Electronic Visit Verification (EVV) was established as law in 2016 under the 21st Century Cures Act to address fraud and abuse in home-based care delivery. The law provides federal guidelines, but individual states can determine which service codes are included. However, years after nationwide implementation, EVV still remains a burden for home care providers.

Simply put, EVV confirms the details of in-home visits. It holds caregivers accountable for their schedules, ensuring that their work is completed on time and in its entirety. Typically, caregivers work within a mobile app to conduct the EVV process. The app sends the necessary information from their devices to their agency’s home care software.

Six data points are captured at the point of care to verify the facts of a home care visit in real time.

Collecting this basic information in home care settings helps providers and states ensure that authorized care is provided and that caregivers deliver the proper care at the right time. When this verified visit data is collected and analyzed, states can use it to help identify and reduce Medicaid fraud, which drains resources from the system and hinders care delivery to those in need.

There was initial confusion because the act required states to implement EVV for at-home visits conducted by Medicaid personal care providers and home health agencies. However, each group had different go-live dates. Medicaid-funded personal care services were required to comply with EVV statutes by Jan. 1, 2020, and home health agencies by Jan. 1, 2023. However, delays and exemptions made compliance anything but simple.

Further, the federal government has passed legislation regarding EVV, but its implementation varies at the state level. States are categorized as “open” or “closed” models. Home health agencies have the freedom to choose their EVV provider in open states, while in closed states, they must work with a vendor selected by the state.

According to Matt Kroll, practice president of Assistive Care & Assistive Care State Programs at Bayada Home Health Care, despite challenges, Bayada has found that EVV helps prevent false claims.

“It allows us to monitor caregivers in real-time, verify service delivery, and allow for faster issue resolution,” he told Home Health Care News. “For example, if a check-in is late or a caregiver indicates that the client is showing signs of a larger issue, we can see that in real time and detect and prevent adverse events before they lead to a larger medical issue or hospitalization.”

Headquartered in Moorestown, New Jersey, Bayada provides in-home clinical care and support services in 21 states and five countries.

“We believe that we will be able to leverage some care documentation data points to help improve the quality of care we provide our clients and, over time, industry-wide data points may improve the industry as a whole,” Kroll said.

Kroll explained that Bayada supports efforts to prevent fraud, waste and abuse, with the caveat that overregulation can actually hurt the industry in some instances.

“We do feel that overburdensome requirements and unfunded mandates can deter agencies from providing Medicaid-based services, which is detrimental to those populations who already struggle to access the care they need to stay safely at home,” he said.

EVV still a pain point for providers

Because EVV varies by state, its challenges differ by market.

“EVV is still a pain point for providers for various reasons – and they vary by state,” Tim Nyberg, senior vice president of strategy at Sandata, told HHCN. “These can include variance in education from states to providers, the provider’s experience in onboarding and implementing EVV systems, how caregivers are educated on EVV, and whether they understand its purpose and benefits.”

Sandata, based in Port Washington, New York, provides agency management software, systems, and services to optimize billing and claims processing and streamline administrative processes.

“Additionally, some caregivers cite privacy issues in using their personal cell phones to clock in and out of shifts and having their location tracked,” Nyberg said. “Some clients and family members share those same concerns.”

Although all states have worked to implement effective EVV programs, some have needed help with clear and open communication regarding their policies, transparent enforcement timelines and timely responses to questions and concerns from the provider community.

“EVV continues to present challenges for providers primarily due to its complex integration into existing workflows,” John Atkinson, chief technology officer at AxisCare, told HHCN. “The additional effort required is not just about submitting claims, but also ensuring that EVV data is accurately collected and transmitted to the aggregator. This process requires meticulous attention to detail, often adding layers of administrative tasks to an already burdened system. Providers must balance maintaining the quality of care and adapting to new technological requirements, often leading to frustrations. While EVV aims to streamline and enhance transparency, the transition and implementation phase continues to be arduous.”

Founded in 2013, AxisCare is a full-service home care software company based in Waco, Texas.

“Bayada has made every effort to ensure that the transition to EVV compliance is as easy as possible for our caregivers and as least disruptive to client care as possible,” Kroll said. “However, pain points persist. Most notably, cost, lack of standardization across states, technology issues for caregivers and lack of cell service in rural areas.”

Providers who fail to comply with Medicaid rules risk not being paid for their work. Non-compliance with Medicaid rules and policies may also result in the provider’s inability to do business under the Medicaid program.

Apart from the stricter compliance issues, there are also significant downstream impacts. When caregivers fail to clock in at a client’s home, the home care agency cannot verify the services provided, especially in the case of a fall or hospitalization during or after a shift.

There is a continued lack of clarity regarding the consequences of non-compliance, according to Kroll.

States and payers each have a compliance threshold that needs to be met, and most – but not all – states have published this information. Non-compliance could result in payment penalties, loss of referrals, audits, and additional penalties and corrective action plans.

The future of EVV

States that have a burdensome EVV system run the risk of losing providers that may be otherwise interested in conducting business there.

“Looking ahead, the future of EVV will be marked by increasingly stringent standards and tighter tolerances,” Atkinson said. “We anticipate a future where the manual entry of EVV data will become largely unacceptable as states demand greater accuracy and efficiency.”

He emphasized the importance of proactively creating a culture of compliance and ensuring that staff are well-prepared to meet changing standards. This includes adopting technology and simplifying processes to enable smooth data transfer to aggregators.

“By staying ahead of these developments, providers can enhance operational efficiency and continue to meet regulatory requirements effectively,” Atkinson said. “Above all, EVV will enhance the accurate delivery of care to seniors, ensuring they receive the attention and services they need when needed.”

The post Years After Implementation, EVV Remains Inconsistent Pain Point For Home Care Providers appeared first on Home Health Care News.

“Individuals go into the role of being a caregiver, normally because they have a passion for helping other people,” HHAeXchange President Stephen Vaccaro told Home Health Care News. “They recognize the value that it’s bringing and how fulfilling that could be, and that becomes an area they want to move into. It’s a difficult job, so you must be passionate about it.”

Founded in 2008, New York-based HHAeXchange is a home care management software company focused on the Medicaid home- and community-based services (HCBS) population.

About 60% of the 4,000 caregivers surveyed said that positively impacting their patients’ health and wellbeing is the biggest motivator for their work. Additionally, 57% of caregivers reported taking extra time to record patient observations after each visit, motivated by the knowledge that it could improve their clients’ care.

Moreover, 91% said the relationships they form with the people they care for increase their job satisfaction.

“That was a 17% increase from our survey last year,” Vaccaro said. “I think it speaks to that human bond that individuals form with each other and how important and special that is. That’s what matters to caregivers at the end of the day.”

Another important finding from the survey was caregivers’ interest in receiving professional training as an additional resource to improve their job satisfaction and longevity. Specifically, caregivers said they would be interested in receiving training on reducing stress, understanding how to treat patients with specific illnesses and using additional medical equipment.

“When taking care of an individual, it’s not always easy to focus on yourself,” Vaccaro said. “Training and strategies for interacting with the client’s families or dealing with different illnesses or medical equipment go a long way in helping caregivers do their jobs better. Because ultimately, that’s what’s most important to them. This goes a long way in retaining and bringing more workers into the field. Pay and benefits can’t always be the answer; it has to be a fulfilling job.”

Unsurprisingly, survey data also showed that 34% of respondents found pay to be the most challenging aspect of being a caregiver.

“Are caregivers going to be paid relative to the value they bring? Sadly, no,” Vaccaro said. “The value that they bring is so immense. Many of these individuals would not be able to live their lives at home without these caregivers. You can’t put a dollar amount on that. However, we need to work together as stakeholders in the industry to elevate the role of the caregiver. The industry is evolving, and the stakeholders are beginning to understand the value and importance of caregivers. That needs to continue.”

The post Home Care Worker, Client Bonds Increase Job Satisfaction And Retention appeared first on Home Health Care News.

Medicaid membership ballooned during the pandemic. Millions of people were suddenly eligible for public health care when companies went through layoffs and when unemployment spiked.

Over the past three years, states were told not to disenroll people who didn’t specifically request it. With Medicaid redetermination requirements restarting across the country, fewer Americans will be considered Medicaid-eligible.

That could be a big deal for home-based care providers, given many offer home- and community-based services to Medicaid populations.

Some believe it will have a significant impact moving forward. Others, like Addus Homecare Corporation (Nasdaq: ADUS), do not.

“When states expanded their Medicaid, it really didn’t add a lot of business for us because all our elderly patients are already qualified,” Addus CFO Brian Poff said earlier this month at the Raymond James Annual Institutional Investors Conference. “So, we didn’t see a lot of upside from [rolling eligibility], and we don’t see a lot of downside with the return of redetermination from the standpoint of losing revenue.”

The Frisco, Texas-based Addus provides personal care, home health care and hospice care. Its largest business is Medicaid-based personal care services.

Others in the space, like the Missouri-based payer Centene Corp. (NYSE: CNC), are focused on maintaining as many Medicaid-eligible beneficiaries as possible.

“We are working closely with our state partners and our network of community partners in each market to facilitate member transition and coverage continuity,” Centene CFO Drew Asher said during the company’s fourth-quarter earnings call. “In the last month, we’ve deployed internal and external training designed to maximize each member touchpoint and our ability to support beneficiaries as their eligibility is reviewed.”

The impact redetermination will have on providers and insurers will vary from state to state. The urgency for starting the process has also varied so far.

According to a survey conducted by KFF and Georgetown University — with additional data from the Centers for Medicare & Medicaid Services (CMS) — eight states started this process in February, 15 states started in March and 28 states will begin in April.

In total, KFF estimates that between 5.3 million and 14.2 million people will lose Medicaid coverage during the 12-month unwinding period.

While home-based care providers will feel these losses, many believe the losses will be offset elsewhere.

Humana Inc. (NYSE: HUM) expects its Medicaid membership to increase in 2023, CFO Susan Diamond said during its fourth-quarter earnings call.

The company will make up for losses, and in this case see gains, from new contracts.

“We expect to add approximately 140,000 members in Louisiana and 65,000 members in Ohio at implementation with Ohio membership ramping to 130,000 by year-end and to a total of 225,000 in 2024,” Diamond said. “The 2023 membership gains in Louisiana and Ohio will ultimately be offset by membership losses resulting from redeterminations beginning April 1, which will continue for 12 months.”

From Addus’ provider perspective, it believes there’s even a chance Medicaid redetermination could bode well for the company.

“As a state’s Medicaid grows gets smaller because some of the folks that were added during the emergency are now taken off, the cost of the Medicaid program will be less for each state,” Poff said. “So we believe that has a potential to bode well for the state’s ability to continue to pay their bill.”

States getting to work

There is also promising data that shows many eligible Medicaid beneficiaries will be re-enrolled over the next 12 months.

“All states took action over the past year to encourage employees to update their mailing addresses and other contact information, including direct outreach to enrollees,” Jennifer Tolbert, associate director of the Program on Medicaid and Uninsured at KFF, said during a KFF webinar last week. “Most states are engaging with key stakeholders, including managed care organizations (MCOs), to assist with that outreach.”

About two-thirds of states plan to follow up with enrollees to complete renewals during the unwinding period and over half of states have created online portals to help enrollees stay on Medicaid.

Until the dust settles, there will be plenty of action from stakeholders to keep Medicaid beneficiaries eligible moving forward. The important thing now for states and other stakeholders is to clearly communicate to members and beneficiaries of the environment.

“We see that it is extremely important to share clear, concise communication – and do it often – to help to prepare our Medicaid recipients, our community health centers, our patients and community organizations for the unwinding and all of the changes that are going forward,” Tia Whitaker, director of outreach and enrollment for the Pennsylvania Association of Community Health Centers, said during the webinar. “Our messaging consists of, ‘There’s no wrong door for enrollment assistance.’”

The post Medicaid Redetermination And What It Means For Home-Based Care appeared first on Home Health Care News.

In a letter that opposed certain aspects of the “Congressional Republican agenda,” the White House criticized Republicans’ previous plans to repeal the Affordable Care Act, cut Medicaid spending and — in general — keep health care on the chopping block for budget cuts.

“Virtually every Republican budget or fiscal plan over the last decade has included repeal of the Affordable Care Act (ACA) and deep cuts to Medicaid,” the White House wrote in its letter. “That would mean: higher health care costs for tens of millions of Americans, ending critical protections for people with pre-existing conditions, millions of people losing health coverage and threats to health care for seniors and people with disabilities — including growing home care waiting lists and worse nursing home care.”

The White House used home care as one of the main sticking points while advocating for the ACA and additional Medicaid spending.

The number of people on home care wait lists has dropped by 20% since 2018, according to the White House.

That progress would likely be reversed under a block grant or a “per-capita cap,” because there would be fewer dollars available for home care services, this administration would argue.

“Over 7 million seniors and people with disabilities could receive worse home care, with ballooning wait lists for those still in need,” the White House wrote. “Faced with large federal funding cuts, states would almost certainly ration care. That would likely mean wait lists for home care in the 13 states and D.C. that don’t currently have them, and skyrocketing wait lists in 37 states that do.”

In an email to Home Health Care News, Bill Dombi — president of the National Association for Home Care & Hospice (NAHC) — said it was encouraging that the President is expressing concerns about the stability of Medicaid home- and community-based services.

“With the diminishing federal financial support coming from the 2021 American Rescue Plan, states are facing difficult choices for the future of Medicaid,” Dombi said. “With the added HCBS support, states have been able to increase payment rates and compensation of caregivers. Further support is needed if the state programs are to remain stable.”

Yet, Dombi added that even greater support is required to impact the service waitlists that affect hundreds of thousands of individuals needing Medicaid-based home care.

Support from both sides of the aisle will be needed to address those issues, Dombi said.

Vicki Hoak, CEO of Home Care Association of America (HCAOA), also told HHCN in an email that the association is grateful for Biden’s interest in making sure seniors and people with disabilities can remain in their own homes and communities, living as independently as possible.

“We look forward to learning more about the Republicans’ plan and remain optimistic that consensus can be reached,” Hoak said. “HCAOA respects the challenging and valuable work that our country’s leaders do to best manage and care for our nation. Remaining economically viable as a nation with a balanced budget is important. Yet, maintaining access to health care and invaluable care and support – like home care – for our growing senior population is also critical.”

The post White House Uses Home Care As Sticking Point In Support Of Medicaid Spending appeared first on Home Health Care News.

Last week, Iowa Auditor Rob Sand voiced how his office could not accurately provide an analysis on certain services provided by the state’s Medicaid program, including home-based care, a local CBS affiliate reported.

Sand reportedly tried to conduct an audit and look into reimbursements for Medicaid-supported in-home care services in Iowa, but ultimately had to shift his focus elsewhere due to unreliable information and poor data.

The state auditor then detailed those frustrations in a 13-page report.

“We were, despite repeated efforts, unable to perform an analysis — an audit — of home health data because the data provided were repeatedly unreliable,” Sand told reports during a press conference.

Sand’s report argues that the data-collection process used by the Iowa Department for Human Services is “not efficient or effective.” To improve transparency into Medicaid-reimbursed home health care, the report calls for the human services department to simplify data workflows and create uniformity requirements for managed care organizations.

Doing so, according to the report, would ensure more consistent and appropriate payments in the future.

As of October 2019, roughly 18% of Iowa’s population was covered by Medicaid or adjacent services, Kaiser Family Foundation data shows. Iowa Medicaid covers roughly one in seven adults, one in two nursing home residents, one in three individuals with disabilities and one in seven Medicare beneficiaries. 

Overall, the Medicaid program in Iowa accounts for about $4.9 billion in spending, with the vast majority of that going to managed care. Long-term care, meanwhile, accounts for about 3% of all Iowa Medicaid spending.

Nationally, Medicaid pays for one in every six dollars spent throughout the U.S. health care system, according to Kaiser Family Foundation. It accounts for roughly one in two dollars spent on long-term services and supports, however.

The post A Dearth of Medicaid Home Health Data Creating Headaches for State Officials appeared first on Home Health Care News.

Home health care companies owned and operated by sisters Arlinda Moriarty and Daynelle Dickens received more than $87 million in Medicaid payments for services that were never performed, according to the 22-count indictment. The alleged fraudulent claims came in between January 2011 and April 2017, during which time Moriarty owned Moriarty Consultants, Activity Daily Living and Everyday People Staffing, and Dickens owned Coordination Care.

The sisters and their employees are accused of committing dozens of crimes, including making false Medicaid claims, creating fake employees, misusing customers’ personal information and falsifying documents. The indictment says company employees even submitted claims for customers who were in the hospital, in jail or dead.

“Home health care programs are critical to the ability of patients with serious physical limitations, especially the elderly, to receive the care they need while remaining independent. Those who provide home health care are expected to deliver services honestly,” said U.S. Attorney Scott Brady. “When criminals cheat and steal from these programs, they not only steal from the taxpayers, but they steal from the most vulnerable members of our community.”

All 12 defendants are charged with health care fraud and conspiracy to commit health care fraud, punishable with up to 10 years in prison or a $250,000 fine. Some also face charges of concealing material facts in relation to a health care matter, punishable with up to five years in prison or a $250,000 fine, as well as aggravated identity theft, which carries a mandatory sentence of two years in prison and a fine of up to $250,000.

Additionally, four different defendants face separate charges for their involvement in the conspiracy to commit health care fraud.

Written by Bailey Bryant

The post 12 Home Health Workers Indicted for $87 Million Medicaid Fraud appeared first on Home Health Care News.

But there’s now a state that’s doing a lot more than looking.

California has launched a new, three-year, $6 million pilot program spearheaded by six local not-for-profit organizations, The New York Times reported. A group of 1,000 Medi-Cal recipients who have Type 2 diabetes or heart failure will receive free, strategically nutritious meals under the new program. Medi-Cal is California’s Medicaid program. Researchers will then compare that group to a larger population of Medi-Cal patients who didn’t receive the delivered meals, all with the goal of assessing whether the food-as-medicine approach does, indeed, reduce re-admission rates and slash health care costs.

“Food-as-medicine has intuitive appeal, and there is some limited evidence that management of diet can reduce complications such as readmissions,” Dan Mendelson, president of the Washington D.C.-based consulting firm Avalere Health, told Home Health Care News via email. “Health plans and governments are interested in expanding these programs—provided that they don’t add substantially to cost.”

Recent research has revealed that a lack of access to nutritious food often leads to higher readmissions rates. Home-delivered meals—both ones that are tailored to medical needs and meals that are not—have been found to curtail emergency department trips, inpatient admissions and the use of emergency transportation.

On a national level, there is currently “considerable experimentation” going on to gauge the food-as-medicine model’s effectiveness, Mendelson said. The Food Is Medicine Coalition, a national association of non-profits that supports nutrition-related public public, for example, has grown to include 27 member organizations scattered across more than states.

“Many states are starting to allow food as a benefit in Medicaid,” Mendelson said. “We expect to see these trends to continue—and to accelerate if food-as-medicine can prove positive medical outcomes.”

Meal delivery has been added as a supplemental benefit in Medicare Advantage plans. And many major providers, including insurance giant Humana (NYSE: HUM), are seeking ways to cover this service and other social determinants of health that impact hospital readmissions.

Funding for the California pilot program was approved in June 2017 as part of a state budget bill.

California may be among the first to fund a food-as-medicine program, but it’s definitely not the first to test the model’s ability to keep people at home and cut medical costs. A previous project by the Philadelphia-based Metropolitan Area Neighborhood Nutrition Alliance found that delivering medically-tailored meals to chronically ill seniors could lower health care costs as much as 55%. University of California San Francisco researchers had similar findings.

The pilot program’s non-profit partners include Project Open Hands in San Francisco, Health Trust in San Jose, Project Angel Food in Los Angeles and Mama’s Kitchen in San Diego, along with the North Bay Area’s Ceres Community Project and Food For Thought.

Although it doesn’t have any “direct experience” working with food-as-medicine programs itself, the California Association for Health Services at Home (CAHSAH) is supportive of all creative efforts to help patients become healthier and remain in their home longer, Dean Challis, president and CEO of the Sacramento-based organization, told HHCN.

“This looks like one of those inventive ideas that might have great merit,” Chalios said. “Nutrition is an important part of staying healthy and, obviously, can lead to somebody being able to stick around in their home, rather than have to go elsewhere.”

Roughly one-third of all Californians are enrolled in Medi-Cal.

“That covers a lot of people,” Challis said. “It’s always tough to fund those types of government-funded health care programs, so it will be interesting to see if Medi-Cal really grasps this program and implements it.”

Written by Robert Holly

The post California to Pay for Healthy Food Delivery for Ill Residents appeared first on Home Health Care News.

The Louisiana Department of Health began mailing notices Thursday to nearly 37,000 Medicaid enrollees, informing them that their eligibility may end on July 1 because of cuts. The official warnings are being sent to “senior citizens and individuals with developmental disabilities who receive care in a nursing home, in other long-term care facilities and through waivers for community-base services,” according to the department.

Of the roughly 37,000 Medicaid enrollees, at least 7,600 are home care recipients, The Times-Picayune reported.

“We recognize the significant impact these cuts will have on the residents of our state and their health,” Louisiana Department of Health Secretary Rebekah Gee said in a statement. “These are not cuts we want to make, but the fundamental truth remains these are cuts we are being forced to make considering the lack of funding available for critical health care services.”

Loss of eligibility would affect more than half of those who receive services through the state’s Adult Day Health Care Waiver and Community Choices Waiver programs. Up to 80% of individuals covered under PACE—Programs of All-Inclusive Care for the Elderly—would also be affected.

The elimination of Medicaid eligibility is an unprecedented action that will have real and dire consequences, Gee said. As of March 2018, more than 1.6 million residents received services provided by Medicaid and the Children’s Health Insurance Program (CHIP). The state was one that opted to expand Medicaid under the Affordable Care Act (ACA).

The march toward budget cuts began last month when the Louisiana House narrowly approved a $27 billion state operating budget with steep reductions in health care spending for the upcoming year. The budget passed in the House with a 55-47 vote, legislative records show. Three representatives were declared absent.

Under the proposed budget, the Louisiana Health Department faces a total deduction estimated to be more than $1.8 billion.

While approved in the House, the budget cuts could still be rejected in by the Louisiana Senate or by Gov. John Bel Edwards.

“To any member of the legislature who, like me, does not want to see these cuts implemented, I am offering, again, to work with you to find a solution,” Edwards wrote on Twitter Wednesday.

In addition to warnings to Medicaid enrollees receiving nursing home and in-home care, the Louisiana Department of Health is also alerting residents that several other programs may soon be terminated, including the state’s pediatric day health care program that serves medically fragile children from birth up to age 21. Outpatient drug and alcohol treatment serves may also be reduced, according to the health department.

Those affected by the potential loss of Medicaid eligibility include residents 65 and older, individuals with disabilities and people with monthly income less than $750. Some individuals whose medical expenses exceed their income may also be affected.

Any change to Medicaid eligibility will ultimately need to be approved by the federal government, a process that can take months, according to the health department.

Besides affecting those receiving in-home services, cuts could also lead to the eviction of thousands of individuals living in Louisiana nursing homes, though industry officials in the state say that scenario is unlikely to happen.

Written by Robert Holly

The post Louisiana Medicaid Recipients May Lose Home Care Benefits appeared first on Home Health Care News.

House and Senate lawmakers voted in favor of the Tax Cuts and Jobs Act—a piece of legislation that updates the nations tax code after three decades and adds nearly $1.5 trillion to the national deficit.

The final stretch of the bill’s passage was not all smooth sailing.

The House passed the bill mid-Tuesday, sending it to the Senate. But in a turn of events later in the day, Senate Democrats ruled that three provisions in the bill violated Senate budget rules, according to an Associated Press report. The Senate passed the bill early Wednesday morning, however, and sent it back to the House, which passed the measure again in a 224-201 vote. No Democrats in either chamber voted for the bill, The Hill reported.

The bill is now headed to President Donald Trump’s desk to be signed into law; however, various news outlet report that he will not sign the bill until a later date.

In an official statement following the passage of the bill, Trump called the legislation a “big, beautiful tax cut for Christmas,” and an “extraordinary victory” for American families, workers and businesses.

Further, the tax reform will bring at least $4 trillion back to the U.S. economy, Trump said at bill passage event in Washington Wednesday afternoon.

House Speaker Paul Ryan explained that Americans can expect to see the result of the tax reform in their paychecks as soon as February 2018, while Vice President Mike Pence called the legislation a “middle-class miracle.”

Lower tax rates

Perhaps the most notable provision within the bill is the new lower corporate income tax rate, which will be set permanently from 35% to 21% starting in 2018.

In its review of the bill, Washington, D.C.-based The Tax Foundation—a non-profit, independent tax policy analyst firm—projected that the bill would reduce marginal tax rates on labor and investment. In broad strokes, this translates into an overall increase in both wages and jobs, the organization explained.

“The larger economy would translate into 1.5% higher wages and result in an additional 339,000 full-time equivalent jobs,” according to the foundation’s analysis.

For the health care services sector, this benefit could result in an overall increase in a business’ value, as reducing the corporate tax rate would drive an approximate 23% increase in earnings per share, according to a published note on the bill by financial services giant JPMorgan.

In terms of its impact on home health, Chicago-based financial firm UBS expects the industry to emerge as a winner from this new lower corporate tax rate.

The reduced corporate tax rate could be a “windfall” for such organizations, leading to an increase in cashflow, which they could use to reinvest in themselves or used for acquisitions, according to Frank Morgan, managing director of health care services equity research at Nashville, Tennessee-based RBC Capital Markets.

And because publicly traded home health companies generally have low financial leverage—or the amount of debt that they have—they stand to get the maximum benefit of a reduction in the corporate tax rate, Morgan explained to Home Health Care News.

“The tax rate going down, that’s good for everybody—but there is an offset: a cap on the deductibility of interest expense,” Morgan said. “If you have high levels of debt or high levels of leverage, you may be capped out on how much of your interest expense you can deduct from your pre-tax income. So, [for companies that have] higher leverage, they would not see as much of a positive impact as companies that have low leverage.”

An enormous burden

While the tax reform bill can be considered a “Christmas present” for some middle-income citizens as well as businesses, those benefiting from Medicare and Medicaid might consider the bill a lump of coal, as it puts such programs at risk.

The AARP projects that the tax overhaul would lead to automatic spending cuts to key programs mandated by the 2010 “pay-as-you-go” law, including $25 billion to Medicare in 2018.

The cuts are the biggest concern for the industry at large, according to Darby Anderson, executive vice president and chief development officer at Frisco, Texas-based Addus HomeCare, Inc. (Nasdaq: ADUS), and vice chairman at the Partnership for Medicaid Home-Based Care (PMHC).

“The concern is how or where any budget cuts would be implemented, should the tax cuts not drive equivalent economic growth to fully offset the cost,” Anderson said.

Katie Smith Sloan, CEO of LeadingAge, a non-profit organization that represents the aging services industry, called the tax legislation “ill-conceived,” in a statement following its passage.

“LeadingAge is concerned about the impact it will have on the federal budget and the availability of resources for Medicaid, Medicare, senior housing and other public programs serving older adults,” Sloan said.

However, Sloan was relieved that Congress preserved the medical expense deduction and tax-exempt private activity bonds in the final language of the legislation—items she said are “crucial” to non-profit providers who care for older adults.

Overall, the possibility of cuts to Medicare and Medicaid should put the industry on alert, Morgan explained.

“That is absolutely something we need to watch because when this tax rate drops and the tax revenues go down, then it’s going to add an enormous burden to the deficit in the near term,” he said. “So, absolutely, it’s something that we’ll watch very closely.”

Discussion on the matter will play out over the course of 2018, and quite possibly into 2019, Morgan predicted.

But policymakers have already taken measures to curb the possibility, with Sen. Susan Collins (R-ME) fighting to ensure no such cuts to Medicare would be triggered by the tax bill.

Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), hopes Congress honors her efforts.

“As it is currently structured, the tax bill can trigger huge Medicare cuts for all providers unless Congress waives the so-called ‘pay-go’ rules when the deficit is increased,” Dombi told HHCN. “Both Speaker Paul Ryan and Majority Leader Mitch McConnell has said that the waiver will happen, but that will take place outside this bill.”

Written by Carlo Calma

The post [Updated] The Trickle-Down Effect of Tax Reform on Home Health appeared first on Home Health Care News.

Currently, home health agencies must be able to report on five of the nine total measures for which CMS rates agencies as part of the QoPC Star Rating program.

These nine measures include items like timely initiation of care, drug education on medication, improvement in ambulation and whether the patient received influenza immunization for the current flu season.

Continued improvement

The impetus to remove the influenza immunization measure stems from the agency’s overall goal to continually improve the ratings program, according to Alan Levitt, MD, medical officer of the Division of Chronic and Post-Acute Care at CMS.

Levitt, along with Sara Galantowicz, senior associate at Abt Associates, a Cambridge, Massachusetts-based global research company contracted by CMS, presented on the proposed change during a webinar Thursday.

“We convened an expert panel to [analyze] how the measures were performing and then make decisions on how to make the ratings better,” Levitt said during the webinar. “In the meantime, we’d also received feedback from home health agencies that felt that the flu vaccination measure—[while] useful in terms of information for patients and family members to have on the Home Health Compare website—was not a measure that was able to show performance of home health agencies to be used in the calculation of star ratings.”

Impact of removal

The October 2017 refresh of Home Health Compare reflected the overall performance of 9,194 agencies, with an average rating of 3.25 out of a possible five-star rating.

In a simulation removing the measure, 9,147 agencies reported with an average rating of 3.27, according to Galantowicz.

“The reason for this very slight fall in reportability is because currently, an agency must have five of the nine measures [reported],” she explained. “With the influenza immunization measure removed, the threshold changes, and agencies must have five of the eight measures available to receive a star rating.”

On average, the removal of the flu vaccination will affect reportability only slightly, while the star ratings average will increase, according to Galantowicz.

“The increase can be seen among both rural and urban agencies, and small and larger agencies,” she said.

CMS received 24 comments during its public comment period regarding the proposed removal, with 100% of agencies supporting the move.

Projected timeline

“Based on this input, CMS is finalizing its proposal to remove the influenza immunization received for current flu season measure from the QoPC star rating,” Galantowicz said.

The removal will be effective with the April 2018 refresh of Home Health Compare, with a preview report reflecting the change to be distributed in January 2018.

However, the flu vaccine measure will still be collected as part of the Outcome and Assessment Information Set (OASIS) and will continue to be utilized by CMS in other capacities, according to Levitt.

“[The flu vaccine measure] will continue to be reported on Home Health Compare even after being removed from the algorithm, and will be monitored to determine whether removal from star ratings impacts vaccination rates,” Galantowicz added.

Written by Carlo Calma

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