Home Health & Hospice Week

Stimulus bill isn't preventing cuts to vital programs.

Florida state legislators are trimming home care services to rein in the budget. 

Lawmakers have cut 4 percent of the $13.3 million budget for the state's Alzheimer's Disease Initiative, which provides in-home help for caregivers, reports the Miami Herald. More state-funded home care programs will be up for cuts when the legislature convenes this month, advocates fear.

The Florida Council on Aging estimates that home care costs the state $4,680 per person per year while institutional care costs $65,251 annually. "It doesn't make economic sense," Max Rothman of the Alliance for Aging for Miami-Dade and Monroe counties told the Herald. "They're cutting services that enable people to remain at home where they want to be and that cost taxpayers less money."

Florida isn't the only state cutting home care budgets. In Massachusetts, the wait list for Medi-caid-funded home care has doubled since the state cut the program's budget, reports 22News.

The cuts will force seniors into nursing homes, Highland Valley Elder Services told the news station.

• If you've had claims incorrectly rejected by RHHI Palmetto GBA using reason code C7080, you'll have to resubmit them to get your rightful reimbursement.

Claims reject for that reason when a home health claim has a detail line item date of service that overlaps an inpatient, religious nonmedical healthcare institution, or skilled nursing facility claim, Palmetto explains on its Web site. 

The RHHI resolved the issue in February. "Providers need to submit a new claim," it instructs.

• Washington state's assisted suicide law, the Death with Dignity Act, will take effect March 5. State officials have laid out the regulations implementing the law, reports the Associated Press.

The Washington Department of Health will require patients to fill out forms requesting lethal drugs, AP says. Participating physicians, psychological consultants, and pharmacists will also have forms to fill out.

Under the law, patients with a prognosis of six months or less can ask doctors for a lethal dose of medication. The patients must administer the drug themselves. Physicians and pharmacists are not required to participate.

• Sens. Charles Grassley (R-Iowa) and John Kerry (D-Mass.) have reintroduced legislation that would increase Medicaid funding for home care services. The Empowered at Home Act of 2009 would liberalize eligibility for state-funded home care programs, Grassley notes in a release.

Among other provisions, the legislation proposes to allow states to offer home care services to beneficiaries before they are eligible for the Medi-caid nursing home benefit and to allow states to let benes keep more of their assets so they can maintain their homes.

• If you want to make sure you're in compliance with Medicare rules and regulations, you may want to check out a newly revised resource. The Centers for Medicare & Medicaid Services has issued an updated fraud and abuse fact sheet that explains common compliance rules and lays out resources from CMS, the HHS Office of Inspector General, and other agencies.

The four-page fact sheet is online at www.cms.hhs.gov/MLNProducts/downloads/Fraud_and_Abuse.pdf.

• The home care sector comes in 32 in a list of 197 industry groups ranked by Investor's Business Daily. The home care market has strong investment potential because it can help control health care costs by substituting cheaper in-home care for pricey institutional care, particularly in hospitals. It also is dominated by mom-and-pop providers, which allows consolidators to grow quickly by buying into markets, the business newspaper notes.

Publicly traded home care firms make up about 11 percent of the 9,000 or so providers in the industry, IBD notes. The growing demand for home care services is a positive, but lower payments expected from Medicare are a negative.

However, the market's strength hasn't kept it from suffering along with the rest of the stock market due to investor fears over bank stabilization and the recession. Recently, stock for LHC Group Inc. and Almost Family Inc. have taken significant hits, IBD notes.

• Gentiva Health Services Inc.'s profits are up but revenues are down since it sold its managed care business last fall.

The Melville, N.Y.-based national chain reports net income of $12.8 million on revenues of $282.9 million for the fourth quarter of 2008. That's compared to an $8.8 million profit on $313.4 million in revenues for the same period in 2007.

The company had had a "strong performance" during the quarter in hiring new clinicians, it says in a release. It also has started up more specialty programs, it says.

• Odyssey HealthCare Inc.'s earnings are on the upswing. The Dallas-based for-profit hospice chain reported net income of $5.4 million on revenues of $167.3 million for the quarter ended Dec. 31. That's compared to a $1.2 million profit on $102.2 million in revenues for the same time period in 2007.

Odyssey acquired rival hospice chain Vista Care Inc. in March 2008. However, average daily census for the 2008 quarter wasn't much higher than 2007's -- 12,357 versus 12,329.

After review, Odyssey has closed or sold eight locations and two inpatient units, it says. The chain also is still battling its Medicare cap allow-ance. It is developing an inpatient unit that will help mitigate the cap impact in one of its larger programs, the company says in a release.

• Owners of a DME company and mail order pharmacy are in hot water for alleged kickbacks. In 2003 and 2004, Kentucky-based pharmacy Life Medical Systems Inc., owned and operated in part by Dewayne Logan, paid DME supplier J and J Medical Inc. for patient referrals, an indictment alleges.

J and J Medical agreed to send its oxygen patients to Life Medical for their medications in exchange for payment, according to a release from the U.S. Attorney's Office for the Western District of Kentucky. J and J Medical received more than $40,000 in illegal payments, the indictment says.

Logan pled guilty to five counts of violating the anti-kickback statute, the U.S. Attorney reports. He faces sentencing on May 11.

J and J owner Carolyn Sue Davis is still incarcerated for a fraud conviction from 2005. In that case, prosecutors alleged that she forged oxygen certificates of medical necessity and prescriptions, among other misdeeds. J and J owner Otis Davis was recently released from prison. Prosecution against the Davises in this case is ongoing.

• An HHA exec has received a nearly two-year prison term for Medicaid fraud. He will also have to repay more than $270,000.

Melee Kermue, who ran Reynoldsburg, Ohio-based Hope Home Health Care Inc., pled guilty to submitting Medicaid claims with fictitious times and dates of service, reports Business First of Columbus. Kermue was extradited from his home country of Liberia in 2008.

Kermue's co-conspirator, Wilma Bailey, was recently sentenced to one year in prison and the same amount of restitution in the scheme.