On the top of this list is the previously announced NAHC and National Hospice and Palliative Care Organization (NHPCO) merger.

“The biggest thing I’m hoping to accomplish fits in with the whole merger aspect, to have the integration completed, to a point where on January 1, it almost looks like we flipped the switch, and everything of the organization is pretty much in place at that point,” Dombi told Home Health Care News at a press briefing during NAHC’s Financial Management Conference last month.

While Dombi calls the goal ambitious, the organization is also hoping to have a new CEO at the helm of the combined organization by then.

What’s more, Ken Albert – chairperson for the merger transition board – gave an update on the CEO search at the conference last month.

“It’s a big step, we’re recruiting people who have very long tenured careers,” he said. “We’re not just looking in the health care sector. We’re looking in the political realm, and other [areas], but we’re super close right now to a final candidate. I could not be more thrilled with the level of interest we had, and hopefully this will come to fruition by the middle of August.”

Ultimately, Dombi has seen home-based care evolve when he reflects back on his tenure at NAHC.

“I’m pretty proud of the work that I’ve done and the things that I’ve accomplished. Was it everything that I wanted? No,” he said. “But I have seen such a significant growth in health care services at home. No one would be able to take credit for the whole, but to go from where things were, when I first was engaged in this work back in the 70s, to see where we are today.”

Outside of regulatory wins, Dombi also sees the evolution of home-based care through large payers, such as Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH), investing in the space.

“I think you can certainly look at it from a positive perspective, saying, these plans had options to invest in X, Y and Z in health care, and they chose home care and physicians,” he said. “Their forecast says it’s about community-based health care services.”

However, he noted the downsides of payers investing heavily in the space, too.

“You can look at it from the negative and say these guys are going to control authorization of services and payment for services, and look at it from a competitive end and say, ‘Am I going to be on a losing end with that?’” Dombi said.

His personal view falls somewhere down the middle however.

“Medicare Advantage is an extraordinarily serious issue, because they’re getting away with paying less than the cost of care, and the providers feel so frustrated,” he said. “They’re taking it because traditional Medicare is offering a subsidy, but a subsidy that’s likely to be diminished over time. I tried to not just focus on whether it is good or bad that the plans have bought into home care. I can give you goods and bads out of it.”

The post NAHC President Dombi: There’s ‘Good And Bad’ To Payers Entering Home Health Care appeared first on Home Health Care News.

Broadly, Medicaid is a state and federal partnership. The federal government sets rules and parameters. The state takes those parameters and implements their own programs within the framework that the Centers for Medicare & Medicaid Services (CMS) provides.

However, the federal guidance around state rates is minimal, according to Damon Terzaghi, senior director of Medicaid advocacy at the National Association for Home Care & Hospice (NAHC).

“What we always refer to, when we’re talking about Medicaid payment policy, is section 1902(a)(30)(A),” he said during a presentation at NAHC’s Financial Management Conference, which took place last week. “[It] basically says that CMS, the federal government, does not have statutory authority to tell states what they must pay for programs, for services and those sorts of things.”

Hospice is one of the few exceptions. It is one of the programs that has a federal minimum payment rate.

In general, the Medicaid program has a history of under-reimbursing for services in comparison to Medicare and private insurance.

“It has led to a lot of challenges and concerns around whether they’re truly meeting that access-to-care requirement,” Terzaghi said.

Terzaghi noted that these problems eventually led to the “Ensuring Access to Medicaid Services” rule.

“You can draw a direct line from the [Armstrong v. Exceptional Child Center] Supreme Court decision, through various iterations of CMS rulemaking, straight to this access regulation where CMS says, ‘We can’t tell you a minimum payment rate, providers can’t sue, [but] we can start to put a framework around what equal access looks like,” he said.

One of the main positives of the rule is that it’s now a regulatory standard for states to have rates high enough to attract a sufficient workforce to deliver care.

There are a handful of ways that different states approach payment. Fee for services is one of the most common ways that HCBS are reimbursed through Medicaid.

There are some states that adjust payment rates to keep pace with cost-of-living differences based on geography.

In addition to geographic adjustments, some states do acuity use adjustments.

“In the Medicaid program, frequently there’s a comprehensive functional assessment of need, for individuals before you start delivering these in-home care services, so we’ve seen more and more states start to tie reimbursement to acuity,” Terzaghi said.

There are also bundled payments, which groups services together, and then providers receive a single rate.

“The states are trying to give some flexibility to meet the individual where they’re at, as opposed to having a more regimented prior authorization process,” Terzaghi said.

Managed care

Managed care organizations (MCO) get paid a per member, per month risk adjusted rate from the state.

It’s important for providers to understand that operating in a state that has managed care doesn’t mean that every home- and community-based service is under the MCO.

“I’ll use Georgia as an example, it’s mandatory managed Medicaid, except if you are using an LTSS service, for example, or if you have private-duty nursing that falls under the GAPP program, which falls outside of the MCO,” Jim Melançon, senior vice president of government affairs at Aveanna Healthcare, said during the presentation.

Melançon noted that managed Medicaid is the predominant service delivery model that most states are following.

Ultimately, providers should pay attention to services covered in their states, how rates are established and their state’s budgeting process.

“The market is going to dictate what the rate is going to be for your workers, and that’s what you will – as a provider – have to look at,” Melançon said.

The post Sorting Through The Complex HCBS Medicaid Landscape appeared first on Home Health Care News.

As one of these next generation leaders, RJ Gagnon is making a name for himself at Andwell, but it doesn’t end with him. The company has already set its sights on developing the next set of future leaders.

“Our organization has really focused on development of leadership,” Gagnon said Monday during a panel discussion at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference. “When we look at our budgets, sometimes that’s one of the things that’s first cut. That’s something we need to invest in.”

Formerly Androscoggin Home Healthcare + Hospice, Andwell is a nonprofit operator that offers home health, hospice, palliative, behavioral health and pediatric care services. The company employs over 500 workers across all 16 counties in Maine.

Along with cultivating the next crop of leaders, companies are figuring out how best to work with a multi-generational workforce.

Currently, UVA Continuum Home Health has four different generations that make up the organization’s staff. Catherine Harris, the home health director at UVA Continuum Home Health, has learned to accommodate individuals based on what stage they’re at in life.

This also gave Harris the opportunity to listen and learn from her more experienced colleagues.

“When you think generationally, you’re really thinking about where that person is in life,” she said during the discussion. “My younger partners are just starting to have kids. They’re taking leave, [it’s about] giving space for that, and celebrating that, versus the generation before us, the baby boomers … who are preparing to retire. Am I listening to them? Am I focused on the lessons that they’ve learned? Because if we’ve learned nothing, it’s that history constantly repeating itself.”

UVA Continuum Home Health is an academic home health agency associated with the University of Virginia in Charlottesville. The organization serves several cities across the state.

Matt Chadwick, CFO of Well Care Health, stressed the importance of not bringing preconceived notions to the workforce when working with multiple generations.

“It’s about, [for example], not going in with the perception that a younger person might know technology better than the older person, but listening to their concerns, hearing what their skill sets are and really trying to find the right space for them,” he said.

Well Care Health is a Wilmington, North Carolina-based provider of home health and hospice services. The company serves more than 4,000 patients, and employs more than 600 employees. It operates across 40 counties in North Carolina and South Carolina.

Chadwick noted that it has been important for Well Care Health to make sure they are placing people in the roles where they’ll succeed the most.

At VNS Health, leaders began to notice a higher turnover among younger nurses. The company sought to address this by establishing a nursing grad program six years ago that emphasized mentorship.

“They’re learning about home care,” Sarani Doshi, vice president of corporate financial planning and analysis at VNS Health, said. “They’re getting their feet wet and taking care of patients in the homes for real now, and we’re giving them the tools they need to be successful, to grow and develop in the way that they’d like to.”

New York-based VNS Health is a full-service home-based care organization. The company has almost 40,000 daily patients.

VNS Health has seen less turnover among younger nurses after the implementation of the program.

Additionally, the company has begun developing closer partnerships with New York area nursing schools, according to Doshi.

“We’re spending a little bit more time in the school, educating students around home care, the value of home care and the benefits of home care, and providing scholarships to students who are showing interest in coming into home care post-graduation,” she said. “That, coupled with our nursing graduate program, has started to gain some traction, and we’re seeing some of that affect turnover and retention.”

Ultimately, Gagnon believes that it’s imperative to set employees up for success by taking professional development seriously.

“We need to let the teams know that they matter,” he said. “We have management meetings where the first half is business as usual. The second half is very direct leadership development with strategies where we bring in facilitators. We are investing in that team. That lets them know, ‘We want you to be successful.’ Our No. 1 job is for our team to be successful.”

The post How Home-Based Care’s Leaders Foster A Multi-Generational Workforce appeared first on Home Health Care News.

“We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.”

Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.

“Our focus more than anything else is remedy coming by way of Congress,” Dombi said. “If we run the clock back 365 days, we had a Congress that was telling us, very overtly, ‘We will not help you.’ They were telling us that because they believed [providers] were making too much profit in the Medicare program. They were not understanding how the business runs. They weren’t understanding how any margin [providers] got was subsidizing other government programs like Medicaid and Medicare Advantage. They now understand it.”

Dombi credits a meeting the organization had with Sen. Ron Wyden (D-Ore.), which took place in Portland, Oregon and included five home health agency representatives from the state.

“Senator Wyden asked the question: ‘MedPAC says your margins average 22%, are those numbers wrong or has something changed?’” Dombi said. “One agency representative immediately spoke up and said, ‘the numbers are wrong and things have changed for the worse.’ He started explaining what happened within his home health agency. Now Senator Wyden is working with us to help us bring about some positive legislative changes.”

Dombi noted that there is already pending legislation.

Still, working with Congress isn’t the only way NAHC plans to address the issue. The organization is still moving forward on its plan to sue the Department of Health and Human Services.

“The action plan continues with this litigation,” Dombi said. “This litigation does not give us quick remedies. My estimate is if we succeed in the first round, we will be facing an appeal by the government. If we lose, they’ll be facing an appeal. Then there’s still the step above that — the U.S. Supreme Court. This kind of litigation may take many years to get through.”

However, Dombi believes that last month’s Supreme Court decision, which struck down the Chevron doctrine, may help NAHC’s lawsuit.

The proposed payment rule wasn’t the only issue highlighted during Dombi’s rundown of legislative and regulatory updates, however.

80-20 silver lining

The “Ensuring Access to Medicaid Services” rule also came under fire, specifically its 80-20 provision, which is controversial among providers.

Dombi pointed out that caregivers should receive higher compensation for their work, but NAHC doesn’t believe that the 80-20 provision is the right method to achieve this.

“We’re in agreement that the direct care workforce is underpaid and underappreciated,” he said. “We don’t agree that the solution is to say, ‘You have to pay 80% of your payment rate as compensation to that workforce,’ when the states are paying you at such an abysmal level for the service. There’s nothing in this rule that increases payment rates for the providers of services.”

There is, however, a silver lining to the provision. It doesn’t require compliance for the first six years.

“In Washington circles, giving that much of a glide path for something to take effect is almost a death sentence, so we expect that there’ll be a number of changes or it will be abandoned along the way,” Dombi said.

Despite the 80-20 provision, Dombi explained that the rule had other aspects that would be beneficial to providers, including more accountability for the states regarding payment rates.

Personal care sees more regulation

Dombi warned private-duty personal care providers not to fall into the trap of viewing the industry as being free of regulation.

“They may not be getting paid by federal or state governments, but they’re subject to a lot of rules and regulations, particularly under the Department of Labor,” he said.

Specifically, personal care is an industry that the department has its eye on when it comes to compliance with the Fair Labor Standards Act.

Aside from the DOL’s personal care focus, The Federal Trade Commission (FTC) also finalized a rule that effectively banned non-competes. Though this impacts all industries, Dombi noted that home care companies often rely on non-competes.

More recently, a federal court in Texas temporarily blocked the FTC’s non-compete ban. Dombi advised providers to follow these updates closely.

The post Why Home Health Providers Should Expect To See A ‘Less Draconian’ Final Payment Rule appeared first on Home Health Care News.

The home health industry has its very own boogeyman — the bad actor.

However, there’s a difference between providers that have made errors in claims processing or quality of care provisions versus those taking part in purposeful fraudulent activity, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.

“The outright fraud, where it’s very overt and purposeful, is the greatest concern,” he told Home Health Care News. “What makes a bad actor is a party that gets into home health care for purposes of stealing from Medicare, Medicaid and others. Their goal is not to provide care, in contrast to those who may make mistakes, but still have a goal to provide compliant high-quality care.”

Put simply, the bad actor is the type of provider that regulators want to drive out of home health care, and the type that industry peers work to avoid being associated with.

The history of fraudsters in the space

In terms of the prevalence of bad actors in the industry, home health care has gone through phases.

In the 1990s bad actors were pervasive in home health, particularly in certain parts of the country, Dombi noted.

“South Florida was an area that drew a lot of attention,” he said. “It reached a point where the Department of Justice actually composed inter-agency hit squads to go after home health, and it included everybody from the Federal Trade Commission to the U.S. mail service, bringing all resources to bear. There were lots of prosecutions, many convictions and guilty pleas with significant amounts of jail time and financial penalties assessed.”

Over the next two decades, the presence of bad actors in home health care would lessen, but these kinds of operators didn’t completely disappear from the space.

In the early 2000s, one scheme that became common was creating a home health agency for the sole purpose of selling inventory instead of delivering care.

“That’s not the kind of roll up that some investors may look at,” Dombi said. “This is where they were just trying to create an inventory, as if it were a convenience store, to sell things off the shelf. We’re seeing a bit of a rebirth of that in home health, but also the same concept is coming into hospice in the [Los Angeles] area. When we’re looking at those [agencies], they have some of the same kinds of identifiers of risk, as we have seen from years past.”

Though the hospice is the focus of fraud in the California area, home health care might not completely be in the clear.

“We’ve heard, anecdotally, that in California, they were switching patients between [home health and hospice] settings, in order to get reimbursement on both sides of the payment system,” Katy Barnett, director of home care and hospice operations and policy at LeadingAge, told HHCN. “I would say that fraud in that way is more prevalent than we might know because nobody has really dug into the data. To be fair to the researchers out there, CMS’ information on surveys of agencies hasn’t been updated since quarter two of 2022.”

Industry-wide impact

While in theory it may seem easy for providers that are operating in good faith to just stay on the right track, the actions of bad actors impact the entire industry.

Oftentimes, the result of these actions are the implementation of regulation with broad-based application that creates administrative burdens for honest providers.

“We would much prefer to see a targeted capability applied,” Dombi said. “They have that capability to target these providers, whether it’s special rules for new providers of services, or just saying, ‘We’re choosing to do an audit, we’re choosing to do a survey of you’ because there’s nothing that prevents them from doing an audit, or a survey, when suspicions arise or otherwise.”

The presence of bad actors also has the ability to taint home health’s reputation at large.

“In the 90s, I was in a taxi in Boston and the taxi driver asked me, ‘What do you do?’” Dombi said. “I explained, and he goes, ‘Isn’t that where all the health care fraud is?’ When it gets to a discussion level from a taxi driver in Boston, you know reputations are being harmed. This might not matter as much in a conversation with a taxi driver in Boston, but when that reputation finds its way to Congress, which we have had to deal with time and time again, they become very hesitant to believe anything that the community offers to them.”

Dombi noted that this becomes a roadblock when industry advocates try to inform Congress about access-to-care issues.

“Their minds divert to, ‘Oh there’s a fraud problem out there, and we can’t trust these people,’” he said. “There’s nothing worse than being distrusted because of the acts of some bad apples in the barrel.”

Arguably, one of the biggest impacts that bad actors have had on the home health space is the implementation of the Patient-Driven Groupings Model (PDGM), in the place of the former Prospective Payment System (PPS).

“That was because a lot of bad actors were trying to prioritize profit over providing for patients, and were gaming the system in order to increase their profits,” Barnett said. “That was the impetus for changing to a different system that didn’t reward the number of therapy visits.”

Despite the detrimental impact of bad actors, good actors aren’t letting them drive the narrative.

“I think there is an effort on the side of good actors to try and elevate themselves and speak out about the issues in the system, and to talk more about the good work that is going on in home health,” Barnett said.

Ultimately, the presence of bad actors has contributed to greater collaboration among good actors.

“I think it has pulled the home health care community together to act in a high level of collaboration, in order to demonstrate to both Congress and CMS that we can be effective, and trustworthy partners,” Dombi said. “Likewise, we’ve seen the same thing happen on the hospice side of it. It has helped unite providers of services.”

The post ‘Bad Apples In A Barrel’: How Fraudsters In Home Health Care Impact The Entire Space appeared first on Home Health Care News.

“Much of what we see in the rule is just, on the payment side of it in particular, an update from ‘23 and ‘24,” he said during a recent webinar hosted by NAHC.

On June 26, the U.S. Centers for Medicare & Medicaid Services (CMS) unveiled its home health proposed payment rule for 2025.

The proposal includes a payment decrease in the aggregate by 1.7%, or by about $280 million.

“That needs qualification,” Dombi said. “That’s $280 million, not to what it would otherwise have been, but rather, in contrast to what it’s expected to be for 2024.”

Providers examining the proposed rule will also see a 2.5% net inflation rate update.

“The 2.5% is a creature of the annual inflation update of 3%, minus the productivity adjustment of 0.5, netting out at 2.5%,” Dombi said. “This is in the same range that we saw for proposed rules affecting inpatient hospital services, skilled nursing facility care and hospice services that were issued by and large in April of this year, and are moving towards final visitation sometime probably in the neighborhood of the end of July. This number of 2.5% will be updated in the final rule, using more recent data than they use for this calculation.”

Dombi pointed out that CMS has refused to increase the inflation updates, for all sectors, based on what wasn’t accounted for each year.

The proposed payment rule also comes with a $100 million reduction in the spending tied to a change in the outlier formula. The change will decrease the frequency of episodes qualifying for outlier payment, Dombi noted.

“The outlier fixed dollar loss ratio is the element of the outlier formula that’s going to be leading to a decrease in the number of outlier episodes,” he said. “When the FDL goes up, it means you have fewer and fewer episodes that will qualify because you’ve got to be above the normal PDGM episodic rate, in terms of cost, at a higher level, before you trigger outlier payments.”

Additionally, CMS proposed a permanent prospective adjustment to the 2025 home health payment rate of -4.067%.

The budget neutrality adjustment is a combination of what was left over when CMS took the almost 5.8% projected, permanent adjustment and cut it in half to 2.89%.

“Kicking the can down the road doesn’t kick the can into a trash can, it just postpones the application of that, so now we see CMS taking that 2.89% leftover from last year and adding to an additional 1.125%,” Dombi said. “They don’t add up together to 4.067 because of the compounding effects of these kinds of things.”

During the webinar, Dombi reiterated NAHC’s view that CMS current methodology is not compliant with Medicare law.

“CMS is on the opposite side of it — their feet are in concrete on this methodology,” he said. “They didn’t even try to defend it this time around. They had been doing so for the last several years.”

Dombi also pointed out that CMS is still tweaking PDGM, including an annual recalibration of the 432 case mix weights, and a resetting of LUPA thresholds. He also urged providers to pay close attention to the wage index.

“I’ve done 38 years of payment rate updates on the Medicare program,” Dombi said. “I’ve probably said it all 38 times — always check out the wage index. This year, there are more changes than there normally are. They have not only applied the 5% cap on any decreases in wage indices. There has been a significant change in the geographic areas that are designated for your particular counties where you provide service.”

The post All The Payment Factors Included In The 2025 Home Health Proposed Rule appeared first on Home Health Care News.

The home health industry has a high concentration of nurses that are closer to retirement age. Providers see the advantages and the drawbacks of having an aging workforce. 

Broadly, the registered nurse workforce age varies based on practice setting.

In home health and hospice, the amount of nurses who are at retirement age are set to surpass new RNs, according to data from the American Medical Group Association.

For context, the average retirement age is 63 for women and 65 for men, according to data from the U.S. Census Bureau.

One of the reasons that nurses close to, or at retirement age, make up a large proportion of the home health industry is because newly graduated nurses aren’t typically being trained to deliver care in the home while they’re in school.

“You don’t have nursing schools that are doing training in the home, it’s really focused on facility-based settings,” Katy Barnett, director of home care and hospice operations and policy at LeadingAge, told Home Health Care News. “Sometimes you’re lucky to get somebody with training in the long-term care facility space, but it’s very rare in the home.”

On the flip side, Barnett pointed out that experienced nurses are often attracted to home health care.

“We’re really looking at nurses with a lot of years of experience in other settings that come to home health, for a lot of the flexibility, but also knowing that they have that kind of clinical capacity to really serve patients on their own,” she said. “They feel comfortable and confident in serving that patient when they don’t have a clinical supervisor down the hall.”

The ability to feel confident providing care in the home is especially important because it’s a setting that calls autonomous decision making, according to Mary Carr, vice president of regulatory affairs at the National Association for Home Care & Hospice (NAHC).

“You have to make a lot of decisions independently in the home, you don’t have other nurses or clinical staff that you can grab, like you do in a hospital,” she told HHCN. “I just think it’s the preferred setting for somebody who’s a seasoned nurse.”

Another benefit of having a workforce full of mostly seasoned nurses is that they are better equipped to handle burnout, according to Barnett.

“They’ve been through a lot, and have seen a lot,” she said. “They understand the burden of the work that they’re undertaking, so the burnout rate is a little bit lower.”

At Masonicare — a Wallingford, Connecticut-based nonprofit senior care provider — 15% of nurses are over the age of 60.

“In the past year and a half, when I looked at the numbers, we actually hired four patient-facing nurses between the ages of 60 and 63,” Laurie St. John, executive director of home health, hospice and palliative Care at Masonicare, told HHCN.

As a company, Masonicare operates the full continuum of care including independent living, assisted living, skilled-nursing facilities, memory care and continuing care retirement communities (CCRCs) across three main campuses. The company also provides home health, hospice and palliative care, plus inpatient behavioral health.

St. John has noticed that working with more experienced nurses has meant less turnover.

“Our highest turnover is in first-year nurses,” she said.

Though nurses near retirement age often bring a wealth of experience to their work, there are still downsides to an aging workforce.

“You really do want people to experience the benefits of retirement, but that does lead to issues in the overall nursing pipeline, and I think that’s one of the significant drawbacks,” Barnett said.

Plus, experienced nurses leaving could mean an industry-wide brain drain of vital knowledge and history.

“Home health and home community services have really come of age in the last 20 and 30 years, so these nurses that are retiring … have been pioneers in this field,” Nicole Howell, director of workforce public policy at LeadingAge, told HHCN. “They have seen the really early stages now, the more flushed out system, and the changing needs of both the individual receiving care, and the families that are there to support them. As they move on to the next stage in their life, we’re losing not just the actual care knowledge, but really the institutional knowledge about the sector, and how far we’ve come.”

Masonicare has been able to avoid this brain drain, company-wide, as its nurses who are reaching retirement age often move into non-patient facing roles. Many of these nurses transition into educator roles that allow them to mentor other nurses at the company.

Additionally, many of these nurses who have moved away from seeing patients have played a major role in the company’s efforts to enhance its orientation process.

“We revamped our orientation process, and these nurses were critical in helping us,” St. John said. “We did focus groups with our nurses, because we wanted to hear from them — what supports you in the best way. We’ve actually added some resources to our quality and education team as a result.”

The post The Hidden Advantages Of Having An Older Workforce In Home Health Care appeared first on Home Health Care News.

NAHC has re-filled its lawsuit against the U.S. Department of Health and Human Services (HHS). The lawsuit focuses on the home health PDGM budget neutrality adjustment, which imposed both permanent and temporary calculations with a methodology that NAHC believes is noncompliant with the law.

The original lawsuit was filed last summer, and in April the case was dismissed by a federal court in Washington D.C. The case was dismissed on the basis that NAHC did not fully exhaust administrative appeal remedies.

“There’s a particular element the court brought into that which is a provision in regulations, where you seek authorization to expedite judicial review and skip over various steps like the administrative law judge and the appeals council, to be able to go into court quicker,” NAHC President William A. Dombi told Home Health Care News. “While we don’t agree with the judge’s ruling, the option was filing an appeal on that procedural issue, which could take us an extended amount of time to get through the court of appeals – even if we win – or doing what the judge said we should have done, which would take less time, and then go back into the court with a re-filed lawsuit.”

There are a number of factors that made NAHC decide to re-file the lawsuit, according to Dombi.

“No. 1, it will be faster,” he said. “No. 2, we are highly likely to get the same judge, as there’s a related litigation standard in an assignment of cases,” he said.

One of the biggest factors that heavily contributed to NAHC’s decision was the Supreme Court ruling, which upended the Chevron Doctrine.

“[The ruling] addresses the issue of: Do federal courts have an obligation to defer to the interpretation of congressional law when evaluating a federal regulation?” Dombi said. “And that’s exactly what we have here. CMS and HHS interpreted the act of Congress — we think they interpreted it wrong. We are in much better shape now, after the Supreme Court ruling.”

Dombi also noted that the proposed rule, released on Wednesday, is CMS essentially restating its intentions to stick to a methodology that NAHC is challenging as illegal.

In addition to the lawsuit, NAHC is also working with Congressional leaders for a solution.

“We’re doing a lot of work behind the curtain, so to speak, to work with Congressional leadership to put this on their priority agenda,” Dombi said. “We’ve made a lot of progress in moving our issue to be up on the priority list. At the same time, the true measure is, can we get it across the finish line?”

Ultimately, Dombi is optimistic.

“With the combination of this new ruling from the Supreme Court, and some of the things that might be hinted at in the court’s analysis of our case, I think we have a better than even chance of success,” he said. “That’s a high level to give it. Nobody’s going to ever say they’ve got a 95% chance of winning a lawsuit. You’re already behind the eight ball because you’re in court. As it relates to the congressional side, I’d say also we’ve got a better than even chance of getting some solid relief from Congress this year.”

The post NAHC Re-Files Lawsuit Against HHS, CMS Over Home Health Cuts appeared first on Home Health Care News.

He became the National Association for Home Care & Hospice’s (NAHC) vice president for law in 1987, and has been a key player in many of the advancements and milestones that have moved the industry forward. Those include the growth of the home health benefit under Medicare, the implementation of the home health prospective payment system in 2000 and much, much more.

In 1987, Dombi spearheaded a notable lawsuit that changed the scope of coverage under the Medicare benefit.

In 2017, Dombi became NAHC’s interim president and was named the association’s permanent president the following year.

Last month, Dombi revealed his plans to retire as president by the end of 2024. This announcement comes amid NAHC’s merger with the National Hospice and Palliative Care Organization (NHPCO).

Home Health Care News recently caught up with Dombi to look back at his time at NAHC, and on what he believes to be the biggest accomplishments during his tenure.

Providers taking on an ownership approach with NAHC

“This translates to the members being highly engaged in everything we do — from advocacy to education and so on. What that means for the community of health care at-home is that we now have an army of people representing the interests of home care, in contrast to many other associations that are staff driven. There’s only so much a small staff can do, and now we have an army working together on behalf of everyone else.”

***

Unifying the voices of home-based care

“Typically, when it comes to trade associations, or other representative bodies, there’s constant fracturing, and sometimes division, that turns into non-productive outcomes for the people that we represent. What we did with what we call NAHC 2.0 was establish a mission to have that unified voice. There’s two ways to have a unified voice. One of them is to speak as a single organization, and the other is to all have the same message. We have made progress on both fronts with our upcoming merger with NHPCO. We’ve made this progress by working with multiple other voices that represent one or more home care interests, on the national and state level. There’s still work to be done, in terms of that unification, but we’re no longer facing a splintered industry voice.”

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The end of site-based continuum of care

“For many years, decades even, people looked at the continuum of care as a step down from a hospital, to a skilled nursing facility, to home care and so on. Now, the breadth of care at home is greater than it’s ever been, with hospital-level of care at home, with skilled nursing facility-level of care at home, etc. When we look at how this happened, there’s no one person or one party that can be credited. It was clearly an effort from a multitude of people. I would have to say, NAHC has certainly played a part in helping make that happen — continuing to have that kind of culture throughout the home care community and believing that there is not yet a ceiling on what can be done.”

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Ushering home care into the future

“I believe we’ve had a lot of impact on both the involvement of technology in care at-home, and also changing the image of care in the home from a high-touch setting to a high-touch and high-tech health care setting – of clinical technologies and operational technologies. When people were trying to figure out what to do with patients during COVID, the clinicians, the administrators and the owners of companies all embraced technology as a serious tool to be able to expand what they could do during that very tragic time, and to invest in the future. Now, of course, we’re seeing the fruits of that in so many other ways, where major international global tech companies are investing in health care services in the home setting as well. A lot of hands, and a lot of brains went into taking tech, and making it such a central part of health care services at home.”

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Working in all forums effectively

“This one goes back to the very beginning in my tenure at NAHC, all the way to 1987, but it carries all the way through today. It’s a recognition that our role, as representative of a community of home-based care providers, requires us to work in all forums effectively. It’s not just dealing with legislation pending before Congress, or regulatory matters through various agencies like CMS, or the Department of Labor, and many others, but also in terms of in-depth research and the ability to demonstrate that we will go to war, if necessary, on behalf of our providers when we think they’ve been wronged. That means going into court with various litigation activities. That began in 1987, when I came to NAHC and prosecuted a case to deal with the entire Medicare home health benefit. This, ultimately, changed the entire benefit, in terms of what the scope of coverage is. That was just one lawsuit of many that we did. Litigation is the last resort, but what we’ve seen when we look at other health care trade associations, we see them doing what we’ve been doing for 30 plus years, and that’s protecting our members interests, even by going to court. Whether it’s the most recent case by the American Health Care Association, on the staffing requirements, or the American Hospital Association on their 340B drug discount litigation, or many others like that. All forms need to be explored in order to be really a bonafide representative of your membership.”

The post NAHC President Bill Dombi Reflects On Tenure: We Went ‘To War’ On Behalf Of Our Providers appeared first on Home Health Care News.

Last month, the Centers for Medicare & Medicaid Services (CMS) revealed that it planned to extend Review Choice Demonstration (RCD) for five additional years. This extension began on June 1. 

Though many home health providers had a bumpy start when RCD first launched, most of the industry has since adjusted. Some even view RCD as a positive.

Broadly, RCD is a CMS program that aims to reduce improper billing from home health providers, and limit fraud in the industry. Providers that operate in Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma are subject to RCD.

In 2016, Illinois providers were subject to Pre-Claim Review Demonstration (PCRD). This was RCD’s predecessor.

“When [PCRD] was first unveiled, the Illinois home health agencies essentially said, ‘This is not what we want,’” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News. “[Providers said], ‘It will be highly costly, from an administrative burden standpoint, and it has no redeeming value.’”

In 2017, lawmakers blocked the PCRD expansion.

“When the program was stopped, CMS went back to the drawing board, and created what’s now known as the Review Choice Demonstration program, where the provider had three options,” Dombi said.

These three options included: Choice 1, which is pre-claim review; Choice 2, which is post payment review and choice 3 which is minimal review with a 25% payment reduction. As part of this recent extension, CMS has eliminated choice 3.

After launching in Illinois, RCD expanded to Ohio, Texas, North Carolina and Florida, and then later to Oklahoma.

Dombi noted that providers operating in Illinois had a change of heart about RCD after a challenging start.

“It was a strange turnabout for them,” he said. “In retrospect, they’d realized that there was a lot of value to the RCD program for them after an initial burden that came with the startup of it. They particularly liked the fact that the program immunized them from retroactive audits on claims, which had plagued home health care for decades. A year, two years, sometimes three years after a claim was paid, Medicare was reopening claims, and saying ‘We want money back.’”

Providers in other states reported having a similar experience to Illinois agencies, which boiled down to a rocky start that later became manageable.

In general, providers also became more accustomed to the administrative requirements of the pre-claim review.

Some providers also think that the RCD program has benefited the industry. At-Home Health Care — Sparta Community Hospital’s home health segment — is one such company.

“I think it made agencies in Illinois clean up their act, per se,” At-Home Health Care Administrator Cheryl Adams told HHCN. “The documentation that CMS is requiring, Palmetto in particular, is nothing new, but agencies were not always following the rules. This just makes everyone more accountable.”

Sparta Community Hospital is located in Southern Illinois and is a 25-bed full-service acute care medical facility. At-Home Health Care is a Medicare-certified home health agency that serves five counties surrounding Sparta.

As a provider that operates in Illinois, At-Home Health Care was also part of the initial PRCD. When RCD began, the agency picked Choice 1.

“We felt that it was easier to do it upfront to make sure that we were capturing all the appropriate documentation that we needed, and that we would have an affirmed record at the beginning instead of waiting and having ADRs after,” Adams said. “Our practices will not change.”

Adams believes that At-Home Health Care has been successful under RCD because the agency already had good processes in place. It used the program as an opportunity to tighten up these processes.

Enhabit Inc. (NYSE: EHAB) is another company that is well prepared for this current iteration of RCD.

“We anticipated the demonstration would be extended, so we were not surprised by the announcement,” Bud Langham, executive vice president of clinical excellence and strategy at Enhabit, told HHCN in an email. “We have been participating in RCD and its predecessor program Pre-Claim Review almost from the beginning, so for us, it simply remains business as usual.”

Dallas-based Enhabit has 255 home health locations and 112 hospice locations across 34 states.

Langham thinks it’s unlikely that the elimination of Choice 3 will have any impact on the industry.

“Provider choices are not public, but our understanding is that very few providers selected this option,” he said. “We don’t expect this to have any material impact on the industry.”

Under the extension, providers will have to select from Choice 1 or 2. The process will begin on June 17. Providers who don’t make a selection will have to participate under Choice 2.

Langham noted that, overall, Enhabit is proud of its performance under the RCD program.

“It has required some investment and strategic focus, but we are pleased with our results,” he said.

Looking ahead, providers wondering if RCD will eventually expand to other states will still have to wait and see.

“CMS has some work to do before it decides to do that,” Dombi said. “It’s a labor intensive process for them, as well as it is for the home health agencies. Is there a point when they think they’ve reached enough success, in terms of complaint claims submissions, or is it something that should be even considered to be permanent, not just extended?”

The post Now-Extended Review Choice Demonstration Forced Home Health Agencies To ‘Clean Up Their Act’ appeared first on Home Health Care News.