Telehealth Gets Short Extension, Physician Pay is Cut in Spending Bill

Healthcare Finance / By Susan Morse

President Joe Biden on Saturday signed a spending bill that averts a government shutdown, but some healthcare provisions that were in the original bill didn't make it to final passage.

Acute hospital-care-at-home and telehealth temporary waivers were continued, but were not given the long-term extensions that were included in a Dec. 18 bipartisan resolution. Both received short-term extensions until March 31.

The original bill extended telehealth for two years and acute hospital care at home by five years.

Stripped out of the bill is a provision to prevent the Medicare pay cut to physicians. This means physicians get a 2.8% Medicare payment cut on January 1, 2025...

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OASIS-E1 Manual Finalized

The Alliance / By Katie Wehri

CMS posted the final OMB-approved OASIS-E1 time points Instruments, effective 1/1/2025, are now available in a zip file in the Downloads section of the OASIS Data Sets webpage.  The Agency has also reposted the final OASIS-E1 Manual effective 1/1/2025. Alliance staff are in the process of reviewing the materials.

A change table OASIS-E1 Instruments March 2024 – December 2024 Changes, also available in the Downloads section of the OASIS Data Sets webpage, lists minor corrections from the draft to final versions. The final OASIS-E1 All Items instrument will be posted when available.

DOGE Has a Plan for Medicare, Medicaid. Will it Work?

Politico / By Ben Leonard and Chelsea Cirruzzo

Presented by the Coalition to Strengthen America’s Healthcare
 
UNPACKING DOGE CLAIMS — Biotech entrepreneur Vivek Ramaswamy, co-leader of President-elect Donald Trump’s Department of Government Efficiency, is eyeing Medicare and Medicaid as potential sources to cut federal spending by trillions, Ben reports.
The goal of DOGE — an outside group that will recommend spending and regulation cuts — is a tall task that would likely involve cutting entitlement programs to extract significant savings. Ramaswamy said last week on CNBC that “hundreds of billions of dollars in savings” could come from just “basic program integrity measures” in Medicare, Medicaid and Social Security.

He’s generally in the right ballpark for the numbers. HHS estimated that, in fiscal year 2024, Medicare and Medicaid accounted for about $86 billion in improper payments, and other estimates peg fraud and waste higher annually.
 
But the devil’s in the details. 
 
Jessica Farb, managing director of the Government Accountability Office’s health care team, noted that most of the improper payments in HHS’ estimates are due to insufficient documentation.

“If these documentation errors were corrected, it is very possible that these payments would no longer be considered improper and therefore there would not be any ‘savings’ to the programs,” Farb said, adding that she doesn’t know what estimates Ramaswamy was using. “Improper payment rate is not an estimate of fraud or waste.”

Controlling fraud might be more difficult than Ramaswamy suggests because many before him have pointed to curbing fraud, waste and abuse as a way to control government spending. Experts on health care fraud say there are ways to reduce it.

“Internal controls are extremely important in trying to deter fraudulent activity from occurring, and to be honest, the government has the worst system of any organization,” Patrick Malloy, program coordinator at the University of New Haven’s health care fraud, waste and abuse program, told Pulse.

He suggested the government could follow the private sector by auditing its waste control processes annually and reporting on their findings. Fraud in private organizations is generally about 5 percent of revenues, he said, compared with up to 15 percent in government.

Still, others are more skeptical that Ramaswamy’s vision could be achieved…

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Home-Based Care Providers, Advocates React To Passage Of Elizabeth Dole Act

Home Health Care News / By Audrie Martin
 
On Dec. 13, the U.S. Senate unanimously approved an amended version of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. This landmark legislation includes various measures to make home care more accessible to veterans. The bill is now awaiting President Biden’s signature to become law.

For almost two years, the Elizabeth Dole Foundation has worked with a coalition of organizations to promote this bipartisan package of legislation.

“Our leaders in Congress have shown that America can still come together to support those who have served our nation and their families,” Elizabeth Dole Foundation CEO Steve Schwab said in a statement. “This bill was not only passed with broad bipartisan support, but it is also the most comprehensive veterans’ legislation this Congress has passed. It includes significant, far-reaching benefits and reforms that will be transformative for the wider veterans’ community and essential in helping our nation’s military and veteran caregivers succeed.”

The Foundation ensured that caregivers and their families were prioritized in the legislation, which includes more than 90 sections addressing issues such as long-term care, mental health resources, education, job training and modernization of the Department of Veteran’s Affairs (VA). The Elizabeth Dole Home Care Act, a bill within the larger package, will allow severely ill and aging veterans to recover at home by increasing their caregivers’ access to support services…

 …In addition to comprehensive updates focusing on mental and behavioral health support, education and training programs, and benefit reforms, the act includes essential long-term care provisions that would establish a pilot program through the VA to offer assisted living options for aging and disabled veterans.

Currently, the VA can only allocate 65% of the cost of providing nursing home care to a veteran on home- and community-based care. This bill permits the VA to increase spending on this type of care.

The bill would require the Undersecretary of Health to review each program administered by the Office of Geriatric and Extended Care and the Caregiver Support Program Office to ensure consistency in program management, eliminate service gaps at medical centers and ensure proper coordination…

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