Tag: CMS

Centers for Medicare & Medicaid Services

Notice of Observation Status Law Signed by President

Legislation requiring hospitals to notify Medicare beneficiaries when they are technically in an outpatient “observation” status was recently signed into law by President Obama.

The NOTICE ACT (Notice of Observation Treatment and Implication for Care Eligibility) requires hospitals to inform patients of their status when they are in observation, but not officially admitted, for more than 24 hours and classified as an outpatient. A written notice must, among other points, state that the beneficiary’s outpatient stay will not count toward the three-day inpatient stay required for the individual to be eligible for Medicare coverage of a stay a skilled-nursing facility. Hospitals will have until August 2016 to comply with the new law.

The NOTICE Act is good news for the home health agencies because tracking the status of the patient hospital stay proved to be a challenge. Patients were often unaware of whether their stay with the hospital was an inpatient admission or an observation stay leaving the HHA uncertain if Transfer/ROC OASIS were needed. Now with the implementation of this notice the HHA will be able to determine an observation stay and know that a Transfer/ROC OASIS is not needed. An Agency may choose to complete a “Significant Change in Condition” OASIS (Reason for Assessment, 5- Other follow-up) based on their agency policy.

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Advocacy Alert: Urge your US Rep to Support HHPPS Proposed Rule Letter

With another $350 million cut to Medicare home health payment and Massachusetts selected as one of nine states for a “Value-Based Purchasing” Pilot, it is important that a strong message is sent to CMS and that means getting strong support from our state’s Congressional Delegation.

A new message is posted on the Home Care Alliance’s Advocacy Center that you can easily send to your federal elected representative to gain support for a Congressional sign-on letter to CMS. Just fill out the contact information, hit “send” at the bottom of the page, and the message will automatically go to your member of Congress.

The letter, which can be seen below, voices concern about the burdensome payment reductions and severe Value-Based Purchasing penalty in CMS’ proposed rule. Home health care champion Congressman Jim McGovern is co-leading the effort – known as a “dear colleague” letter in Congress – and the Alliance continues to appreciate his ongoing support of our issues.

Here is the text of the letter:

The Honorable Andy Slavitt
Acting Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Dear Acting Administrator Slavitt:

We are writing today to express our concern with Medicare home health funding cuts set forth in the Home Health Prospective Payment System (HHPPS) proposed rule for 2016. Home healthcare is a vital service that allows millions of the most vulnerable senior citizens and disabled individuals to receive the treatment they need in the cost-effective environment they most prefer – their home. As a result, we request a careful reconsideration of two of the draft policy changes in light of their anticipated impact on homebound Medicare beneficiaries and the home health delivery system upon which they depend.

First, we are concerned with the draft HHPPS rule’s proposal to cut home health payment rates by an additional 1.72 percent in 2016 and again in 2017. This proposed “case mix” reduction is of concern because it appears to be based on a 2000-2010 case mix weight change analysis rather than changes in the condition of beneficiaries during the 2012 to 2014 period that Medicare proposes to address.

Second, the draft rule proposes a Home Health Value-Based Purchasing (HHVBP) program that would impose an incentive/penalty range of as much as 5 to 8 percent over a 5-year period. We are very concerned with the aggressive nature in which the Secretary intends to ramp up HHVBP. Implementing a VBP program with a 5 percent withhold that increases to 8 percent just three years later is too much too fast. We are also concerned that the Secretary is proposing 25 measures for use in the HHVBP— far too many for providers to focus on.

In closing, we wish to express our concern that, in its current form, the draft rule may drive Medicare reimbursement to unsustainable levels for thousands of small, rural and other home health providers across the country, impacting the care upon which many of the most vulnerable Medicare beneficiaries, as well as their communities, depend. As a result, we request that the Agency reconsider its proposed case mix cut until it evaluates the specific causes of case mix weight changes from 2012 to 2014 and consider a more reasonable implementation schedule for the proposed withhold amount in the HHVBP program.

We thank you for your attention to this critical matter.

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CMS Announces Proposed Home Health PPS Update for 2016; Massachusetts Included in Value-Based Pilot

Massachusetts is one of nine states randomly assigned to pilot the Home Health Value-Based Purchasing (VBP) model, which is included in the calendar year 2016 Medicare Home Health PPS Rule released by CMS.

VBP will test whether incentives for better care can improve outcomes in the delivery of home health services.  The model will apply a payment reduction or increase to current Medicare-certified home health agency payments, depending on quality performance, for ALL agencies delivering services within the nine selected states.  Payment adjustments will be applied on an annual basis, beginning at five percent and increasing to eight percent in later years of the initiative.

According to CMS, the model is designed so there is no selection bias, participant states are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified home health agencies nationally.

The proposed rule implements the third year of the four year phase-in of the rebasing adjustments to the HH PPS required by the Affordable Care Act.  The CY 2016 downward adjustment to the national standard episode rate is $80.95.  CMS also proposes to recalibrate the HH PPS case-mix weights for CY 2016, which would be the second year of recalibration and identical to CY 2015.

In addition, the proposed rule includes a decrease to the national, standardized 60-day episode payment amount by 1.72 percent in each of CY 2016 and CY 2017 to account for nominal case-mix coding intensity growth unrelated to changes in patient acuity between CY 2012 and CY 2014.  CMS will also be updating the HH PPS payment rates by the home health payment update percentage, 2.3 percent in CY 2016.

For the Home Health Quality Reporting Program, in keeping with the requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act), CMS is proposing one standardized cross-setting measure for CY 2016 under the skin integrity and changes to skin integrity domain.  Measures for the IMPACT Act’s other domains will be addressed through future rule-making, although CMS is seeking feedback on four future, cross-setting measure constructs to potentially meet requirements of the IMPACT Act.

In order for home health agencies to avoid a two percent reduction in their annual HH payment update percentage, the rule further proposes to require all home health agencies to submit both admission and discharge OASIS assessments for a minimum of 70 percent of all patients with episodes of care occurring during the reporting period starting July 1, 2015.  CMS proposes to incrementally increase this compliance threshold by ten percent in each of the subsequent periods (July 1, 2016 and July 1, 2017) to reach 90 percent.

CMS has prepared a fact sheet about the proposed rule and a press release about the Home Health Value-Based Purchasing model.  The proposed rule will be officially published in the Federal Register on July 10, 2015. CMS will accept comments on the proposed rule, including comments about the Home Health Value-Based Purchasing model, until September 4, 2015.

The Alliance will closely examine the Value-Based Purchasing proposal — as well as all other aspects of the proposed rule — and will present a briefing for members within the next weeks.

We will work with the state associations in the other states chosen for the pilot to advocate for any needed changes to the program to protect agency cash flow and operational integrity.  We will also develop educational sessions for our members over the next months.  Stay tuned!

Return to www.thinkhomecare.org.

Special Open Door Forum on F2F Template; Alliance Seeks F2F Data

CMS hosted a Special Open Door Forum call yesterday to provide an opportunity for physicians/practitioners, home health agencies and/or all other interested parties to provide feedback on both a paper clinical template and an electronic clinical template for face to face documentation.

Many questions were raised and often the presenters were unable to answer the audience’s questions; the presenters stated they would provide answers during at the April call. The PowerPoint presentation (see slide 5) raised many more questions on which physicians could actually certify homecare; the hospitalist or the community physician. Again the presenters were unable to clarify the regulation for the audience. The presenters were actually debating among themselves whether a discharge planner or physician’s staff could assist completing the documentation for the face to face. A caller confirmed that this was acceptable and CMS had already addressed this issue in the CMS Face to Face Questions, question number 8.

CMS is seeking public comment on this voluntary paper clinical template. Feedback and questions can be sent to: HomeHealthTemplate@cms.hhs.gov.

Additional Special Open Door Forum calls on the templates will be held on April 8 and May 6, 2015, both at 1:00 PM Eastern Time.

In the Alliance’s continued advocacy on the Physician Face-to-Face Requirement, agencies that have ongoing appeals of claims denied for “invalid” F2F documentation are encouraged to send the number of denials, amount of money tied up in those claims, and the status of the appeals to James Fuccione at HCA.

We will share these data by congressional district with the Massachusetts federal delegation so that they can follow up with CMS. Months after a letter was sent from US Senators from the New England region on the same subject, CMS has failed to respond and the Alliance wants to make sure this issue gets the attention it deserves.

Please send this information, along with any questions, to James Fuccione at the Alliance.

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Industry Newsletter Publishes HCA-Issued Notices on Face-to-Face Rule

Home Health Line, a widely-distributed industry newsletter, has published notices to hospitals and physicians on Face-to-Face Requirement changes created by the Home Care Alliance of MA as a resource for home health agencies across the country.

The notices on the rule changes as of January 1, 2015 were distributed in a previous blog post and were created by HCA staff to help educate partners in the hospital and physician community about their responsibilities to ensure Medicare beneficiaries receive the necessary home health services.

The notices are also posted below and Home Health Line notes in a disclaimer that “The Home Care Alliance of Massachusetts created such a note to clear up confusion about face-to-face requirements, although it believes agencies and physicians still need more guidance from CMS.”

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Federal Lawsuit on Face-to-Face Rule Moving Forward

In a major win for home health agencies across the country, a federal district court determined that they will hear a legal challenge presented by the National Association for Home Care & Hospice (NAHC) to the validity of the physician narrative portion of the face-to-face requirement.

According to NAHC, the court issued an order denying Medicare’s effort to have the lawsuit dismissed by the court. The face-to-face requirement (F2F) was troublesome and frustrating from the outset as CMS released no standardized form for providers to follow and provider education was insufficient at best. It took constant advocacy and education on the state and local levels and strong lobbying on the federal level from state and national home care associations and agencies to even call attention to the problem.

The physician narrative where physicians must write a detailed account of patient eligibility for home health care services proved to be the paramount concern. Although the new final rule effective 1/1/2015 removes the narrative piece of the requirement, NAHC will continue to litigate the dispute to address the past claim denials and those denials that may still come involving home health services provided prior to January 1, 2015. If the lawsuit is successful, Medicare would be required to reopen and pay any claim previously denied for an insufficient narrative and stop any further claim reviews related to the narrative requirement.

NAHC and the Home Care Alliance continue to advise home health agencies to consider appealing any narrative-related claim denials while the lawsuit is progressing. Such action will preserve the opportunity to have the claims reviewed by Administrative Law Judges and also allow for easy identification of claims that may be subject to reopening if the lawsuit is successful.

The Alliance will also continue to provide education and updates on the new rule, including an upcoming webinar in early February. The Alliance helped lead the effort on a letter from New England Senators to CMS on F2F reviews and is out front with notices to physicians and hospitals on the recent rule changes.

Return to www.thinkhomecare.org.

HCAs Home Health & Hospice Emergency Prep Workbook Now Available

HCA’s new Home Health Care & Hospice Emergency Preparedness Workbook, co-published with RBC Limited, is now available!

The workbook incorporates all of the Emergency Preparedness requirements in the proposed new regulations recently developed by CMS, and includes a number of sample policies and tools to make compliance easier.

Barbara Citarella of RBC Limited will conduct a series of two webinars on August 27 and September 3 to discuss the proposed regulations and orient home health and hospice providers to the new manual.

You can purchase the Workbook and register for the webinars here.

Webinars will be held on the following dates:

Part I August 27, 2014
10:00 – 11:30 AM

Part II September 3, 2014
10:00 – 11:30 AM

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CMS Establishing Star Rating System for Home Health Care

In an effort to be consistent with quality reporting measures for various health care providers, the Centers for Medicare and Medicaid Services (CMS) are reportedly beginning to bring home health care, hospitals and dialysis facilities into the five-star rating system used for other sectors.

Already, nursing homes, Medicare health plans with Part B coverage, Medicare Advantage plans, physician group practices, and accountable care organizations use the star rating system. According to Visiting Nurse Associations of America (VNAA), CMS hopes to transition home health care to the five star rating by the end of 2014, or at latest, the beginning of 2015. However, the Home Health Quality Improvement Campaign (HHQI) reports that hospitals will be the next provider group to get the star rating system and home health will come online in 2016.

Nursing homes are rated on staffing, health inspections and a set of 9 quality measures on the Nursing Home Compare website. Home health agencies and other providers each have their own range of quality criteria. Currently, there are no details on how CMS plans to determine the star ratings for home health agencies.

More information on this topic will be reported as it becomes available.

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Urgent: Your Advocacy Needed on F2F Fix Now

We cant fix it without your help!!!

The Home Care Alliance of Massachusetts is working nationally on new strategy for a F2F fix in the House Appropriations Committee.

The Alliance, along with the Forum of State Home Care Associations (FSA) of the National Association for Home Care and Hospice (NAHC), is pushing on a unified front for a simple legislative fix that would provide relief from the onerous Medicare face-to-face (F2F) rule.

The  legislation would specifically allow for physician certification of the face-to-face requirement on the ‘485,’ or plan-of-care document, in place of a separate, redundant narrative requirement currently being enforced by the U.S. Centers for Medicare and Medicaid Services (CMS).

What we need from you!

Massachusetts has no Congressional representative on the House Appropriations Committee, which is where we are trying to get the language introduced.   

All HCA members should urge their Congressional representatives to reach out to House Appropriations Committee Ranking Member Nita Lowey (D-NY) seeking assurances that the face-to-face fix is included in the House Appropriations bill.

The best way to reach your Congressional Representative is to call the main switchboard at (202) 224-3121.

In addition to calling your House representative, every Alliance member should send an e-mail.  This process will only take a minute of your time. Click HERE to send a message to Congress with a push of the button.

Script for Phone Call or email

Please Help Home Care:  Insert F2F Fix in Appropriations Bill

The home care industry needs your help to fix the face-to-face encounter rule. This federal rule requires a physician to certify that he or she has seen a home care patient face-to-face for authorization of home care services. The problem is not so much the requirement itself, but CMS’  interpretation of the requirement, and its expectations for physicians to document it. A simple line of legislative language would clarify Congress’ intent for the regulation to be met with the least disruption in patient care services.

Please work with your Congressional Colleagues on the Appropriations Committee to advance this vital legislation. If you need, I would be happy to forward the draft legislation, along with further background information, to your office.

Links for More Information

Home Care Face-to-Face Mandate: A Major Problem, a Simple Fix. Use this resource to show Congressional offices how the existing 485/plan-of-care already certifies the patient’s need for home care and could include a simple edit for meeting the face-to-face mandate.

The HCA-FSA-NAHC draft legislation to fix F2F. This draft legislation simply states: “Physician documentation of the face to face encounter shall consist solely of a simple and concise confirmation that such encounter occurred and that is provided by notation on the same plan of care document the physician signs to order the home health services required by the patient.”

Thank you for your help.

Return to www.thinkhomecare.org.

 

Summary of Conference Call WIth Senior CMS Officials on the Face-to-Face Rule

On May 20th, the Home Care Alliance of MA, along with several member agencies, physicians and a representative from the MA Medical Society had the opportunity to speak to a number of officials at CMS regarding problems with the face to face rule.  Among those on the call from CMS were: Laurence Wilson, Director, Chronic Care Policy Group;  Carol Blackford, Deputy Director, Chronic Care Policy Group and Randy Throndset, Director, Division of Home Health and Hospice.

Below is the summary of the meeting and our suggested fixes as sent to the CMS officials in a follow-up email.  Thank you to members Judy Flynn and Dr Mark Yurkofsky, Partners Health Care at Home; Robin Seidman, Metrowest Home Care & Hospice; Dr Richard Lopez and Keren Diamond, Atrius Health/VNA Care Network/VNAB,  Jeanne Ryan, VNA & Hospice of Cooley Dickinson, and Alex Calcagno, Mass Medical Society for participating and making such a strong presentation. Continue reading “Summary of Conference Call WIth Senior CMS Officials on the Face-to-Face Rule”