Tag: CMS

Centers for Medicare & Medicaid Services

Hospice WebEx Training on Data Submission — Taken Offline

CMS put out notification last week that the WebEx training related to the Hospice Quality Reporting Program (HQRP) was available online.  It was available for a BRIEF time on Wednesday night and Thursday; the WebEx training is temporarily unavailable due to technical issues.  Only the Technical User Guide is available on the website. The contractor is working to correct the issues and will get the training and manual back up as quickly as possible.  The HCA will keep you updated.

Return to www.thinkhomecare.org.

Hospice Quality Reporting WebEx Now Available

Looking for more information about the new requirements for Hospice Quality Reporting?

The CMS WebEx training module on data submission for the Hospice Quality Reporting Program is now available online.  It will remain available until April 2013. The training will help hospices prepare for web-based data entry and submission of quality data affecting the FY 2014 reimbursement rates.

To meet the hospice quality reporting requirements in order to qualify for full payment of Medicare rates in FY 2014, hospices must submit two measures: the Structural/QAPI measure and the NQF #0209 measure. Reporting of the structural measure may begin Jan. 1, 2013, and must be completed by Jan. 31, 2013, while reporting of data on the pain measure (NQF 0209) must be completed by April 1, 2013.

For more information visit Spotlight and Announcements on the Hospice Quality Reporting website.

State Reveals ICOs in Dual Eligible Care Demonstration

More than a month passed their anticipated announcement date of September 21st, the state’s Executive Office of Health and Human Services (EOHHS) named the Integrated Care Organizations, or ICO’s, that will be managing and directing both payment and care for the demonstration to integrate services for dual eligibles.

The six organizations are Blue Cross and Blue Shield of Massachusetts HMO Blue Inc. (BCBSMA), Boston Medical Center HealthNet Plan (BMCHP), Commonwealth Care Alliance (CCA), Fallon Total Care, LLC (FTC), Neighborhood Health Plan (NHP), Network Health, LLC. Only Network Health was picked to serve every county in the state and will be the only ICO in Nantucket and Martha’s Vineyard.

Aside from Network Health, all other ICO’s are listed in as few as three counties and as many as eleven.

These organizations were selected for full (F) or partial (P) Massachusetts counties as follows:

BCBSMA BMCHP CCA FTC NHP Network Health
Barnstable F F F F
Berkshire F F
Bristol F F F F
Dukes F
Essex F F F F F
Franklin F F F F
Hampden F F F F F
Hampshire F F F F F
Middlesex F F F F F F
Nantucket F
Norfolk F F F F F
Plymouth F F P F F
Suffolk F F F F F F
Worcester F F F F

These organizations will now be engaged in a “readiness review” over the next two months. As part of the review, EOHHS and CMS will require that the organizations demonstrate full readiness and meet operational requirements.  An ICO will not be able to accept enrollments without successfully completing the joint Readiness Review, negotiating and executing a three-way contract, and receiving any necessary state and federal approvals.

Return to www.thinkhomecare.org.

Medicare Home Health Final Rule Issued

The Centers of Medicare and Medicaid (CMS) issued the Home Health Final Rule on Friday, November 2nd.  The Rule updates the HH PPS rates, including the national standardized 60-day episode rates, the national per-visit rates, the low-utilization payment amount (LUPA), the non-routine medical supplies conversion factor, and outlier payments. These rates will be effective January 1, 2013. This Rule also establishes requirements for the Home Health and Hospice quality reporting programs, important policy changes on CoP Non-compliance Sanctions, and improvements on Face to Face Encounter and Therapy Assessment Rules.

Return to www.thinkhomecare.org.

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.

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.

Return to www.thinkhomecare.org.

HCA Starts Congressional Letter on Home Care Moratorium

Thanks to the advocacy efforts of the Home Care Alliance and the cooperation of legislative home care champions, Congressmen Jim McGovern (D-MA) and Walter Jones (R-NC) are circulating a letter to be sent to federal Health and Human Services Secretary Kathleen Sebelius urging her agency to utilize the authority given in the Affordable Care Act to establish a temporary and targeted moratorium on new home health providers to control fraud and abuse in troubled areas.

Alliance staff drafted the letter, which is now a bipartisan effort that is seeking support from Congressional representatives from across the country. HCA has sent direct letters to Secretary Sebelius in the past and has supported drives by national associations towards getting a temporary and targeted moratorium established. The fact that the entire industry has been punished for the actions of a few agencies in a few areas of the US has driven the repeated attempts at lobbying HHS. This moratorium action certainly would not halt fraudulent and abusive practices, but it does help to contain the problem, especially in areas that have seen dramatic growth in the number of certified home health agencies.

The Alliance strongly encourages its members and supporters to contact their representative and urge them to sign on. Let your federal representative offices know that they should contact Congressman McGovern’s office to sign on.

Return to www.thinkhomecare.org.

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.

Return to www.thinkhomecare.org.

Last Chance to Apply for CMS Community-Based Care Transitions Program

The final deadline for applications for the Community Based Care Transitions Program, administered by the Center for Medicare and Medicaid Innovation (CMMI), is quickly approaching.

Any interested applicants must have their proposals in by September 3rd to make the final panel review on September 20th. Any interested home health agencies can contact James Fuccione at the Home Care Alliance for assistance. Additionally, CMMI has made a slide deck available with everything health care providers and community-based organizations need to know for the application process.

Recently, there were 17 proposals that were accepted in the third round of site selections and, again, a Massachusetts project was among them. Here is the “site summary:”

Somerville-Cambridge Elder Services, a Massachusetts-designated Aging Services Access Point (ASAP) and an Area Agency on Aging (AAA), is partnering with Mystic Valley Elder Services,  two large integrated hospital networks (Cambridge Health Alliance and Hallmark Health System) and dozens of community-based health and social service providers to provide care transitions services to high-risk Medicare beneficiaries throughout Middlesex County, Massachusetts.

For more on HCA’s work on care transitions issues, see these blog posts.

Return to www.thinkhomecare.org.