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Home Health Regulatory Update – NAHC 2016

By Stephen Tweed  nahc-logo

It’s Sunday, October 23, 2016, and I’m coming to you live from the Gaylord Palms Resort in Orlando, FL, and the National Association for Home Care & Hospice annual conference and exhibition.

The conference opened with a welcome from Denise Schrader, Chair of the NAHC Board of Directors, who introduced keynote speaker James Parker, former CEO of Southwest airlines.  Parker told the story of the founding of Southwest, and his journey as CEO which began three months before 9/11/01.  He then went on to share some insights from his book, “Do The Right Thing.”  Some key points he made:

  • Give people something to believe in
  • Help them want to make a difference
  • People respond to the culture they are in.

He went on to talk about a mantra we share – “Hire for attitude, train for skills.”  He said, “we can find an abundance of people with the right skills – pilots, mechanics, flight attendants.  It’s much harder to find people with the right attitude.”

We see the same principles in home care and hospice.  I’ll be talking about this in more detail tomorrow in my presentation, “Strategic Focus: A Game Plan for Growing the Agency you Want.”

Washington Update

After Parker’s keynote, Val Halamandaris, President of NAHC, introduced members of his leadership team who gave us a Washington Update on what’s going on in their areas of responsibility.

Jeff Kincheloe, VP Govt. Affairs –  The Leadership Council of Aging Organizations is supporting home care in saying that the pre-claim review process currently underway in Illinois is a threat to access to care for elderly patients.

Prue Fitzpatrick, VP Govt. Affairs – In the coming “lame duck” session of Congress, it is unlikely we will see any action related to home care and hospice.  In the 2017 session, the major issues likely to be addressed are Pharmaceutical fees, challenges to the Affordable Care Act because of insurance companies exiting, and a CHIP re-authorization bill.

Richard Brennan, VP Government Affairs – A big issue we are working on is giving advance nurse practitioners the authority to certify patients for home health care, and sign face-to-face documents.  The Congressional Budget Office is scoring the cost of the bill.  Currently there are 204 Members of the House and 52 Senators on board with the bill.

Bill Dombi – Vice President for Law – It is possible we could see some “Christmas Tree” bills in the “Lame Duck” session on which we can hang some ornaments, so we need to be ready. The three big issues we are ready for are Nurse Practitioners, Face to Face, and Pre-claim review.

Former Senator Ben Nelson, NAHC Counsel – Look for legislation next year to Repair and Retool the Affordable Care Act.  Republicans want to Repeal and Replace the ACA, but that is unlikely to happen.

Gina Sherick, Medicaid Policy Advisor – The coming presidential election will affect the future of Medicaid.  Secretary Clinton will move to expand it.  We don’t know what Donald Trump will do.

Theresa Forester, Vice President for Hospice Policy and Programs – We are seeing the beginning of Hospice payment reform.  This is a down payment on future reimbursement changes.  A big issues is transparency, with a Hospice Compare web site coming, and new disclosures on Hospice Agency Utilization.

Mary Carr – Vice President for Regulatory Affairs – We will see more regulation than ever.  We will continue to work with regulators as much as we can, and we will turn to the courts if that doesn’t work.

Coming Lawsuits

Bill Dombi, Vice President for Law, reported on the NAHC Board’s decision to sue CMS over the Pre-claim Review process.  Bill referred to the “Staggers” Lawsuit back in 1987 when NAHC, several members of Congress, and a group of home health patients sued what was then known as HCFA.  The court ruled in favor of the plaintiffs, and the way Medicare reimbursed home health was changed.

This year, NAHC will sue CMS based on how this new Pre-claim Review process is hurting patients’ access to care.  Bill gave several examples of patients who have been receiving home health services for years in Illinois, but were denied care under Pre-claim review.  One person denied care happened to be a relative of a Senator from Illinois.

NAHC is also filing “Friend of the Court” briefs in two other lawsuits. One is a suit by a number of Hospice industry organizations over a new regulation on false claims.  The other is a case where judges in the 6th Circuit in Nashville issues a ruling that changed the way Medicare deals with delayed documentation by physicians for Medicare home health patients.

Get to know your Federal and State Legislators

The team on stage encouraged all NAHC members to get to know your state and federal legislators by visiting them in their offices, making friends, and attending fund raising events.  Having a relationship with legislators is key to telling the story of home care when it comes to legislative issues.

Strategic Focus: A Gameplan for Growing the Agency You Want  strategic-focus-nahc-16-x-9-final

I’ll be speaking on Monday at 9:45, presenting “Strategic Focus: A Gameplan To Grow the Agency You Want.”  This is a brand new speech based on revisions to my original Strategic Focus book.  We’ll be talking about “having a vision for the agency you want, a strategy to get there, and the talent to execute with excellence.”  If you are here at NAHC, join me in the Miami Room at 9:45.  If not, you can download the handout at





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