Introducing Home Health 101, our new online orientation for home health clinicians and managers, with a focus on compliance regulation.
Have you hired staff new to home health care? Need a refresher on the basics of home health compliance? Due for a review on the latest regulation changes?
As the Alliance’s director of clinical and regulatory affairs, I’m often asked these questions from members looking to ensure that their clinical staff and managers have the tools they need to successfully navigate the regulatory challenges they’ll face in home health. In the past, I’ve done in-person presentations on this material but now—to ensure that even more people have access to it—I’m pleased to announce that Home Health 101 is available digitally for the first time.
In Home Health 101, I highlight the Conditions of Participation standards (COPs), Medicare regulations related to the survey process, and how the survey process works. 5 CEU credits are available (for a small processing fee) to those who complete the course and pass an evaluation.
To ensure that home health agencies in Massachusetts can provide high-quality care to older adults, the Home Care Alliance of Massachusetts has submitted comments to the federal government regarding the proposed rule for next year’s Medicare home health rates. Our comments to the Centers for Medicare and Medicaid Services (CMS) address several sections of the proposed rule, including:
CMS’s flawed reasoning behind the -4.36% “behavioral adjustment” to the rates;
Concerns about a budget neutrality adjustment based on 2020 data skewed by COVID;
A market basket adjustment that does not account for ongoing costs related to COVID;
Protections for counties with large wage index reductions;
Modifications to the Value Based Purchasing model before it is implemented nationwide;
Greater flexibility around the five-day deadline to submit the new Notice of Admission;
Greater flexibility to allow therapist to conduct initial assessments; and
Expanded allowances for virtual aide supervisions.
To help members stay abreast of developments regarding COVID-19 vaccines, the Alliance has developed a guide that puts everything you need in one place.
To help member agencies (and the public) stay abreast of developments regarding COVID-19 vaccines, the Home Care Alliance of Massachusetts has developed a reference guide that puts everything you need in one place.
What You Need to Know About the COVID-19 Vaccines is based on guidance from the Centers of Disease Control (CDC) and Massachusetts Department of Public Health (DPH). We are committed to keeping this guidance updated as new information becomes available and as additional vaccine products are authorized.
Veteran litigator Angelo Spinola answers questions about how agencies are rising to meet the biggest employment law challenges they face, including those posed by the COVID-19 Pandemic.
Even in the best of times, human resource issues pose an enormous challenge to home care agencies. But when responding to a global pandemic, many agencies found themselves scrambling to address new questions. How do you help employees with childcare challenges? How do you handle on-boarding (and firing) when everyone is working off-site? Who pays for COVID tests, and how should time spent getting the test be compensated? Can employers require vaccinations?
For the 15th episode of Talking Home Care, Pat speaks with Angelo Spinola of Littler Mendelson, a leading employment law litigator about these and other issues. They also discuss the subscription-based, on-line Home Care Toolkit Littler developed and constantly updates. The Toolkit gives agencies access to a world-class HR resource, policy manual, and document library that’s like adding an expert to your staff.
The Home Care Alliance of Massachusetts has negotiated a special agreement with Littler to give our members access to the Toolkit at a great price, with a portion of all sales supporting the Alliance! To learn more or to order your subscription, contact Melissa Mann at MMann@littler.com or (404)760-3928.
You may listen to the podcast by clicking any of the platform images above, clicking “play,” or downloading it directly (Length: 40 minutes; Size: 29 MB).
NGS will resume medical record review after suspension from Public Health Emergency
National Government Services (NGS) recently contacted Alliance staff to review details for the resumption of medical record reviews. This follows the suspension of the Targeted Probe and Educate (TPE) audit because of the Public Health Emergency. We expect that this review will start this week. All the Medicare Administrative Contractors (MACs) will publish information indicating that medical reviews will resume.
NGS has shared some details with Alliance staff about this resumption, which are summarized below; however, the details are not yet posted on their website.
NGS will resume post-payment medical reviews. This is different than the TPE program. CMS has not provided any direction to the MACs thus far regarding the resumption of TPE.
The post-payment reviews are service-specific (as opposed to provider-specific) and will be a random sample. A service-specific review is one where the MAC is focused on the claim and not the provider.
CMS has given a resumption date of August 17, 2020. It is anticipated that providers will begin receiving Additional Documentation Requests (ADRs) once NGS posts more information on their website. NGS indicated it will post a brief description of the service-specific audits on its website and ADRs will be sent approximately 2-3 days after this posting.
The timeframe from which NGS will pull claims is January 2019 through February 29, 2020
The maximum number of claims to be pulled per provider is 20. There is no minimum. This is less than the total number under the TPE program, and a provider may or may not receive ADRs for a full 20 claims. It is anticipated that the majority of hospice and home health providers will not have this many claims pulled. Any providers having difficulty responding to the ADRs on time should contact NGS and they may be able to work with the provider if the provider makes them aware of the situation.
Providers should not wait to receive an ADR request in the mail, but should check the status of their claims processing and identify any with the S B6001 status. These are claims that have had an ADR generated.
NGS has 60 days to review the provider’s response to the post-payment ADR. Though providers have 45 days to respond to the ADR, a 30-day response is strongly recommended to ensure that the response is received and recorded by the 45th day.
A results letter will be sent after each claim is reviewed.
A provider may request education and the NGS may suggest education. Providers are not required to participate in education, although the Alliance strongly recommends it.
The error rate (payment error rate or claim error rate) is not as important with a service-specific post-payment review as it is with TPE, since there are no “rounds” in post-payment review as there are with TPE. The MACs are not setting error rate thresholds upon which further NGS action is predicated. As with all medical reviews, if NGS identifies a concern, i.e. a quality concern or indication of potential fraud or abuse, NGS will refer to the appropriate entity (i.e., the appropriate QIO or the division of CMS).
NGS will continue to make phone calls to providers for missing documentation or questions about documentation submitted.
It is still possible that providers will receive some other ADRs as part of other review programs such as CERT. CMS contractors, including Unified Program Integrity Contractors, may conduct targeted prepayment and post-payment reviews when there is evidence of potential fraud or gaming. CMS has not yet indicated if the results of the post-payment reviews that are resuming this month would be used for future TPE audits.
On July 6th, the Massachusetts Department of Public Health (DPH) updated the Comprehensive Personal Protective Equipment (PPE) Guidance based on CDC recommendations to clarify the PPE that health care personnel (HCP) use in a clinical care area, especially during this time when providers are trying to optimize PPE supplies. Although this guidance is specifically written for health facility use, there are some best practices that may be helpful for home health agencies when reviewing and updating their protocols.
In this updated guidance DPH has adopted a universal facemask use policy for health care personnel, to use at all times when in the clinical setting. Facemasks are defined as surgical or procedure masks worn to protect the mouth/nose against infectious materials. Homemade and cloth facemasks are not considered PPE. Their capability to protect HCP has not been demonstrated and they have not been shown to be effective in preventing transmission of illness.
DPH also updated the guidance regarding the use of KN95 respirators to be consistent with the Food and Drug Administration (FDA) update to the Non-NIOSH Approved Respirator Emergency Use Authorization (EUA) concerning non-NIOSH-approved respirators that have been approved in other countries. Consistent with the FDA’s updated EUA, KN95 respirators may be considered for use as a substitute for N95 respirators only if:
N95 respirators are not available, and
The KN95 respirators have been tested for filtration effectiveness, and
The use of KN95 respirators has been approved by your organization.
If a N95 respirator or equivalent is not available, a facemask should be used.
For more details on optimizing PPE refer to the updated guidance.
Providers will need to use the renewed ABN form starting this August.
CMS just released the long-awaited Advance Beneficiary Notice of Noncoverage (ABN). The current ABN form expired in March 2020, so CMS instructed providers to continue using the expired form, since the form’s renewal was on hold at the Office of Management and Budget during the Public Health Emergency. Yesterday, CMS posted the updated ABN Form CMS-R-131 and form instructions (see the Downloads section at the bottom of the linked page).
The renewed form (with the expiration date of June 30, 2023) will be mandatory beginning August 31, 2020. The ABN is issued by home health and hospice providers to Medicare beneficiaries in situations where Medicare payment is expected to be denied. The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances. Guidelines for issuing the ABN can be found beginning in Section 50 in the Medicare Claims Processing Manual, 100-4, Chapter 30 (PDF).
The Alliance has unveiled detailed guidance for agencies regarding admissions from, and discharges to, hospitals related to COVID-19.
Today, the Home Care Alliance of Massachusetts unveiled detailed guidance for home health agencies regarding admissions from hospitals related to COVID-19. The guide is available as a Word document and providers are encouraged to create policies and procedures that reflect their own agencies’ operations, capabilities, and community/patient needs.
The guide was co-authored with Kimberly Skehan of Simione Healthcare Consultants. Because of the nature of the crisis, we are making this available to all agencies, regardless of current membership status.
Pat Kelleher speaks with Layla G. Taylor about what employers need to know about marijuana.
With many states (including Massachusetts) decriminalizing marijuana in recent years, home care agencies and other employers find themselves having to answer questions they never thought to ask. How do I protect my clients? What are my employees’ rights? Am I still allowed to issue drug tests and, if so, under what circumstances?
For the 13th episode of the Talking Home Care podcast, Pat Kelleher explores these and other questions with Layla Taylor, a partner at Sullivan, Hayes & Quinn and an expert in employment and labor law.