Introducing Home Health 101

Introducing Home Health 101, our new online orientation for home health clinicians and managers, with a focus on compliance regulation.

Have you hired staff new to home health care? Need a refresher on the basics of home health compliance? Due for a review on the latest regulation changes?

As the Alliance’s director of clinical and regulatory affairs, I’m often asked these questions from members looking to ensure that their clinical staff and managers have the tools they need to successfully navigate the regulatory challenges they’ll face in home health. In the past, I’ve done in-person presentations on this material but now—to ensure that even more people have access to it—I’m pleased to announce that Home Health 101 is available digitally for the first time.

In Home Health 101, I highlight the Conditions of Participation standards (COPs), Medicare regulations related to the survey process, and how the survey process works. 5 CEU credits are available (for a small processing fee) to those who complete the course and pass an evaluation.

Objectives include how to:

  • Review the Home Health’s Conditions of Participation (COPs);
  • Identify three of the five criteria for Medicare certification for home health benefit;
  • Understand Requirements for Physician Orders and Face-to-Face (F2F);
  • Identify Medicare’s definitions of “confined to home”; and
  • Review patient notices.

The program is broken into five sections:

  • Part 1: Orientation to Home Health
  • Part 2: Conditions of Participation (CoPs)
  • Part 3: Patient Notices
  • Part 4: Conditions of Participation, Contin.
  • Part 5: Skilled Professional Services and HHA Services

MassHealth Releases Prior Authorization Presentation

The first in a series of education sessions administered by MassHealth on their newly implemented prior authorization process occurred on March 16th and the slides have been made available.

After a basic overview of home health regulations, the prior authorization portion begins on slide 20 with helpful information and links as well as the contact information for the MassHealth Prior Authorization Unit (PAU). With a limited number of spots for this webinar, the Home Care Alliance is continuing to work with MassHealth on offering additional sessions.

The Alliance continues to take questions from agencies and is actively and constantly in contact with MassHealth to address ongoing issues.

Next week, MassHealth will be offering separate one-hour sessions on utilizing the Provider Online Service Center, or POSC.

During this training, MassHealth will provide step-by-step instruction on how to submit a prior authorization via the POSC, including how to inquire on and view prior authorization decisions, as well as other POSC techniques.

As space is limited, agencies are encouraged to register soon, if they have not already.

The sessions will be held at UMass Medical School (333 South St, Shrewsbury, MA 01545) on the following dates.

  • Wednesday, March 23, 2016  1:00 PM – 2:00 PM
  • Friday, March 25, 2016 10:00 AM – 11:00 AM
  • Friday, March 25, 2016 1:00 PM – 2:00 PM

Register here for POSC Training

The official Public Notice of the regulatory change requiring prior authorization was published last Friday. The notice include an invitation for public comment, with all comments due by April 1, 2016. Agencies are encouraged to submit constructive comments.

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HCA Returns from Productive Washington, DC Trip

Home Care Alliance staff and member agencies attended the Visiting Nurse Associations of America’s (VNAA) Public Policy Leadership Conference in the nation’s capital this past week and met with most of the state’s Congressional delegation.

Before and during the trip, the Alliance was able to secure support from eight of the nine US Reps on a letter to CMS voicing concern on case mix cuts and the impending Value-Based Purchasing demonstration. The ninth congressperson may still sign on, but it was still a productive trip where home health agencies from across the country were lobbying on the Physician Face-to-Face Requirement, allowing NP’s and PA’s to sign and certify home health plans of care, expanding palliative care career opportunities and showing the impact of proposed payment cuts.

Much of the activity was documented on the HCA’s Twitter page along with photos of congressional visits. The Alliance will be following up on our meetings and advocacy in DC and will continue to represent our members regarding the CMS proposed rule, Face-to-Face, and other federal issues. The HCA thanks member agencies that attended as well as our supportive Congressional Delegation, particularly Congressman Jim McGovern who co-led the letter to CMS.

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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:

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.

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F2F Rule Change Guides Released by HCA

With misinformation and uncertainty swirling around the new Physician Face-to-Face Requirements (F2F), the Home Care Alliance has released notices for hospitals and physicians as a guide for both home health agencies and their partners to utilize in understanding the impending changes.

As reported in HCA newsletters and alerts, CMS hosted its first (and only) educational forum on the new changes to the Face-to-Face physician encounter requirement for Medicare home health coverage on December 16. Given the lateness of the guidance, the effective date of January 1, 2015, and the many still unanswered questions, the Home Care Alliance of MA, the National Association for Home Care and Hospice, and others have asked CMS to phase-in enforcement of the requirements to allow time for home health agencies, physicians and hospitals to be educated about the new rules. CMS has not yet responded to that request.

In an effort to counter some misinformation circulating that the F2F requirement has been repealed, the Alliance has released the notices for agencies to use with their individual partners in the provider community. The Alliance is also working with the MA Medical Society and the MA Hospital Association on efforts to educate physicians and hospitals about the changes. We have encouraged MMS and MHA to inform hospitals and doctors that:

•    the F2F encounter requirement is still in place for Medicare patients in need of home health services.
•    the F2F encounter still MUST be documented, signed and dated by an MD, along with the documentation of the patient’s need for skilled care, homebound status and plan of care.
•    home health agencies will work with our hospital and physician partners to understand the requirements once CMS clarifies the rule and begins educational sessions for all providers.
Clearly, there are still issues that need to be clarified around the hospitalist as the certifying physician.

HCA will continue to push for more guidance from CMS on this, as well as more physician and hospital education from CMS.

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New England’s Senators Urge Action on ‘Face-to-Face’ Concerns

US Senators representing the New England states have stepped in to send a letter to CMS regarding the onerous medical review process relative to the Physician Face-to-Face Requirement being undertaken by National Government Services (NGS), which is the Medicare Administrative Contractor (MAC) for the region.

The state home care associations in the region, including the Home Care Alliance, worked together to draft the letter, gather data, and mobilize agencies to ask that Senators sign on to the letter.

The letter to CMS Administrator Marilyn Tavenner convey that the reviews and unjustified claim denials could “jeopardize seniors’ access to home health care” and that any measures meant to attack fraud and abuse should be clear, consistent and not threaten a beneficiary’s ability to receive needed care. The letter also highlights that, in some cases during 2014, withheld and denied reimbursements have exceeded the cost of a two-week payroll for some agencies.

While acknowledging the CMS final rule that changes the Face-to-Face Rule’s narrative requirement, the letter urges the following:

  • Explain what additional steps CMS will take to better ensure the clarity of the F2F regulations to prevent any further inconsistent denial of claims across the country;
  • Describe how you will ensure that patient care will not be compromised while the appeals of F2F denials are being considered;
  • Provide us with a current list of the outcomes of Medicare home health F2F denials and appeals across the country; and
  • Consider the feasibility of working with home health agencies to reopen or settle claims related to F2F in a manner that is equally fair to both taxpayers and home health providers.  Such considerations could include analysis as to whether an agreement similar to the administrative agreement process recently offered by CMS to hospitals that have a high volume of backlogged claim denials would be appropriate for backlogged home health claims related to F2F.

Nine of the twelve US Senators representing the New England region signed on, including both Massachusetts Senators Elizabeth Warren and Ed Markey. The Alliance thanks them for their continuing support of home health care issues and particularly efforts to improve the Physician Face-to-Face Requirement.

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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.

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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”

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