Category: Regulation

Guest Post: Utilization of Post-Acute Services by ALF Residents

The following is a guest blog post on the utilization of post-acute services by residents of an assisted living facility written by Elizabeth Hogue, Esq. The author plans future articles on this subject so be sure to check back for updates!

As the number of years in which they have been in business increases, ALF’s are more eager to help their residents to “age in place.”  ALF’s often view availability of services from post-acute providers; including Medicare home care, private duty home care, hospice, and home medical equipment (HME); as essential to allow them to achieve this goal.  While ALF’s want to encourage utilization of these types of services by residents, ALF’s cannot lose sight of the fact that the healthcare industry is highly regulated.  With ever-increasing emphasis on fraud and abuse compliance, ALF’s and post-acute providers cannot afford to violate the law.

How can ALF’s encourage the use of services available from post-acute providers by residents?  What are the potential legal pitfalls that ALF’s and post-acute providers must avoid?  The most effective way to maximize utilization of these services may be to take a multi-pronged approach that includes:

1. Assignment of liaisons/coordinators from post-acute providers to ALF’s

Use of coordinators/liaisons at ALF’s raises issues related to violation of the federal anti-kickback statute.  This statute generally prohibits providers from either offering to give or actually giving anything to referral sources in order to induce referrals.  Consequently, liaisons and coordinators must be scrupulous about avoiding the provision of free services to ALF’s and/or their residents.  Possible violations include “staffing” an office with an RN who responds to requests from residents in their apartments or has “office hours” to address health conditions of residents.

Continue reading “Guest Post: Utilization of Post-Acute Services by ALF Residents”

New OASIS Guidance from CMS

CMS has just released the latest guidance for OASIS, October 2012 Quarterly Q&As.  This quarterly update contains 11 new Q&As including the latest CMS OASIS-C guidance with a special item about selecting fall risk assessment tools based on standardization, validation and multi-factor requirements.Other highlighted items:

  • situations where the physician-ordered ROC date is outside the assessment time frame
  • selecting a response for patient confusion when confusion level varies
  • how/when bipolar disease and other psychiatric diagnoses might impact the depression process measure.

ODF-Medical Review of Therapy Claims

The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum on the Manual Medical Review of Therapy Claims on October 22, 2012 from 2:00pm-3:30 pm.

The review of therapy claims applies to all Part B outpatient therapy settings and providers including home health agencies that bill Part-B outpatient (TOB 34X). The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for providers to ask questions about the mandated manual medical review of therapy services from October 1-December 31, 2012 that was enacted by the Middle Class Tax Relief and Job Creation Act of 2012.

During this Special Open Door Forum, CMS will discuss therapy documentation requirements and answer any questions providers may have. Participants may submit questions prior to the Special ODF.

To participate in the call, dial: 1-866-501-5502; Conference ID: 44803009.

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OIG Releases 2013 Work Plan for Home Health

The HHS Office of Inspector General (OIG) Work Plan for Fiscal Year 2013 was recently release and provides brief descriptions of activities that OIG plans to initiate or continue in fiscal year 2013.

The Work Plan describes the primary objectives and provides for each review its internal identification code, the year in which we expect one or more reports to be issued as a result of the review, and indicates whether the work was in progress at the start of the fiscal year or will be a new start during the year.

The OIG’s Work Plan for home health addresses seven areas for review:

  • Home Health Face-to-Face Requirement (New)
  • Employment of Home Health Aides With Criminal Convictions (New)
  • States’ Survey and Certification: Timeliness, Outcomes, Follow-up, and Medicare Oversight
  • Missing or Incorrect Patient Outcome and Assessment Data
  • Medicare Administrative Contractors’ Oversight of Claims
  • Home Health Prospective Payment System Requirements
  • Trends in Revenues and Expenses

Return to www.thinkhomecare.org.

New Info Coming Soon on Money Follows the Person Initiative

The Massachusetts version of the federal Money Follows the Person initiative, held a stakeholders meeting at the Worcester Public Library with a review of activity and a “heads-up” that an RFR will be coming out next month for the five coordinating entities that will manage money and services.

Dubbed Regional Coordinating Offices, or RCO’s, these newly formed entities will provide access to housing search for MFP transitional entities along with transition assistance itself as participant move from a facility to the community. RCO’s will also provide orientation and mobility training, assistive technology, and case management. The five RCO’s will chosen by January 2013 based on an RFR due out by this November.

In February 2011, CMS awarded a five-year Money Follows the Person Demonstration grant to Massachusetts. The funding will, according to the state’s office of Health and Human Services, will help transition more than 2,200 individuals out of nursing facilities, long-term care facilities, chronic care hospitals, and intermediate care facilities into community-based care.

HCA will continue to provide updates on this program, which are also available at on mass.gov here.

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State Holds Health Payment Reform Info Session

Health care advocates and stakeholders packed and overflowed a large conference room meant to host an information session on the implementation progress of the new health care payment reform law.

Governor Patrick walked in mid-session and summed up the intent of the meeting where every state agency and department mentioned in the law was present to speak on their respective piece. The Governor explained that it took a lot of work to pass what he termed ‘a good bill’, but added that ‘now the real work begins.’ He said that it will take work on the part of government, providers, and stakeholders to ensure that the law is implemented effectively and the way in which it was intended.

To that end, Health and Human Services Secretary JudyAnn Bigby reported that the 11-member board of the Health Policy Commission, the main group charged with developing the policy necessary to implement the law, will be convened by November 5. The work of putting together other task forces and commissions, including those where the Home Care Alliance has the authority to name a representative, has already begun.

One of HCA’s victories in the legislation was the ability to name members on the Behavioral Health Task Force and the Commission to Review Public Payer Reimbursement Rates.

Other state agencies and their responsibilities are being reconfigured, including the Division of Health Care Financing becoming the Center for Health Information and Analysis. That group will be an independent state agency and so-called “pricing activities” relative to rate setting will move under the Executive Office of Health and Human Services.

The Alliance will provide updates as they become available and the state has an implementation website with more information at http://www.mass.gov/governor/agenda/healthcare/cost-containment/.

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MassHealth To Hold Briefing on Primary Care Redesign

The Commonwealth of Massachusetts Executive Office of Health and Human Services, Office of Medicaid (MassHealth) will be hosting a town hall meeting specifically geared towards health care providers regarding the Primary Care Payment Reform initiative.  This is an opportunity for providers to interact directly with Dr. Harris and share their thoughts, comments, concerns regarding the initiative. The goals of the MassHealth Primary Care Payment Reform initiative are to improve access, patient experience, quality, and efficiency through care management and coordination, and to integrate behavioral health care with primary care. The proposed model is designed to support the delivery of primary care through practices consistent with a patient-centered medical home with integrated behavioral health services.

The first of four town hall meetings is set up to provide a general program overview which will be given by MassHealth Director Dr. Julian Harris. The details of this meeting are as follows:

Date: Wednesday, October 23, 2012

Time: 6:30– 8:00 PM

Location: Morse Institute Library

14 East Central Street, Natick, MA 01760

The web site below includes more information on this initiatives and information regarding upcoming provider town hall meetings.

http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/primary-care-payment-reform-initiative.html

NEW! Validated and Multi-factorial Falls Risk Assessment Tool

The Missouri Alliance for Home Care (MAHC) has developed a multi-factorial Fall Risk Assessment Tool (MAHC-10) that has been studied and recently validated. The MAHC-10 has been scientifically tested and the validation study published.  Agencies may now use just the MAHC-10 alone to meet the OASIS requirement. .

In a Press Release posted October 9, 2012, MAHC reports “Home health agencies will now be able to meet the OASIS requirements utilizing the MAHC-10 as an initial screen for fall risk… This single tool can be used with all patients, including bed-bound patients and those with severe mobility limitations, thereby meeting CMS criteria to mark a ‘yes’ response on M1910.”

Agencies may use the MAHC-10, including incorporating it into internal documents and computer systems, at no cost, however, Missouri Alliance for Home Care  requires that proper credit be given to MAHC and that the content is not modified in any way.   For more information visit the MACH website

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The Alliance’s Colleen Bayard on the the Affordable Care Act

Colleen Bayard, the Alliance’s director of regulatory & clinical and regulatory affairs, spoke to WWLP News 22 this week about the impact of the Affordable Care Act on seniors in Massachusetts.

BOSTON (WWLP) – Government health officials say that President Obama’s national health care reform law is saving Massachusetts seniors big bucks.

Federal officials say the 2010 law has helped save Massachusetts seniors more than $76 million on medication bills this year.

The U.S. Department of Health and Human Servicessays in the first eight months of this year, the Affordable Care Act has saved seniors in Medicare’s “donut hole” about $610 dollars. Previously, when seniors were in this “donut hole” they would go from making copayments for their drugs to paying 100 percent of the cost.

The law gives them significant discounts.

“There’s actually extra funding for medications for seniors,” said Colleen Bayard, the Clinical Affairs Director for the Home Care Alliance of Massachusetts.

“They may not have enough money for their medications and it becomes unaffordable, but I think they’re trying to, they made changes with the medication in Medicare D to help with that.”

The average savings for a Massachusetts resident with Medicare will be $5,000. People with high prescriptions costs will save more than $18,000 from 2010 to 2022.

Compliance Date for ICD-10 Announced

The deadline for the transition to ICD-10 is October 1, 2014.

Health and Human Services Secretary Kathleen Sebelius announced the release of the rule that makes final a one-year proposed delay—from October 1, 2013, to October 1, 2014—in the compliance date for the industry’s transition to ICD-10 codes. Secretary Sebelius first announced the proposed delay in April, as part of President Obama’s commitment to reducing regulatory burden.

Keep Up to Date on ICD-10,visit the ICD-10 website for the latest news and resources to help you prepare.

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