Best Around the Home Care Web IV

Each week, the Alliance scours the blogosphere for the news affecting — and of interest to — the home care industry.  Here are highlights from this week:

How Home Care Helped Save the Day During Hurricane Sandy

Rosita Ortiz, RN of the VNSNY on how home care saved the day during last year’s storm:

What Happens If A Client’s Power of Attorney Designee… Becomes Incompetent?

Making end of life wishes clear is crucial, both for each individual and their family members. It’s also vital to designate who will look out for your interests and desires when the time comes to assure your wishes are honored…

Fast forward five to ten years (or more) in the future and the holder of the power of attorney, the one charged with seeing that your senior loved one’s final wishes are followed, is now incompetent to carry out that role and may even be causing trouble due to their incompetence. — via Senior Care Corner.

NAHC Still Accepting Nurse Recognition Nominations

The National Association for Home Care & Hospice has extended the deadline to submit nominations to the Nurse Recognition Program to Monday, April 15, 2013. Each of the 50 state winners will receive a free registration to the NAHC Annual Meeting & Exposition in Washington, DC, and will be featured in the May issue of CARING. —  Via, HCAF

Return to www.thinkhomecare.org.

Neighborhood Health Plan Drops Out of Dual Eligible Demonstration

Neighborhood Health Plan announced to partnering providers and organizations that they are withdrawing from the Dual Eligible Demonstration Project as an ICO, or Integrated Care Organization.

NHP was one of six groups that were working to become an ICO, but dropped out due to concern about payment rates conveyed from the state’s Executive Office of Health and Human Services (EOHHS) and the federal Centers for Medicare and Medicaid Services (CMS).

“EOHHS and CMS have acted in good faith to mitigate many of the factors involved in the rate discussions and unfortunately, for NHP, the final proposed rate structure, as projected, would result in substantial losses for NHP,” stated the emailed announcement.  “We feel that it is in our best interest at this time not to pursue the Duals demonstration further.”

The Home Care Alliance  spoke with NHP and met with other potential ICO’s with most expressing concern about the rates of payment. For months, stakeholders have been told that providers will receive no less than Medicare payments for Medicare services and no less than Medicaid payments for Medicaid services, but it is unclear if that is the case.

The Home Care Alliance will be attending the next “open stakeholder” meeting on April 19th in Shrewsbury to obtain more information.

“We strongly believe in the potential of truly integrated care models to improve care for the dually eligible and all Medicaid populations,” the NHP statement continued. “We wish your organization and the remaining ICOs much success.”

Return to www.thinkhomecare.org.

CMS Issues Fact Sheet-Jimmo Lawsuit

CMS has recently issued a Fact Sheet on the Jimmo v. Sebelius Settlement Agreement. The settlement agreement puts an end to the Medicare contractors inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care. ”It is intended to clarify that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration”.  

Forthcoming Activities:

1)     Clarifying Policy-Updating Program Manuals:  This is the first action CMS will undertake as specified in the settlement agreement, revising the relevant program manuals used by Medicare Contractors

2)     Educational Campaign-Informing Stakeholders:  CMS will conduct national conference calls with providers and suppliers, as well as, Medicare contractors, Administrative Law Judges, medical reviewers, and agency staff, to communicate the policy clarifications and answer questions. CMS will also begin an educational campaign for contractors, adjudicators, and providers and suppliers utilizing a variety of written materials, including:

• Program Transmittal;

• Medicare Learning Network (MLN) Matters article;

• Updated 1-800 MEDICARE scripts.

3)     Claims Review:  CMS will engage in accountability measures, including review of a random sample of home health coverage decisions to determine overall trends and identify any problems, as well as, a review of individual claims determinations that may not have been made in accordance with the principles set forth in the agreement.

According to the terms of the settlement agreement, CMS will complete the manual revisions and educational campaign by January 23, 2014, which is within one year of the approval date of the settlement agreement.

 

Return to www.thinkhomecare.org.

CMS Rescinds Reporting Modifier for Home Health Claims

Good news for Home Health Agencies…

CMS will no longer require home health agencies to apply a modifier to changes/additions to the plan of care by a physician other than the certifying physician for episodes starting on or after July 1. That’s the result of an April 3rd transmittal published on the CMS website. CMS states, “Transmittal 2650, dated February 1, 2013, is being rescinded and replaced with Transmittal 2680, to remove… instructions regarding reporting a new modifier.”

HHA are still required, effective July1, to report on claims the location where services were provided using one of three Q-codes.

  • Q5001: Home health care provided in patient’s home/residence
  • Q5002: Home health care provided in assisted living facility
  • Q5009: Home health care provided in place not otherwise specified

Return to www.thinkhomecare.org.

CMS Notification: April 2013 Quarterly System Release – Claim Hold

CMS issued the following notification; home health final claims with a through date of April 1st or after will not be released into processing until April 15th; this is due to a problem with the quarterly release that will not be fixed until April 14th.

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release.  For claims with dates of service or “Through Dates” on or after April 1, 2013, the issues affect (1) all Home Health final claims, (2) outpatient Critical Access Hospital (CAH) and Rural Health Clinic (RHC) claims where dollars have been applied to the beneficiary deductible, and (3) the remittance advice summary payment amount for Medicare Advantage inpatient prospective payment system (IPPS) claims with indirect medical education (IME).  Actual payments and the claim-level payment amounts on the remittance advice are correct for these Medicare Advantage IPPS IME claims.  Final home health, outpatient CAH and RHC, and Medicare Advantage IPPS IME claims with dates of service or “Through Dates” prior to April 1, 2013, are unaffected.  In addition, for claims pending with or received by the Medicare claims administration contractors on or after April 1, 2013, the issues affect (1) all claims for assistant-at-surgery services, and (2) all Ambulatory Surgical Center claims.  As a result of these issues, CMS has instructed its Medicare claims administration contractors to hold all of these specific claim types until April 14, 2013, when system fixes are expected to be implemented.  These claims will be released into processing on April 15, 2013.  The claim hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt.

CMS regrets any inconvenience and is working to resolve these issues as quickly as possible.

Return to www.thinkhomecare.org.

New HIPAA Rules Issued: Disclosures and Revised Notices of Privacy Practices

The following information was submitted by Elizabeth Hogue, Esq:

The U.S. Department of Health and Human Services (HHS) has issued final rules to:

  • Modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Enforcement Rules to implement statutory amendments under the Health Information Technology Economic and Clinical Health Act (HITECH Act) to strengthen the privacy and security protection for individuals’ health information;
  • Modify the rule for Breach Notification for Unsecured Protected Health Information (Breach Notification Rule) under the HITECH Act to address public comments received on the interim final rule;
  • Modify the HIPAA Privacy Rule to strengthen the privacy protections for genetic information by implementing section 105 of Title 1 of the Genetic Information Nondiscrimination Act of 2008 (GINA); and
  • Make other modifications to the HIPAA Privacy, Security, Breach Notification and Enforcement Rules to improve their workability and effectiveness, and to increase flexibility and decrease burden on regulated entities.

The final rules were published in the Federal Register on January 25,2013, and will be effective on March 26, 2013.  Covered entities and business associates must comply with the final rules by September 23, 2013.  This is the third in a series of articles that will address key provisions of the rules, their impact on post-acute providers, and practical solutions for compliance. Continue reading “New HIPAA Rules Issued: Disclosures and Revised Notices of Privacy Practices”

State Releases Mass HIWay Implementation Grants Solicitation

The Massachusetts eHealth Institute (“MeHI”), a component of the Massachusetts Technology Collaborative (“Mass Tech Collaborative”), has just released an RFP offering grants to eligible applicants to fund projects that ‘catalyze connections’ to the Statewide Health Information Exchange (the Mass HIway) by migrating existing processes away from paper based exchanges and exchanges using proprietary interfaces to use the Mass HIway. This program, budgeted at $2M, will issue awards up to $75,000 each. The state is holding  on‐line information sessions for interested applicants on March 21 and March 27. Applications are due April 16th

Return to www.thinkhomecare.org.

Best Around the (Home Care) Web III

Each week, the Alliance scours the blogosphere for the news affecting — and of interest to — the home care industry.  Here are highlights from this week:

Treating Older Veterans for PTSD and Dementia

Because post-traumatic stress syndrome can trouble veterans’ physical health, their emotional lives and their relationships (there is also a connection to dementia, researchers are finding), the Department of Veterans Affairs and veterans advocacy groups have made it their mission to inform service members returning from Iraq and Afghanistan about their PTSD risk.

But older veterans tend to know less about the syndrome, even as it haunts many of them. Their generation had less experience with psychotherapy, which once carried a stigma. Even now, if they do seek help, they are likely to describe their problems as physical. — via the NYT’s New Old Age Blog

New Group to Advocate for Improved Interoperability Standards

Top executives from Allscripts, athenahealth, Cerner, Greenway and McKesson appeared on the same stage at HIMSS 2013 Monday to announce that they will collaborate to push for interoperability standards to enable advancements in patient data exchange. McKesson CEO John Hammergren and Cerner’s Neal Patterson joined colleagues Jonathan Bush, CEO athenahealth, and Tee Green, CEO Greenway, to introduce the CommonWell Health Alliance (commonwellalliance.org).

The organization will become operational early next year but wanted to announce its formation and publicize its mission statement during the March 3-7 HIMSS meeting. The five charter members expect that they will soon be joined by many others. “One of the key challenges we face is not just automated healthcare but connected and together care,” said McKesson’s Hammergren. “Data liquidity is necessary to make it happen.” —  Via, HomeHealth News Continue reading “Best Around the (Home Care) Web III”

Hospice Reporting Reminder- Deadline April 1st

The following is a noticed released by CMS last week reminding Hospice Providers of the April 1st deadline for submission of the hospice pain measures (NQF #0209). 

Hospice Quality Reporting Program: NQF #0209 Deadline April 1

Important Alert: The deadline to submit the NQF #0209 data is quickly approaching. Hospices that fail to submit and attest to their data will receive a 2 percentage point reduction in their Annual Payment Update (APU) for the FY 2014.

To comply with the Payment Year 2014 Hospice Quality Reporting Program (HQRP) requirements, providers should currently be entering their NQF #0209 data on the data entry and submission website. Providers that have not already created a data entry account should do so now.

The deadline for reporting NQF #0209 data for Payment Year 2014 is April 1, 2013. In order to avoid a 2 percentage point reduction in their Annual Payment Update (APU), providers must have submitted their structural measure data by January 31, 2013 and must submit their NQF #0209 data by April 1. Providers that may have missed the structural measure deadline can still visit the data entry website, create an account, and enter their NQF #0209 data. The link to the data entry site, along with a Technical User Guide giving step-by-step instructions on the data entry process, can be found on the Data Submission portion of the CMS HQRP website.

User Account Deactivation Requests for the HQRP

If you anticipate needing a deactivation request for your HQRP user account, please submit the user account deactivation request to the Technical Help Desk via fax at 888-477-7871 or email at help@QTSO.com prior to March 25, 2013. Any deactivation requests received on or after March 25 puts a hospice organization at risk for missing the NQF #0209 deadline, which is April 1. Please note: all data submitted by a user who is deactivated is permanently deleted.

Return to www.thinkhomecare.org.

CDC and CMS Alert – “Super-bug” CRE on the Rise

Infections with the deadly Carbapenem-Resistant Enterobacteriaceae (CRE) are on the rise in hospitals nationwide, and are a serious threat to public health according to the Centers for Disease Control and Prevention (CDC). Due to the movement of patients throughout the healthcare system, if CRE are a problem in one facility, then typically they are a problem in other facilities in the region as well as in the home. Home health agencies may want to alert staff about CRE and steps to take if an infection is suspected.

CDC and CMS Sound Alarm on “Nightmare” Bacteria

The Centers for Disease Control and Prevention (CDC) and CMS are asking your assistance in tackling what may be one of the most pressing patient safety threats of our time—carbapenem-resistant Enterobacteriaceae (CRE). CDC recently released a report on the presence of CRE in U.S. inpatient medical facilities, demonstrating that action is needed now to halt the spread of these deadly bacteria. We are asking for rapid action from healthcare leaders to ensure that infection prevention measures are aggressively implemented in your facilities and those around you.

Enterobacteriaceae are a family of more than 70 bacteria, including Klebsiella pneumoniae and E. coli, that normally live in the digestive system. Over time, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. During the last decade, CDC has tracked one type of CRE from a single healthcare facility to facilities in at least 42 states. In some healthcare facilities, these bacteria already pose a routine threat to patients.

CDC has released a concise, practical CRE prevention toolkit with recommendations for controlling CRE transmission in hospitals, long-term acute care facilities, nursing homes, and health departments. Key recommendations follow CDC’s “Detect and Protect” strategy, including:

  • Enforcing use of infection control precautions (standard and contact precautions).
  • Grouping patients with CRE together.
  • Dedicating rooms, staff, and equipment to the care of patients with CRE whenever possible.
  • Having facilities alert each other when patients with CRE transfer back and forth.
  • Asking patients whether they have recently received care somewhere else (including another country).
  • Using antibiotics wisely.

When fully implemented, CDC recommendations have been proven to work. Medical facilities in several states have reduced CRE infection rates by following CDC’s prevention guidelines.

The United States is at a critical point in our ability to stop the spread of CRE. If we do not act quickly, we will miss our window of opportunity and CRE could become widespread across the country.

Return to www.thinkhomecare.org.