable

knowledge that I am able to use in the

agency to enhance quality patient care

with a knowledgeable sta�.”

“I re-energize myself every year with the conference from the camaraderie of

fellow clinicians to the wonderful classes to reminding me why I do what I do -

Homecare!”

“It is wonderful to meet other directors/agency owners and network - there is a comfort level that we can share stories of common interest and ideas on handling employee issues. It is not only educa-tional but a support group - I highly recommend

both the classes and networking events.”

“Wonderful educational sessions and networking opportunities. Each year I look forward to the

inspiration I receive...this conference always helps to re-set my �oundering rudder.

Can't wait till next year!”

“The ability to have time set apart and focus on

building relationships and sharing knowledge with other home care profes-

sionals is invaluable.”

Register online at cahsah.org or call (916) 641-5795 ext 113

PO

LIC

Y U

PD

ATE ADVERTISE

& REACH

CA H S A H B U L L E T I NFor more

information contact, Ranesh Maharaj

(916) 641-5795 ext. 120 or email rmaharaj@cahsah.org

HOME CARE

PROFESSIONALS

EVERY MONTH

MORE THAN 1,800

Chapters Include:Chapter 1: Doctor’s Offices

Chapter 2: Hospitals

Chapter 3: In-Patient Rehab

Chapter 4: Skilled Nursing Facility with Rehab

Chapter 5: Assisted Living Facilities

Chapter 6: Independent Living Centers

Chapter 7: Hospice

Chapter 8: Professional Geriatric Care Managers

Chapter 9: Medicare Certified Home Health Agencies

Chapter 10: Fiduciaries

Chapter 11: Long Term Insurance Companies

Chapter 12: Veterans Administration (VA)

Chapter 13: Health Plans

Product Description:

This chapter series is a handbook of top targets for referral sources: techniques to find them, focus areas, and ways to respond to some of the most common objections. Use these ideas and tactics to help you organize and plan for your company. Designed with you in mind, this manual helps you make the most of your

time. Each chapter stands alone allowing you to research what you need to know before going on your call - without having to read the full manual.

Available in Electronic PDF File

CAHSAH BOOKSTORETop Targets for Referral Sources!

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NON MEMBER: $598.13 NON MEMBER: $53.29 EA

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*prices include shipping, handling & taxCall (916) 641-5795 ext. 113

or visit www.cahsah.org to order these essential resources!

mailto:rmaharaj@cahsah.orghttp://www.cahsah.org