In The News

Crisis Averted as Senate Sends Debt Limit Package to Biden

Roll Call
Senators staved off a financial crisis — and a weekend of voting in Washington — on Thursday night [June 1] when the chamber signed off on a bipartisan deal to suspend the debt limit into 2025, giving the Treasury authority to borrow trillions of dollars more to pay its bills.

With only days to spare before a Monday deadline, the Senate cleared for President Joe Biden’s signature a measure that would suspend the statutory $31.4 trillion debt ceiling and impose two years of caps on discretionary spending.

The bill also would claw back unspent pandemic aid, redirect some IRS funding for other uses, streamline energy permitting, end a pause on student loan repayments and toughen some work requirements for certain recipients of food stamps and cash assistance.

Passage of the measure was virtually ensured after Biden and Speaker Kevin McCarthy, R-Calif., reached a bipartisan deal on the debt limit over the weekend to end months of partisan wrangling. It also ends fears of triggering what Treasury Secretary Janet L. Yellen warned could be an "economic catastrophe" if the debt limit were breached and government payments had to be delayed.

"It is so good for this country that both parties have come together at last to avoid default," Senate Majority Leader Charles E. Schumer, D-N.Y., said before passage.

The bipartisan Senate vote of 63-36 came after a day of backroom negotiating, as senators aired their grievances over the package and sought votes on amendments that were designed to lodge protests without blocking final passage.

The biggest threat to the bill erupted on the Senate floor around midday, when several Republican defense hawks and top appropriators said they could not vote for the measure without a commitment from leadership to take up a supplemental defense spending bill.

They said the 3 percent defense spending increase allowed in the debt limit deal for the coming fiscal year, and a 1 percent increase allowed the following year, amount to cuts after adjusting for inflation.

"We'll be here ’til Tuesday until I get commitments that we're going to rectify some of these problems,” said Sen. Lindsey Graham, R-S.C., who wanted to ensure there would be more money for the Pentagon, as well as for Ukraine, Taiwan and Israel.

Senate Appropriations Chair Patty Murray, D-Wash., said any supplemental bill would also need to include funding for domestic purposes such as border security and disaster relief.

To remove that obstacle, Schumer and Minority Leader Mitch McConnell, R-Ky., entered a statement into the record pledging that the debt ceiling package wouldn't preclude consideration of emergency supplementals, whether for defense and national security-related purposes or domestic needs.

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CMS Plans to Unwind Mandatory COVID-19 Vaccination Requirement for Healthcare Employers

Consistent with EEOC guidelines, which permit healthcare institutions to voluntarily institute mandatory vaccination policies, CMS continues to support the COVID-19 vaccination and encourages healthcare professionals to stay current on their vaccination status. CMS’s planned withdrawal of the mandatory vaccination rule does not, and will not, prohibit employers from requiring employees to be vaccinated and, absent state-specific requirements, is expected to allow healthcare employers to self-determine whether to require COVID-19 vaccinations, including incorporating the vaccines in existing infectious disease policies.

We are monitoring CMS activity and will issue an update as soon as the vaccine mandate is officially withdrawn.


Denials of Health Insurance Claims are Rising—and Getting Weirder

Fierce Healthcare | By Elisabeth Rosenthal
Millions of Americans in the past few years have run into this experience: filing a health care insurance claim that once might have been paid immediately but instead is just as quickly denied. If the experience and the insurer’s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims—sometimes bundles at a time—without reviewing the patient’s medical chart. A job title at one company was “denial nurse.”
It’s a handy way for insurers to keep revenue high—and just the sort of thing that provisions of the Affordable Care Act (ACA) were meant to prevent. Because the law prohibited insurers from deploying previously profit-protecting measures such as refusing to cover patients with preexisting conditions, the authors worried that insurers would compensate by increasing the number of denials.
And so, the law tasked the Department of Health and Human Services (HHS) with monitoring denials (PDF) both by health plans on the Obamacare marketplace and those offered through employers and insurers. It hasn’t fulfilled that assignment. Thus, denials have become another predictable, miserable part of the patient experience, with countless Americans unjustly being forced to pay out-of-pocket or, faced with that prospect, forgoing needed medical help.
recent KFF study of ACA plans found that even when patients received care from in-network physicians—doctors and hospitals approved by these same insurers—the companies in 2021 nonetheless denied, on average, 17% of claims. One insurer denied 49% of claims in 2021; another’s turndowns hit an astonishing 80% in 2020. Despite the potentially dire impact that denials have on patients’ health or finances, data show that people appeal only once in every 500 cases.
Sometimes, the insurers’ denials defy not just medical standards of care but also plain old human logic. 

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LHC Group, VNS Health, Curana Execs On How To Take ‘Baby Steps’ Into Value-Based Care

Home Health Care News | By Patrick Filbin
Post-acute care has steadily been shifting toward value-based care and away from fee-for-service payment models. But despite the fact this trend is years in the making, many home health providers are still asking themselves, “How do we get started?”
Executives from four different post-acute and value-based care-focused organizations explored that question on Tuesday during a webinar conversation hosted by the health care technology company Netsmart.
“If you’re starting right now, partnering with another organization — especially the payviders — is a great place to start,” Devin Woodley, vice president of managed care contracting at VNS Health, said during the panel. “We’re empathetic towards the provider side. We understand what providers are looking for and where they’re trying to go. Partnering with a payvider or a consultant is the best place to start in order to take those steps in the right direction.”
The New York-based VNS Health is one of the largest and oldest nonprofit home- and community-based health care organizations in the U.S. The company’s service offerings include home health, hospice, personal care, palliative care services, mental health support and more.
In health care, the term “payvider” refers to an organization that operates both as an insurer and a provider of services. Take Humana Inc. (NYSE: HUM), which has CenterWell and then its insurer arms, as an example.
About 25 years ago, VNS Health also built out its own health plan. With over 35,000 members, it’s now where most of the company’s revenue comes from.
By partnering with a payvider like VNS Health, Woodley said providers can avoid a lot of the pitfalls that come in the early days of value-based contracting.
Finding the right value-based partner with similar expectations is another key component in establishing a presence in value-based care, Amy Kaszak, EVP of strategic initiatives at Curana, said during the webinar.
“Finding a partner that will meet you where you are [is also important] so your first step doesn’t have to be into the deep end,” Kaszak said. “There are more ways to do that today like Medicare Advantage plans and smaller organizations focused on the populations that you care for – that’s a great place to start.”

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The Top Legal, Regulatory Issues Home-Based Care Providers Are Facing In 2023

Home Health Care News | By Joyce Famakinwa
There are a number of key issues that home-based care providers looking to navigate legal and regulatory hurdles need to keep their eye on – some old, and some new. 
In some areas, it will be important for providers to increase their advocacy efforts, like when it comes to a potential ban on non-competes, Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, told Home Health Care News.
“When the industry has pulled together, worked together, and spoken in a singular voice, that has been a very effective strategy,” he said.
A potential ban on non-competes is just one of the many issues providers need to prepare for. HHCN recently caught up with Spinola and Katy Barnett – director of home care and hospice operations and policy at LeadingAge – to get a complete overview nearly halfway into the year.
Increased government investigations into the home-based care industry
During the height of the COVID-19 pandemic, many home-based care providers relied on the financial lifeline of government relief programs.
Moving forward, home-based care providers should expect to receive more attention from government watchdogs, as those relief programs — such as the Paycheck Protection Program (PPP), the Economic Injury Disaster Loan (EIDL) and employee retention tax credit programs — receive more scrutiny, according to Spinola.
“There’s been a lot of investigation around qualifications to participate in those programs, the use of funds from those programs, and I think we can expect to see that trend continue,” he said.
An increase in investigations means that providers will need to be more proactive.
“Understand what the requirements are, and take proactive steps to be in compliance with those requirements before the government investigation,” Spinola said.
Specifically, it will be imperative for providers to perform self-audits and be able to trace how they’ve spent these funds.
Aside from providers’ use of the aforementioned program funds, there is also more investigation activity around anti-kickback issues and referral relationships.

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