New Home Health Advance Beneficiary Notice Available

The “new,” or revised,  Home Health Advance Beneficiary Notice (HHABN) is out of the clearance process and available on the CMS website.

Agencies can start using them immediately, although all HHABNs with an expiration date of 08/31/09 — which was on the older form — will be considered invalid on and after April 1, 2011.  The Alliance is in the process of organizing an educational program just to be sure everyone understands how to use this form.  Stay tuned to our website for details.

Equally important are the expedited appeals process and notices for “traditional” Medicare beneficiaries and for Medicare Advantage.  Masspro will be holding 4 regional meetings in January, 2011 on the matter and registration materials will be available soon.

According to the National Association for Home Care & Hospice (NAHC), HHABNs apply to all services provided by a home health agency, whether potentially included in the home health or other Medicare benefits or outside of the Medicare benefit. The notices must be issued whenever Medicare or the beneficiary is the payer and services and/or Medicare coverage are reduced or discontinued, with certain exceptions. The notice requirements have limited application in cases where other third parties pay for services provided by home health agencies.

Return to www.thinkhomecare.org.

Advocacy Alert: Congress Circulating Letter on Physician Face-to-Face Rule

Congressman Jim McGovern, along with Congressman Mike Ross of Arkansas, have circulated a sign-on letter to their colleagues in the US House of Representatives that urges CMS Administrator Donald Berwick to delay implantation of the physician face-to-face encounter rule.

Please contact your Congressperson and urge them to sign this letter and note that the deadline for signatures is Wednesday, December 15. The “dear colleague” letter and letter to Administrator Berwick is available below.

~~~~~~~~~~

Dear Colleague,

As you may be aware, the Centers for Medicare and Medicaid Services recently issued a Final Rule setting out various regulatory changes for the Medicare home health benefit.  One rule within the recent regulatory changes issued by CMS is intended to maintain benefit integrity by ensuring strong physician involvement in care planning and authorization. That rule implements a provision in the Affordable Care Act that requires face-to-face encounters between home health care patients and their physicians or certain non-physician practitioners. While this rule serves an important purpose, we are very concerned that neither the physician community nor the Medicare beneficiaries will be prepared for this change in time for meeting all the requirements by January 1, 2011.

We are asking members to cosign the following letter to CMS requesting a delay in implementation of the face-to-face requirement so that beneficiaries and providers have additional time to prepare for implementation of this new requirement.  If you would like to cosign, please e-mail Kate Callanan at kate.callanan@mail.house.gov.

Sincerely,

Mike Ross                                               James McGovern
Member of Congress                             Member of Congress

~~~~~~~~~~

Donald Berwick, MD
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Ave, SW

Washington, DC 20201

Re; Medicare Home Health Services
Physician Face-to-Face Encounter Requirements

Dear Dr. Berwick:

The Centers for Medicare and Medicaid Services recently issued a Final Rule setting out various regulatory changes for the Medicare home health benefit. As you are very aware, home health services is one of the most important benefits in the Medicare program as it is a very viable solution for Medicare’s increasing costs, allowing people to recover at home and thereby reducing spending for higher cost care such as hospitalizations and institutional care. At the same time, we are cognizant of the need to manage that crucial benefit with high integrity.

One rule within the recent regulatory changes issued by CMS is intended to maintain benefit integrity by ensuring strong physician involvement in care planning and authorization. That rule implements a provision in the Affordable Care Act that requires face-to-face encounters between home health care patients and their physicians or certain non-physician practitioners. While this rule serves an important purpose, we are very concerned that neither the physician community nor the Medicare beneficiaries will be prepared for this change in time for meeting all the requirements by January 1, 2011.

We understand that CMS has not initiated any educational efforts yet directed to physicians and Medicare beneficiaries on this new rule. The rule is not simple. It is complicated for both doctors and their patients to fully understand. The consequence of a patient’s noncompliance with the rule is severe as Medicare benefits will be denied. However, even if CMS begins to educate everyone affected by this rule immediately, we strongly suspect that the message will not get through in time.

We urge you to establish a plan of action to transition this new requirement into operation rather than fully enforce it on January 1. That transition should include a well planned and executed education campaign, the issuance of comprehensive guidelines to address existing ambiguities in the rule, and a trial period where compliance with the rule is monitored and appropriate adjustments made before denying Medicare benefits to a patient who does not have the qualifying encounter. Further, we request that you schedule a meeting with us and representatives from the physician, beneficiary, and home health agency community to plan that transition.

Given the short time before this rule becomes effective, we respectfully request your immediate attention to this matter.

Thank you for your time and consideration.

Sincerely,

Return to www.thinkhomecare.org.

Alliance Members Thrive With Accreditation

From the Halifax Plympton Reporter:

In addition to the economic situation, [Comfort Keepers of South Shore, Cape Cod & Metrowest co-owner Robert] Mullaney credits the company’s growth in part to their recent accreditation by the Home Care Alliance of Massachusetts. Accreditation for in-home pay care is new to Massachusetts, and Comfort Keepers was among the first pay-for-care organizations to be accredited.

“Accreditation allows Comfort Keepers to be a preferred provider with government agencies. We were just approved by Massachusetts Brain Injury to be a preferred provider as well,” Raquel Mullaney said.

The Alliance launched its Agency Accreditation Program in July 2010 and accredited 34 of its agencies as of December 9, 2010.   To become accredited, agencies must demonstrate compliance with and/or documentation of 14 points regarding hiring, background checks, training, complaint/abuse reporting, and proof of various insurances.  The program is the only of its kind in Massachusetts and is open to all home care agencies in the state.

Return to www.thinkhomecare.org.

EOHHS to Hold Hearings on FY12 Budget

The Massachusetts Executive Office of Health and Human Services will be holding a special hearing on the Fiscal Year 2012 budget and the Home Care Alliance wants to take the opportunity to offer testimony.

This will NOT be a chance to talk about MassHealth rates, but rather ideas on how home health care can help the state offer services more efficiently. The Alliance would like to set up a panel to present oral testimony so please contact us if you are interested in speaking on subjects like expanding telehealth, or anything else you believe addresses the three key questions in the notice below.

Of course, HCA would welcome the submission of written testimony and are willing to collect and submit materials on behalf of agencies.

Another hearing will be announced shortly for Western Massachusetts. See the notice from EOHHS below.

The Executive Office of Health and Human Services (EOHHS will be conducting a public hearing on the upcoming Fiscal Year 2012 budget. Secretary JudyAnn Bigby, M.D., and the Assistant Secretaries at EOHHS are looking forward to hearing the views of members of the community regarding the agencies under their purview.

Gardner Auditorium, Massachusetts State House
Monday, December 13, 2010
Boston, MA 02133
1:30 p.m. – 5:30 p.m.

The hearing will be tentatively divided as follows:

  • 1:30 to 2:30              Disabilities & Community Services – MCDHH, MCB, MRC, DDS
  • 2:30 to 3:30              Veterans, Elder Affairs, Soldiers’ Homes
  • 3:30 to 4:30              Health Services – DMH, DPH, DHCFP, MassHealth
  • 4:30 to 5:30              Children, Youth and Families – DCF, DYS, ORI, DTA

 

Since the start of the budget crisis, the Governor’s Administration has worked with you to solve deficits totaling nearly $13 billion.  As FY12 approaches, we are facing the expiration of federal stimulus funds and reduced rainy day funds and even though revenues started to grow in FY11, revenue collections historically lag behind national economic growth and will remain moderate over the next two fiscal years.

To overcome this budget challenge, we will need to work together to reexamine all public services and their delivery and find innovative solutions so that we can continue our mission with minimal disruption. Governor Patrick, Secretary Bigby and all of us at EOHHS are seeking your input to identify potential efficiencies, cost-saving initiatives and partnership opportunities that will preserve core services to the fullest extent possible without additional expenditures.

Due to the number of individuals anticipated to attend, oral testimony will be limited to three minutes. Following are three questions we want you to address in your testimony or as a supplement to your testimony.  Please do your best to address each question specifically.

  • Are there areas where you believe EOHHS can regionalize, consolidate or streamline services, programs or offices to better serve clients, increase efficiencies and achieve savings?
  • Are there areas where you believe EOHHS can use technology to better serve clients, increase efficiencies and achieve savings?
  • Are there ways you believe EOHHS can reduce expenditures while maintaining essential and core services?

In the interest of time, representative panels are welcome.  If you need accommodations please call 617-573-1600 and let the receptionist know. In addition, written testimony is strongly encouraged and may be mailed to:

Secretary JudyAnn Bigby, EOHHS
One Ashburton Place, Room 1109,
Boston, MA 02108

Or emailed to:  eohhshearings@massmail.state.ma.us

Return to www.thinkhomecare.org.

HCA Welcomes New Member: Charaka Home Care

The Alliance is pleased to welcome its newest member, Charaka Home Care, a private care agency in Boston, Massachusetts.

Physician Face-to-Face Call Details Role of Inpatient Physician

In a previous newsfeed post, it was stated that, according to 42 CFR 424.22, as a condition for payment, the content of a home health certification includes a signed statement that:

* The patient needs intermittent skilled nursing or therapy
* Home health services are required because the patient is confined to home
* A plan for furnishing the services has been established
* Services were furnished while the patient was under the care of a physician

The first two bullets under certification requirements were not at issue. However, CMS has responded to questions on how they intend for inpatient facility physicians who end their responsibility to patients will be able to meet requirements for the plan of care and attestation about services administered in the latter two bullet points.

According to NAHC, CMS responded with the following statement:

424.22 (a)(1)(iii) states “A plan for furnishing the services has been established and is periodically reviewed by a physician.”

“As we discussed yesterday, currently, many hospital docs sign the cert and the plan of care for their patients, prior to acute discharge. In this case, long standing practice has allowed the hospital physician’s referral to home care orders to satisfy the establishment of a care plan, and the combination of the hospital doc’s attending role during the remaining acute stay, coupled with the discharge plan which transfers the patient’s care to the patient’s community PCP satisfies the ‘under the care of” requirement.

We believe that in the (hopefully rare) scenario where a hospital doc would sign the cert but wouldn’t (for whatever reason) sign the plan of care, as long as the hospital doc has ordered HH services, we would consider the POC to be initiated. As above, if the hospital doc describes in the discharge plan that the patient will be under the care of a PCP physician at discharge, we would consider the patient to be under the care of a physician at the time of the certification signing. We will allow the doc described in the discharge plan to sign the cert in such a case.

I note that “services were furnished while the patient was under the care of a physician” is a long-standing certification requirement. Long standing practice should ease your concerns here. We’ve never enforced a policy which precluded the certifying physician from transferring care of the patient to another physician. And, we’ve never precluded a hospital physician who was attending to the patient during the acute stay from certifying HH or establishing the care plan. Longstanding practice has allowed the hospital docs referral orders and acute discharge plan which described the patient’s transfer to the PCP physician for continuing care to satisfy the “under the care of’ cert reqmt. We have then looked to the HHA to ensure that the patient remains under the care of a physician during the episode.”

Return to www.thinkhomecare.org.

CMS Clarifies Role of Hospitalist in Physician Face-to-Face Rule

CMS Provides Details for Face to Face Encounter by Hospitalist, Other Clarifications

Effective January 1, 2011, home health agencies will be required to meet current certification and plan of care requirements and new face to face encounter requirements.

During a lengthy conference call, a representative from the Centers for Medicare & Medicaid Services (CMS) provided detailed information to the National Association for Home Care & Hospice (NAHC) as to how home health agencies will be able to meet face-to-face encounter requirements for patients referred to home health from institutional settings. CMS explained that this policy will apply not only to patients referred by hospitalist, but to patients referred by physicians from all inpatient settings, such as rehab facilities and skilled nursing facilities.

Generally patients are referred to home health agencies as follows:

  1. By a community physician who is caring for the patients in an institutional setting or in the community, or
  2. By an inpatient facility physician who is willing to continue to be responsible for patients after their discharge from institutions until they see a community physician, or
  3. By an inpatient facility physicians who is unwilling to be responsible for patients after their discharge from institutions.

When referred by community physician, whether the patient is in an institutional setting or the community, that physician will document face to face encounters and continue to meet all certification and home health plan of care requirements as they do today. When inpatient facility physicians refer patients and are willing to continue to be responsible for those patients after discharge from institutions until they see a community physician, those physicians will document face to face encounters and continue to meet all certification and home health plan of care requirements, as they do today.

It is in those cases where an inpatient facility physician is unwilling to be responsible for patients after discharge from the facility that will present problems for home health agencies in meeting face to face encounter requirements. In order to remove roadblocks for these patients, CMS announced that it will amend the longstanding policy in Pub 100-02 Chapter 4, Section 30 that “since the certification is closely associated with the plan of care (POC), the same physician who establishes the plan of care must also certify to the necessity for home health services.”

According to CMS, since the certification and plan of care regulations do not specify that these functions be performed by the same physician, CMS will amend the policy and allow different physicians to perform each of these functions. As a result, facility physicians will end their responsibility for patients upon discharge from the inpatient setting will be permitted to complete the required face to face encounter documentation based on the patients clinical condition while under their care, and to certify that the patient is homebound and requires intermittent skilled nursing or therapy services. The community physicians will establish the home health plan of care, as they do at the present time.

Unresolved Issue

According to 42 CFR 424.22, as a condition for payment, the content of a home health certification includes a signed statement that:

  • The patient needs intermittent skilled nursing or therapy
  • Home health services are required because the patient is confined to home
  • A plan for furnishing the services has been established
  • Services were furnished while the patient was under the care of a physician

The first two bullets under certification requirements are not at issue. However, NAHC has asked CMS to respond as to how it intends for inpatient facility physicians who end their responsibility patients will be able to meet the plan and attestation about services furnished requirements in the third and fourth bullet.  This information will be shared with home health agencies once a response if received from CMS.

Travel Together Requirement

In regard to the CMS Open Door Forum statement that the face to face encounter documentation and certification (versus plan of care) must “travel together” CMS explained that certification and plan of care are two separate requirements: CMS wrote in to an email inquiry:

The “traveling together” discussion may be the source of the confusion. Our intent was to describe that the face to face encounter documentation is a part of the certification.  It isn’t a separate thing.  Although we allow the documentation to be on an addendum, that addendum is still part of the certification.  The entire certification is also part of the patient’s entire medical record documentation, and of course the physician who assumes POC responsibility would need to have access to the documentation associated with the encounter, as would the HHA.

Face to Face Encounter Guide

In regard to agencies concerns as to whether a guide or template is acceptable, similar to that found on the NAHC web site, CMS was asked by a home health agency whether “it would be acceptable to label the section of the plan of care or addendum where the physician’s documentation should be placed, titling it and include subheadings such as: Date of Encounter, Medical Condition for Encounter, Services Needed, Clinical Findings, Homebound Status, Physician Signature, Date.”  CMS responded:

“Yes, this is fine.  As long as the info/clinical findings and how the findings support eligibility are documented by the physician,  in his/her own words.”

Certification Statement on Home Health Plans of Care

NAHC advised home health agencies to retain the certification statements for intermittent skilled nursing and therapy services and homebound statement on plans of care when another physician does the face to face encounter and initial certification. Also, although face to face encounters are not required at recertification, the homebound and medical necessity statements are required for recertification plans of care.

Face to Face Encounters After Start of Care

In response to inquiries from home health agencies as to what steps to follow when face to face encounters are to occur after the start of care and before day 30, NAHC suggests that the following steps:

  1. HHA obtains verbal orders
  2. HHA documents the orders on the plan of care, which includes a “box” or “addendum” with directions to the physician to document the face to face when it occurs and identify what information that must be included in the narrative.
  3. HHA drops the RAP once the plan of care, “certification,” form has been sent to the physician.
  4. Physician has an encounter with the patient
  5. Physician completes the encounter documentation, signs and DATES the plan of care and certification of the encounter/homebound status/medical necessity and returns it to the agency
  6. HHA agency files final claim.

Enforcement Effective Date

NAHC has been urging members of Congress and CMS via letters to Dr. Donald Berwick, the CMS Administrator, to delay enforcement of face-to-face encounter requirements for six months after the January 1st effective date. This endeavor is similar to that undertaken by NAHC regarding PECOS, whereby the effective date of the regulation will remain unchanged but CMS will not impose penalties for failure to comply until a time when physician education has taken place and home health agency questions have been adequately addressed.

NAHC and the Home Care Alliance will provide updates on progress toward achieving this end.

Materials for educating physicians, patients and home health agencies are available here in a previous newsfeed post.

Return to www.thinkhomecare.org.

State Selects 46 Physician Practices as Medical Homes

The Massachusetts Executive Office of Health and Human Services (EOHHS) announced that it has selected 46 primary care physician practices to participate in a new Patient-Centered Medical Home initiative (PCMH) designed to promote comprehensive, coordinated, patient-centered care delivered by teams of primary care providers.

In a patient-centered medical home, according to an EOHHS press release, a primary care provider and members of his or her team coordinate all of a patient’s health needs, including management of chronic conditions, visits to specialists, hospital admissions, and reminding patients when they need check-ups and tests. The medical home model supports fundamental changes in primary care service delivery, as well as payment reforms, with the goal of improving health care quality.

The intention of this initiative is that it will evolve, likely in congruence with other payment reform projects and initiatives, into a new and more efficient payment model.

The Home Care Alliance has written a position paper on the PCMH initiative and strongly encourages home care agencies working with the PCP practices listed below to reach out and offer collaborative efforts in order to be involved in their model.

The physician practices are listed by region:

Metro Boston:
Boston Health Care for the Homeless, Boston
Boston Medical Center, Family Medicine Center, Boston
Bowdoin Street Health Center, Dorchester
Broadway Health Center, Somerville
Cambridge Family Health, Cambridge
Codman Square Health Center, Dorchester
Dorchester House, Dorchester
East Boston Neighborhood Health Center, East Boston
Family Practice Group, P.C., Arlington
Geiger Gibson Community Health Center, Dorchester
Harvard Vanguard Medical Associates, Medford
Joseph M. Smith Community Health Center, Allston
Joseph M. Smith Community Health Center, Waltham
Malden Family Medicine Center, Malden
Manet Community Health Center, North Quincy
Neponset Health Center, Dorchester
Revere Family Health Center, Revere
South Boston Community Health Center, South Boston
South End Associates of Fenway Health, Boston
Southern Jamaica Plain Health Center, Jamaica Plain
Tufts Medical Center, Adult Primary Care, Boston
Union Square Family Health Center, Somerville
Whittier Street Health Center, Roxbury

Central Massachusetts:
Barre Family Health Center, Barre
Family Health Center of Worcester, Worcester
Fitchburg Community Health Center, Fitchburg
Foley Family Practice, P.C., Athol
Edward M. Kennedy Community Health Center, Worcester
Grove Medical Associates, P.C., Worcester
Greater Gardner Community Health Center, Gardner
UMass Memorial Pediatric Primary Care Associates, Worcester

Western Massachusetts:
Atkinson Family Practice, Amherst
Baystate High Street Health Center, Adult Medicine, Springfield
Baystate High Street Health Center, Pediatric Medicine, Springfield
Baystate Mason Square Neighborhood Health Center, Springfield
Fairview Pediatrics, Chicopee
Hilltown Community Health Centers, Worthington
Holyoke Health Center, Holyoke
Lee Family Practice, P.C., Lee
Pediatric Associates of Hampden County, Westfield

Northeastern Massachusetts:
Drum Hill Primary, LLC, Chelmsford
Greater Lawrence Family Health Center (Haverhill Street), Lawrence
Lynn Community Health Center, Lynn

Southeastern Massachusetts:
Brockton Neighborhood Health Center, Brockton
Greater New Bedford Community Health Center, New Bedford
Mid Upper Cape Community Health Center, Hyannis

Additionally, HCA encourages collaboration and outreach to the following participating payers:
Blue Cross Blue Shield of Massachusetts; Boston Medical Center HealthNet Plan; CeltiCare; Commonwealth Health Insurance Connector Authority; the Health Safety Net, administered by the Division of Health Care Finance and Policy; Fallon Community Health Plan; Group Insurance Commission; Harvard Pilgrim Health Care; Health New England; MassHealth Primary Care Clinician (PCC) Plan; Neighborhood Health Plan; Network Health; Senior Whole Health; Tufts Health Plan; and UniCare.

Return to www.thinkhomecare.org.

HCA Welcomes New Member: Adlife Health Care LLC

The Alliance is pleased to welcome its newest member, Adlife Health Care LLC, a private care agency in Framingham, Massachusetts.

Ed Note (03/09/2011): The Alliance has suspended Adlife’s membership, effective immediately.

Return to www.thinkhomecare.org.

HCA Welcomes New Member: Private Care @ CCB

The Alliance is pleased to welcome its newest member, Private Care @ CCB, a private care agency in Brookline, Massachusetts.

Return to www.thinkhomecare.org.