July 30

Home Health Agencies Get Medicare’s Star Treatment

The federal government has released a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad. Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings. The star ratings come as home health agencies play an increasingly important role in caring for the elderly. Last year, 3.4 million Medicare beneficiaries received home health services, with nurses, aides, and physical and occupational therapists treating them in the home. Medicare spends about $18 billion on the home health benefit, which provides skilled services that must be authorized by a doctor, not housekeeping care that some elderly pay for privately. For both the government and patients, Medicare’s home health visits are one of the least expensive ways to provide care, and the system has been especially susceptible to fraud. Assessing quality is often challenging for patients and their doctors, who must authorize the visits, often just as patients are leaving the hospital.

For the article from Kaiser Health News, click here.

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July 27

Associated Press Publishes State-by-State Analysis of Medicaid Expansion Statistics

AP has published a series of reports examining the success of state efforts to expand Medicaid coverage and the financial repercussions. Related stories show projected and actual enrollment figures for the newly eligible Medicaid population in the 30 states and the District of Columbia that have opted to expand the program under the federal Affordable Care Act.

For the article from Kaiser Health News, click here.

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July 22

Centers for Medicare and Medicaid Services to Test Concurrent Coverage of Hospice and Curative Care

Terminally ill patients no longer will have to give up curative treatment to receive Medicare-paid hospice care, under a limited new program the CMS will start testing with 140 hospice providers as early as January. The Medicare Care Choices Model, established by the Affordable Care Act, waives the requirement that terminally ill patients must end curative treatment such as chemotherapy to qualify for Medicare hospice coverage. The model, which will run through 2020, will test whether the expanded benefits will convince more patients to enter hospice and whether it improves care, enhances patient satisfaction, and reduces costs. Under the Medicare Care Choices Model, patients can continue to receive curative services such as physical therapy, prescriptions, medical equipment, physician services, and short-term hospital visits for pain or symptom management. Instead of getting a per diem payment, hospices will receive a Medicare monthly payment of $200 to $400 per patient for any hospice care that patients need. Meanwhile, other providers will continue to be able to bill Medicare for curative services. The program will launch in two phases with the first hospices entering in January and a second wave to begin in January 2018.

For the article from Modern Healthcare, click here.

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July 13

94-Year-Old Must Pay Alimony to Offset Ex-Spouse’s Nursing Home Costs

Nebraska’s highest court determines that a 94-year-old husband must pay alimony to his 95-year-old ex-wife in order to help offset her nursing home costs, even if doing so puts his income below the poverty level. Binder v. Binder (Neb., No. S-14-783, June 26, 2015).

Laura and Glen Binder married in 1982. It was a second marriage for both of them and they had no children together. Mr. Binder owned farmland and operated a fertilizer business. Ms. Binder did not work outside the home. In 2012, Ms. Binder moved into a nursing home. Her income did not cover the cost of care, so Mr. Binder contributed the remaining amount.

Mr. Binder filed for divorce from Ms. Binder when he was 94 years old and she was 95 years old. The court dissolved the marriage and awarded Ms. Binder alimony in order to offset her nursing home costs. Mr. Binder appealed, arguing that the amount of alimony was presumptively an abuse of discretion because it drove his income below the poverty level in violation of state child support guidelines.

The Nebraska Supreme Court affirms, holding that the state child support law does not apply because the Binders do not have any minor children. The court concludes that the alimony award is not unreasonable because Mr. Binder has the power to dispose of farmland.

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