RISE summarizes recent regulatory-related headlines.
CMS ISSUES FINAL RULE ON NURSING HOME OWNERSHIP
The Centers for Medicare & Medicaid Services (CMS) on Wednesday released a final rule to increase transparency of nursing home ownership. The rule, which is scheduled to be published in the Federal Register on Friday, requires disclosure of private equity ownership. Research indicates that this type of ownership is associated with poorer staffing conditions and a decrease in quality of care.
The new provisions require nursing homes enrolled in Medicare or Medicaid—most of the country’s nursing homes—to disclose additional information regarding their owners, operators, and management; for example, nursing homes will disclose individuals or entities that provide administrative services or clinical consulting services to the nursing homes. Nursing homes will also be required to disclose entities that exercise financial control over the facility, such as an organization the nursing home hires to manage all its financial matters. The final rule also requires additional information about entities that lease or sublease property to nursing homes, since the facilities and property owners may be set up as different corporate entities even though the entities work together.
“The Biden-Harris Administration believes that residents living in nursing homes should receive the dignity, care, and respect they deserve. Taking steps to help consumers to learn more about the owners of a nursing home will allow them to make the choice that best meets their needs,” Department of Health and Human Services Secretary Xavier Becerra said in the announcement.
THE COMMONWEALTH FUND INVESTIGATES OPTIONS TO SUPPORT MEDICARE FAMILY CAREGIVERS AT HOME
Millions of family caregivers to Medicare beneficiaries experience poor health, emotional stress, and financial insecurity, according to a new issue brief published by The Commonwealth Fund. Researchers noted that because Medicare does not provide caregivers with adequate support, policymakers could implement short- and long-term measures, many which don’t require congressional action. The 15 policy options aim to increase coverage of in-home services and supports for family caregivers; provide financial support for family caregivers; expand the availability and accessibility of resources and navigational support for families; and conduct research on ways to advance equity, alleviate caregiver burden, and reduce disparities in access to home-based services.
AHIP: INCREASED MEDICARE UTILIZATION COULD BOOST MEDICARE TRUST FUND VIABILITY
The Medicare Part A Trust Fund could be extended by as much as 17 years if Part A services in the original Medicare program were used at the same level as Medicare Advantage, according to new research commissioned by AHIP and conducted by Avalere. The study found that original Medicare uses hospital and post-acute services at a higher rate than Medicare Advantage. The report finds that if FFS Part A utilization was the same as Medicare Advantage utilization, spending would be lower, which would increase the solvency period of the Hospital Insurance Trust Fund to 2048.
“This new research shows that Medicare Advantage holds the key to extending Medicare’s Part A Trust Fund,” said Jeanette Thornton, executive vice president of policy & strategy at AHIP, in the research announcement. “Avalere’s findings are remarkable: showing a 17-year boost for the trust fund if original Medicare could match Medicare Advantage’s efficiency. That demonstrates that Medicare Advantage is not only good for enrollees and taxpayers, but also offers a roadmap for delivering greater benefits without sacrificing quality.”
HHS OCR, MASSACHUSETTS SNF SETTLE DISABILITY DISCRIMINATION CASE
The Office for Civil Rights (OCR) at the United States Department of Health and Human Services and United States Attorney’s Office in the District of Massachusetts this week announced an agreement with North End Rehabilitation & Healthcare Center, a skilled nursing facility (SNF) in Boston, Mass. The center offers clinical services, subacute rehab, chronic kidney disease management, a ventilator program, long term care, respite care, and urgent SNF services. The investigation began in March 2022 after a nurse at a local area hospital revealed that the center denies admission to individuals because the individuals are taking prescription medication to treat their opioid use disorder (OUD), when they are otherwise eligible for admission. Individuals receiving medications to treat their OUD are protected under federal civil rights laws which protect persons who are in active treatment and recovery under disability laws. The settlement calls for the center to revise its admissions policy, provide training to admission staff about federal civil rights laws and OUD, and revise language for customer service intake scripts to include whether the individual with a disability is qualified for the services provided at the center with a reasonable accommodation. Click here for a copy of the agreement.
KFF: MEDICAID OFFICIALS EXPECT SHARP ENROLLMENT DECLINES, INCREASE IN STATE SPENDING
An annual survey of state Medicaid directors reveals that states expect national Medicaid enrollment will decline by 8.6 percent in state fiscal year (FY) 2024 as state Medicaid agencies continue to unwind pandemic-related continuous enrollment protections. After reaching record high enrollment, these estimates reflect a dramatic year-over-year decline in program enrollment from that high, KFF said in a statement. Most officials who participated in the survey indicated that their projections reflect what is assumed in their states’ adopted budgets, though estimates of both enrollment and spending are uncertain, and the effects of unwinding are evolving, with significant variation across states. Enrollment change estimates for FY 2024 reflect new enrollments as well as coverage losses due to unwinding, but they also assume some “churn” that is, that some individuals losing coverage will re-enroll within the year.
NEW ORLEANS HOSPICE OWNER CONVICTED FOR DEFRAUDING MEDICARE
A federal jury this month convicted Shiva Akula, 67, of health care fraud related to fraudulent claims billed to Medicare. Akula owned and oversaw the day-to-day operations of Canon Healthcare, LLC, a hospice facility with offices in the New Orleans area, Baton Rouge, Covington, and Gulfport, Miss. Between January 2013 and December 2019, Canon’s New Orleans area office billed Medicare approximately $62 million and was paid approximately $47 million. Akula was found guilty of overbilling for hospice patients for general inpatient services, and fraudulent billing for physician services, history and physical forms, and home visits. Sentencing is scheduled for February 21. He could receive a maximum sentence of 10 years in prison, a maximum fine of up to $250,000, up to three years of supervised release, and a $100 mandatory special assessment fee.
FEDS EXPAND VETERAN BENEFITS
The White House this month announced it will expand health care coverage for veterans, including eligibility for no-cost health care (including nursing home care) to all living World War II veterans. Veterans Affairs will also now cover health care costs associated with Parkinson’s disease under the Camp Lejeune Family Member Program. President Biden is also having the VA accelerate the eligibility timeline for toxic exposed veterans to enroll in VA health care.
OIG PUBLISHES GENERAL COMPLIANCE PROGRAM GUIDANCE
The Office of Inspector General (OIG) has released a reference guide for the health care compliance community and other health care stakeholders. The voluntary guidance addresses general compliance risks and compliance programs and includes information about relevant federal laws, compliance program infrastructure, and OIG resources.