On the 36th day: The SCIC episode payment
October 1, 2000 2 minutes read
NEWS BRIEF
On the 36th day:
The SCIC episode payment
The National Association for Home Care (NAHC) has asked the Health Care Financing Administration (HCFA) for clarification regarding its position on how payments should be calculated when an episode of care involves a significant change in condition (SCIC). As it now stands, HCFA wants to implement a new method of calculation, which would result in significant payment reductions where SCICs are involved.
HCFA’s position is that the promulgated regulation establishes the SCIC episode payment as a combination of portions of episodes before and after a SCIC as represented by the days between the first billable visit and last billable visit prior to and subsequent to the change in condition. In other words, HCFA says that the SCIC episode payment comprises two parts: the days between the first and last billable visits prior to the occurrence of the SCIC and the days between the first and last billable visits following the occurrence of the SCIC. Based upon this formula of blended proration, payments can be reduced to the point where the last billable visit occurs prior to the 60th day within the episode.
NAHC says the reason for introducing the SCIC provision was to ensure adequate payment to home health agencies in cases where increased resources are required to care for patients who either experience complications or encounter new problems during the course of their care.
However, the SCIC proration method as proposed by HCFA will result in reduced payments in many instances and will penalize home health agencies that claim SCIC when caring for those same patients.
Under HCFA’s approach, an agency could receive payment for the full 60-day period when a patient is discharged after day 15 without any significant deterioration in their condition. However, if the same patient experiences an SCIC and is discharged on the 36th day, the payment is limited to 36 days. NAHC contends that it is both improper and irrational for HCFA to establish a reimbursement formula that might lead to a home health agency receiving lower payments for a patient with increased needs than for a patient whose care needs are less or decrease.
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