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National Healthcare Decisions Day

Death and taxes - the only two inevitables. With April 15 as tax day, it's only fitting that April 16 is National Healthcare Decisions Day (or, a great day to discuss with your loved ones and care providers how you wish to live until the end). That means talking about what kind of care you want to receive and don't want to receive, where you want to be cared for, what your life goals are before you go, and what your loved ones should do if you can't communicate for yourself, among other issues.

CMMI New Initiative Round-Up

The Center for Medicare and Medicaid Innovation (CMMI) announced several initiatives last week—some of which provide opportunities for VNAA members. This flurry of activity is likely only the beginning of what may be a very busy 18-24 months for CMMI as the current administration winds down.

Crossing the Bridge: Frank Conversation on End of Life Care

When you ask people what hospice is, many will tell you that it's where you go when the doctor says, "There is nothing more we can do for you."

I don't think John and Audrey would agree.

Burwell Confirmed as New HHS Secretary

Last week, the Senate voted 78-17 to confirm Sylvia Mathews Burwell to succeed Kathleen Sebelius as secretary of Health and Human Services. Ms. Burwell was previously the Director of the Office of Management and Budget (OMB) and prior to that she worked as the President of the Walmart Foundation and the President of the Global Development Program at the Bill & Melinda Gates Foundation. Ms. Burwell was officially sworn-in on Monday.

VNAA Launches Toolkit on Face-to-Face Encounter Documentation

CMS's implementation of the face-to-face encounter documentation requirement has created one of the most pressing policy issues facing home heathcare providers. These challenges extend to both obtaining physician documentation as well as ensuring appropriate and consistent contractor review and approval. VNAA continues to work with both Capitol Hill and CMS to achieve remedy and clarity on this issue. As such, the VNAA Policy and Communications departments developed a new toolkit to assist you in addressing these issues with your members of Congress.

New Study Finds Medicare Home Health Payment Reform May Jeopardize Access for Clinically Complex and Socially Vulnerable Patients

A study published in the June 2014 issue of Health Affairs found mandated updates to the Medicare payment system, known as rebasing, will greatly impact patients with clinically complex conditions and social vulnerability factors, as they have substantially higher service delivery costs than other home health patients. This means vulnerable patients with complex conditions represent less profit for home health agencies and could reduce such patients' access to care as Medicare payments decline and agencies operate on smaller margins.

ONC Accepting Applications for Health IT Policy Committee and Standards Committee Workgroups

The Office of the National Coordinator for Health Information Technology (ONC) is now accepting applications for its Health IT Policy Committee and Standards Committee Workgroups. These workgroups contribute to health IT strategy and policy, or to help identify which standards, implementation, and certification criteria are needed to help providers better use their health information technology.

GAO Makes MedPAC Appointments and Designates Vice Chair

Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of three new members to the Medicare Payment Advisory Commission (MedPAC), as well as the reappointment of two existing members and the designation of the Commission's Vice Chair.

Office of Management and Budget Details Spring 2014 Agency Rule List

This week, the White House Office of Management and Budget (OMB) detailed the Spring 2014 Agency Rule List, including a number of updates on proposed rules for the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). VNAA members should pay particular attention to two proposed rules regarding home health and hospice.

CMS Finalizes Program Changes for Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015

The Centers for Medicare & Medicaid Services (CMS) issued final regulations (CMS-4159-F) for the Medicare Advantage and prescription drug benefit (Part D) programs that continue efforts to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs. The final rule is projected to save an estimated $1.615 billion over the next ten years 2015 - 2024. To view a fact sheet on the final 2015 Part C and D rule, click here. To view CMS' response to hospice related comments, click here.

Subcommittee on Health Explores Medicare Payment Reforms for Seniors

The Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), scheduled a hearing for Wednesday, May 21, 2014, at 10:15 a.m. in room 2123 of the Rayburn House Office Building. The hearing is entitled "Keeping the Promise: Site of Service Medicare Payment Reforms." Mark E. Miller, PhD, Executive Director of the Medicare Payment Advisory Commission will testify. Other witnesses are to be announced.

Senator Warner Questions HHS-Secretary Nominee on Hospice Part D Issue

There continues to be rising Congressional interest in CMS' released guidance around payments for drugs under Part D and hospice. In March, CMS issued Final 2014 Guidance, "Part D Payments for Drugs for Beneficiaries Enrolled in Hospice" in an effort to clarify prior authorization requirements for hospices and Part D plans to prevent duplicate payments for drugs covered under the hospice benefit. Since the final guidance was issued, the hospice community has expressed confusion and concern about ensuring appropriate payment for drugs and the new processes for prior authorization.

Senate Aging Committee to Hold Roundtable on Advanced Care

This week, the Senate Special Committee on Aging will host a roundtable discussion on advanced care on Wednesday, May 21 at 10:00 a.m. in Dirksen 106 Senate Office Building. The roundtable will foster a dialogue between health care providers and Senate Aging Committee Members on the role of health care providers in advance care planning.

VNAA Releases Summary of Hospice Payment Rule

VNAA has released its summary of key points in the HHS Hospice Payment Rule. The summary also highlights specific areas for VNAA's comment development. VNAA will host a Hospice Roundtable call later this month to outline these areas for comment and to share insights with members. We will announce the date and time of the call as soon as possible. Meanwhile, we welcome your insights and feedback on the regulation as we develop comments to CMS.

VNAA Submits Comments on Common Assessment Tool

On Friday, May 9, VNAA submitted comments to the Chair and Ranking members of the Senate Finance and House Ways and Means Committees on the discussion draft , Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT). IMPACT proposes to phase-in a "Common Assessment Tool" to for use across all post-acute settings including home health agencies, (HHAs), skill nursing facilities (SNF), inpatient rehabilitation facilities (IRF) and long term care hospitals (LTCH).

VNAA Helps To Craft Telehealth Legislation

At the request of Representative Mike Thompson (D-CA-5), VNAA recently provided recommendations on a discussion draft of the Telehealth Promotion Act of 2014. Rep. Thompson sought input from VNAA and other stakeholders to strength and enhance the Telehealth Promotion Act of 2014, prior to introduction. VNAA's recommendations include:

Resources and Background on Health Homes

There are many ways that states can modify their Medicaid programs to provide more targeted and coordinated care to their beneficiaries. One important option available to states is to develop a "health home" model for specific beneficiaries.

Confirmation Hearings Begin for HHS Secretary Nominee

Last week, the Senate Health, Education, Labor and Pensions Committee held a nomination hearing for 48-year-old Sylvia Burwell, the current director of the Office of Management and Budget (OMB) and President Obama's nominee to serve as the next Health and Human Services Secretary.

CMS Seeks Answers Related to Part D Plans and Hospice Payments

In the 2015 proposed hospice rule released on May 2, the Centers for Medicaid and Medicare Services (CMS) seeks suggestions on the best way for hospices to coordinate with Part D plans regarding payments for certain prescriptions.

CMS is considering requiring Part D sponsors to communicate with hospices to determine coverage for drugs "whenever a coverage determination process is initiated or a hospice furnishes information regarding a beneficiary's hospice election and/or drug profile." Coordination would occur after the hospice contacts the sponsor to report information concerning a hospice election and/or drug profile. It also would occur after the beneficiary, the beneficiary's appointed representative or the prescriber initiates a coverage determination request.

VNAA Hosts Hospice Roundtable Call Regarding CMMI Hospice Demo

On May 5, VNAA and Cindy Massuda from the Center for Medicare and Medicaid Innovation held a conference call to provide members with an introduction and answer questions on the Medicare Care Choices Model (MCCM) program. Massuda and with her team walked members discussed the Centers for Medicare and Medicaid Services requested hospice applications to participate in its Medicare Care Choices Model (MCCM).

Medicaid Managed Care Resources Now Available on VNAA Website

VNAA recently collected a diverse series of resources on Medicaid managed care to reflect the growing need to understand which Medicaid beneficiaries are covered by managed care and what those benefits look like for vulnerable patients (including dual eligible). These resources range from technical to general so there is something for everyone. State Medicaid programs vary tremendously, so state-level data are included where possible.

Federation of State Medical Boards Approve Telehealth Guidelines

On April 28, The Federation of State Medical Boards approved a model state telehealth policy entitled "Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine," designed to encourage the use of telehealth and provide a uniform, though non-binding, approach to integrating telehealth into the practice of medicine. The policy encourages the use of all telehealth but does put emphasis on video technology for the first encounter to establish a provider-patient relationship.

Read the full study here.

VNAA to Participate in Future of Home Health Project Launch: Achieving the Triple Aim with Home Health Care

On May 5 at 10 a.m. ET, the Alliance for Home Health Quality and Innovation will hold a Capitol Hill briefing to formally launch the Future of Home Health project and release a white paper on the same. VNAA, led by President, CEO and Alliance board member Tracey Moorhead, played a key role in development of this project and hopes members will join VNAA and the Alliance for the briefing, whether in person or via webcast, and encourage your key contacts (from the policy community, health care stakeholders, thought leaders, and others) and your members of Congress (and their staff) to attend.

MedPAC Recommendations for Home Health and Hospice

On Dec. 12 and 13, VNAA attended a MedPAC meeting covering a number of issues of interest to members. At the December meeting, MedPAC staff presented recommendations to the commissioners for consideration and feedback. MedPAC Commissioners will vote on the recommendations in January 2014. A report with final recommendations will follow in March.

Below are highlights of the meeting as well as links to relevant handouts. Please note that MedPAC materials provided to the public do not contain draft recommendations or other more detailed materials provided to commissioners.

VNAA Briefs House Democratic Caucus Senior Task Force

At the invitation of the Senior Task Force (STF) Co-Chairs, Rep. Doris Matsui, (D-CA-6) and Rep. Jan Schakowsky (D-IL-9), Visiting Nurse Associations of America (VNAA) provided a briefing to over 15 Members of the House of Representatives, including Rep. Xavier Becerra (D-CA-34), and more than 30 congressional offices. The focus of the presentation was Medicare Waste, Fraud and Abuse.

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