CMS Clarifies Titling and Dating F2F

Good News for HHAs…

Face to Face (F2F) changes finalized in the 2013 Home Health PPS update Federal Register notice are effective for episodes ending on or after 1/1/2013.  In this notice the Centers for Medicare & Medicaid Services (CMS) wrote: “We are finalizing regulatory text changes as proposed. The regulation text will be changed to not be prescriptive as to what entity needs to date and title the face-to-face documentation, but will still require the same content and the certifying physician’s signature.”

The National Association for Home Care & Hospice (NAHC) in an effort to clarify the intent of changes related to titling and dating F2F encounter documentation, asked the CMS to confirm whether home health agencies are now permitted to title and date F2F encounters, and to clarify what “date” the change is referring to.

In the response received by NAHC, CMS wrote: “the new regulations are not prescriptive as to what entity may date/title the encounter documentation.” CMS further qualified this statement saying “to comply with documentation requirements, the face-to-face encounter document has to have two dates: the date of the encounter and the date of the documentation. Our new regulations are not prescriptive as to who can title or date the form, but the form must be signed by the physician. As such, the HHA may add the title and the date of the documentation if this was not done by the physician.”

CMS also reported to NAHC that, “if the physician does not date next to his/her signature, then it would be acceptable for the HHA to date the documentation and consider it the “date of documentation.” This date does not need to be the date that the physician affixed his/her signature in cases where the physician did not date the form at the time of signing.”

This change in the regulation will ease the burden for home health agencies for all the times when they needed to return the F2F document back to the physician  because of a missing date.  In the near future, CMS plans to update its Manuals and F2F Questions and Answers to address the F2F regulatory and policy changes detailed in the 2013 Home Health PPS update Federal Register notice.

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Guest Post: New MA Staffing Agency Regs

By: Allyson Kurker, Kurker Paget, LLC

On January 31, 2013, Massachusetts will become the second state to require staffing agencies to provide basic job information to employees assigned to temporary or part-time jobs.  An Act Establishing a Temporary Worker’s Right to Know will amend Massachusetts General Law, chapter 149, section 159C.  The following article provides an overview of the substance of the law and how to comply.

Why was the law passed?

According to Governor Patrick, the law was passed because “thousands of Massachusetts workers are sent off to work by staffing agencies without any idea of where they are going, what work they will do, and what they will be paid.  This bill levels the playing field for all of our businesses while fulfilling our responsibility to make sure all of our workers are being treated fairly.”

Who does the law protect?

Any person employed directly by a staffing agency to provide temporary or part-time employment services to a work site employer.  Temporary employment lasts less than 10 weeks.

Does this law apply to all temporary workers?

No.  The notification requirements do not apply to secretaries, administrative assistants or professionals as that word is defined in 29 USC § 152.

What is a staffing agency?

An employment agency that places workers in jobs, assignments, engagements or employment for a fee. The official definition of an employment agency can be found in Massachusetts General Laws chapter 140, section 46A.  The Commonwealth’s FAQs about Employment Agencies is a helpful resource.

What does the law require?

The bullet list below summarizes the information a staffing agency is required to provide to part-time or temporary employees:

  • the staffing agency’s contact information;
  • the staffing agency’s workers’ compensation carrier;
  • the rate of pay for the job;
  • shift start and end time, and if known, the duration of the assignment;
  • the date of pay day;
  • details related to any meals or transportation, such as whether either is provided, and whether either the staffing agency or the work-site employer is going to charge for meals or transportation;
  • a description of the position and whether it requires special clothing, tools, licenses, or training; and
  • the name of the worksite employer

In addition, staffing agencies must post a notice of rights provided under the law, as well as the Massachusetts Department of Labor Standards’ contact information.

How can I comply with the notice requirements if I won’t see the employee prior to the commencement of the assignment?

Agencies may communicate the required information by telephone, provided that written details are provided to the employee before the end of the first pay period.

Is there a sample notice I can use?

The Department of Labor Standards will provide a sample notice to all staffing agencies that will satisfy the notification requirements prescribed by the law.  This sample notice has not been posted on the DLS’s website yet, but check back soon.

What does the law prohibit?

Employment Fees:

Staffing agencies may not charge an applicant or employee:

  • To register to use its services.
  • For any cost associated with performing a criminal background check.
  • More than its actual costs for any of the following: bank cards, debit card, money orders or drug screens.
  • A fee for a good or service if such fee would cause the employee to earn less than minimum wage (currently, $8.00/hour).

Transportation Fees:

The following provisions apply to transportation:

  • If the agency provides transportation to the work site, it must notify the employee of any fee associated with the service.
  • Any transportation fee charged to the employee cannot exceed the actual cost to the agency, and cannot amount to more than 3% of the employee’s daily wages.
  • The agency cannot charge a transportation fee if it requires the employee to use its transportation.  Said another way, agencies only can charge for transportation if it is a service provided to the employee rather than a requirement of the position.

Other Prohibitions:

The law also specifically forbids certain activity, most of which should be common sense.  These prohibitions include: providing false or fraudulent information to applicants and employees; assigning employment by force or for illegal purposes; refusing to return an employee’s personal property, and; using any name that has not been registered with the DLS.

Allyson E. Kurker
Kurker Paget, LLC
(P) 978.254.5487

Judge Approves ‘Improvement Standard’ Settlement

On January 24, 2013, the Chief Judge of Vermont’s U.S. District Court gave her approval  during a scheduled fairness hearing for an ‘improvement standard’ settlement (Jimmo v. Sebelius).  This settlement could lead to more long-term care in the home health setting and open the benefit to patients who were previously denied coverage.

According to The Center for Medicare Advocacy, that helped litigate the case on behalf of beneficiaries, “With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatients settings. CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.”

It should be noted that the Settlement Agreement standards for Medicare coverage of skilled maintenance services applies immediately, The Center of Medicare Advocacy encourages people to appeal should they be denied Medicare coverage for skilled maintenance nursing or therapy because they are not improving.

For more information read, Judge Approves Settlement in Jimmo vs. Sebelius After Court Hearing

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Guest Blog Post: Reducing Winter Loneliness in the Elderly

By: Wendy Drastal, RN
Vice President, HomeCare, Inc., a home care provider in the Merrimack Valley, Northeastern Massachusetts and Southern New Hampshire. To learn more visit their web site at

The cold and snowy winter months can be challenging for many people.  A trip outside, even for a brief errand, can be both difficult and dangerous.  The winter can be especially treacherous for the elderly, who are at risk for broken bones from falls on ice, breathing problems caused by cold air, hypothermia and frost bite.  Many hold less body heat due to a slower metabolism and reduced physical activity, so they feel the cold more severely.  And, as people age, the ability to feel changes in temperature decreases, making it important for elders to monitor the house temperature and to dress in layers.

For the elderly, the winter months can also be long and lonely.  With the holidays over and family members back to work and family responsibilities, January and February can be especially lonely months for the elderly who find themselves homebound with fewer social activities and outside contact.

So what can you do to help an elderly family member, friend or neighbor reduce the isolation and loneliness of winter?

  • Make it a New Year’s resolution to visit once a week for a meal, cup of coffee or just to socialize for an hour or two.
  • Encourage other family members to visit, call or e-mail on a regular basis.
  • Contact your local senior center or community center to check for opportunities for group meals, social programs and outings, or even friendly visitor programs.
  • Buy, fill and hang a bird feeder in a backyard or attach it directly on a window.  Birding activity can be very entertaining and a great topic for conversation.
  • Check the local library for a mobile book loaning program, or offer to pick up and drop off books and magazines.
  • Send a letter.  An old-fashioned letter in today’s age of electronic communication can mean a lot to the elderly and bring a sense of anticipation while awaiting a mail delivery.  Enclose a couple of pictures for added enjoyment.
  • Plan an occasional outing for lunch, a trip to the barber or hairdresser, or for some shopping.

Finally watch for signs of depression.  The elderly are at increased risk for depression due to life changes, medication and illness.

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January 31- Deadline for Submission of Structural Measure Data for Hospice

Reminder:   The deadline for attestation and submission of structural measure data for the Hospice Quality Reporting Program (HQRP) is Thursday, January 31, 2013.

Hospice providers that have not already created a user account and begun structural measure data entry should do so immediately. The link to the data entry site is available on the Data Submission portion of the HQRP website at the bottom of the webpage under “Related Links.” For step-by-step guidance on account creation, account activation, data entry and data submission, refer to the Technical User’s Guide for Hospice Quality Reporting Data Entry and Submission

For any questions about using the Hospice Quality Reporting Data Entry and Submission Site  contact the QIES Technical Support Office Help-desk by phone at 1-877-201-4721 or email at

Technical Help-Desk hours are 8:00 a.m. through 8:00 p.m. ET.

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HIPAA Final Rule Brings Changes to Health Care Industry

On January 17, 2013 the U.S. Department of Health and Human Services (HHS) announced the release of the HIPAA final omnibus rule, which was years in the making. It modifies the HIPAA privacy, security and enforcement rules and breach notification. The regulation is effective March 26, 2013 with a compliance date of September 23, 2013, for both covered entities and business associates.

Features of the regulation:

  • Expands an individual’s right to receive electronic copies of his or her PHI
  • Restricts disclosures to a health plan concerning treatment for which the individual has paid out of pocket in full.
  • Requires covered entities to modify certain elements of their notice of privacy practices and redistribute those revised forms.
  • Holds business associates liable for certain HIPAA requirements.
  • Clarifies requirements for when a breach must be reported to authorities.
  • Adopts increased and tiered civil monetary penalties of up to $1.5 million per violation
  • Strengthens the limitations on the use and disclosure of protected health information for marketing and fundraising purposes
  • Prohibits the sale of protected health information without individual authorization.
  • Prohibits most health plans from using or disclosing genetic information for underwriting purposes, as required by the Genetic Information Nondiscrimination Act.

Stay tuned-the HCA is working on an educational program for our members on these HIPAA changes.

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Caregiver Videos: What to Expect When Bringing An Aide Into Your Home

Earlier this month, we introduced the Care Giver Video Resource Center, our YouTube series for family care providers about home care and home care agencies.

In the third video in the series, Holly Chaffee, RN, BSN, MSN of Porchlight VNA demonstrates the knowledge, respect for privacy, and professionalism you can expect from a home care caregiver.

To view the full series, visit our YouTube channel.  To access library of hundreds of care giver resources on a variety of subjects, visit, who produced the videos with us.

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