Other Test Government Post

In an opinion issued August 9, the U.S. Court of Appeals for the District of Columbia Circuit upheld a federal trial court’s dismissal of a lawsuit alleging that U.S. Department of Health and Human Services (HHS) is failing to properly administer the Medicare home health benefit. The Center for Medicare Advocacy filed the suit in October 2022, on behalf of three Medicare beneficiaries who have chronic, disabling conditions and rely on home health aide services but have struggled to find providers that can provide the services needed. The Complaint alleged that HHS is not doing enough to enforce existing requirements for home health agencies and must establish policies and strategies to ensure access to home health aide services. The federal trial court dismissed the case in April 2023, and the Circuit Court’s decision affirms the lower court. The case is Johnson v. Becerra, and this LeadingAge article provides additional information and background. 

United Healthcare (UHC) announced it will start a gold carding program on October 1, 2024 that will let certain “qualifying practices” skip requesting prior authorizations for certain services. It is not yet clear if the program will be limited to physicians or what other implications it may have for post-acute care providers. UHC is expected to provide more details on September 1. For more information, members can check out the latest bulletin in the Improving Medicare Advantage serial post here. 

Office of the Inspector General (OIG) Staff had additional questions about where to find certain data points in a patient’s record or in Medicare Advantage (MA) plan records regarding concurrent review, and situations where the provider does not agree with the MA plan decision related to last day of coverage or termination of services.  The specific questions are outlined in this LeadingAge article and we ask members to share their insights as soon as possible, as OIG is working to finalize their framework for evaluating these MA plan practices right now. 

LeadingAge has received many questions about the COVID test kits that were previously being sent to nursing homes and assisted living and were available to affordable senior housing upon request from the Department of Health & Human Services (HHS). LeadingAge has confirmed with HHS that the program continues at this time and into 2025.  

Nursing homes and assisted living providers can request to be added to weekly distributions by emailing TDX@hhs.gov and providing their shipping information. Any requests to increase, decrease, pause, or re-initiate shipping should also be sent to TDX@hhs.gov. HHS states that requests are usually processed within a couple of weeks of being received. LeadingAge understands how vital this program is for members. LeadingAge is grateful that the Administration continues this program and they continue to advocate for access to tests, vaccines, and therapeutics for aging services across the continuum. 

Members have reached out to LeadingAge Kansas about HealthyBlue, the newest MCO contract awardee, asking for providers to sign their MCO contractual agreement. As a reminder, providers are able to choose which of the MCOs they would like to contract with – one, two, or all three. Ensure you read over the contract in its entirety and carefully examine for any language related to Medicare Advantage plans. If you have thoughts, feedback, or concerns – especially with anything related to Medicare Advantage language in the contracts, please contact Kylee Childs.