Tag: Federal Regulations

Deadline is TODAY for Congressional Signatures on Face-to-Face Letter

The deadline for a Congressional letter that seeks to streamline the burdensome Medicare home health face-to-face (F2F) requirement is today. New York Congressmen Tom Reed and Paul Tonko, as well as New Jersey Congressmen Christopher Smith and Robert Andrews, are circulating the letter and we need your help in cultivating Massachusetts Congressional support.   Please act now!

Use these talking points and call your legislator’s office and ask to speak to the healthcare staffer TODAY. Phone numbers for each office are listed below and if you’re unsure which member of Congress represents you, please contact James Fuccione at the Alliance.

Massachusetts federal delegation phone numbers:

Senator Elizabeth Warren:     (202) 224-4543
Senator Edward Markey:     (202) 224-2742
Congressman Jim McGovern:     (202) 225-6101
Congresswoman Niki Tsongas:     (202) 225-3411
Congressman Joe Kennedy:     (202) 225-5931
Congressman John Tierney:     (202) 225-8020
Congressman Stephen Lynch:     (202) 225-8273
Congressman Richard Neal:     (202) 225-5601
Congressman Michael Capuano:     (202) 225-5111
Congressman Bill Keating:     (202) 225-3111

The Congressional letter is addressed to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner. Referring to the F2F mandate, the letter describes the “complicated, confusing and overlapping documentation requirements that exceed the intent of the law passed by Congress,” and it urges CMS to allow the F2F requirement to be met through the completion and collection of the separately signed 485 form.  Such a change would significantly ease the burden of the F2F mandate.

Almost 40 state home care associations (including the Alliance) are already listed in support of the letter, but in order to have the strongest impact with CMS, we need resounding support from as many Members of Congress as cosigners to this letter.

Agency members with any questions can contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Proposed PPS Rule for Home Care and a Call to Action

In the July 3rd Federal Register, The Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare Home Health Rule for 2014.  A key provision of this rule is the first year of a multi-year planned adjustment of home health prospective payment rates, otherwise known as “rebasing”.

The directive to rebase the home health PPS rates comes from language in the Affordable Care of 2010 that was a reaction to multiple years of MEDPAC Reports to Congress calling for dramatic steps to reform the home health payment system, which they claim have widely exceeded  program costs almost from the 2001 launch of the current PPS system.

Starting with 2014 rule and going forward through 2017, CMS plans to impose a 3.5% rebasing adjustment to the home health base rate.  This 3.5% reduction is based on CMS’ projection of an average home health profit margin of 13.63% in 2013 (calculated from 2011 data trended forward as the difference between the average national episode revenue in home health and the average national episode cost). The 2014 rule does include a 2.4% market basket update as well.

The phase-in of this rebasing cut and the inclusion of a market basket update is in conflict with what MEDPAC had recommended to Congress (no update and deeper and faster rebasing cuts) and is direct result of industry advocacy form these mitigating factors during the ACA debate.

Now, that type of industry advocacy is needed once again.  While eliminating any rebasing cut may well be impossible, it is possible that with strong Congressional support, we can challenge the CMS calculation and achieve some decrease in the 2014 cut.   Particularly subject to challenge is CMS’ calculation of industry profit margins from which the rebasing number are derived.

We also know the following about CMS’ calculations on profit margins:

  • Only freestanding and not hospital base agency cost reports are considered
  • They are at odds with what MEDPAC’s and NAHC’s numbers show
  • They may fail to adequately capture industry costs around mandates such as the Face to Face requirement, the ICD-10 implementation and investments in electronic health records .

The Alliance believes that we can make a strong case to Congress, but we need members to be engaged as advocates and as sources of information for us.

Please use the questions below as a guide to provide information on the anticipated impact of the CMS Proposed Rule by Friday, July 26th at 12pm. Alliance staff is traveling to Washington DC to meet with members of congress and the national associations, so please have information in ASAP:

  • What is the impact on your agency’s bottom line (in dollar amount and percent loss)?
  • What is the impact on staff, including reducing staff time, cutting jobs, or halting new hires?
  • Do you anticipate cutting or reducing service lines, particularly MassHealth/Medicaid?
  • What is the impact on innovative service lines, like hospital readmission, dementia, chronic disease management, falls prevention and etc?
  • How will the proposed rule affect other ways your agency does business?

Answers to the above can be emailed to James Fuccione at the Alliance

Return to www.thinkhomecare.org.

OASIS-C1 is Here!

CMS has issued a Notice in the June 21st Federal Register announcing the proposed version of the OASIS–C1.  This draft of OASIS C-1 has 110 items and reflects changes to accommodate the need to enable the coding of diagnoses using the ICD-10-CM coding set which goes into effect October 1, 2014. The draft also reflects changes to address issues raised by stakeholders, such as updating clinical concepts and modifying item wording and response categories to improve item clarity; and to reduce burden associated with OASIS data collection by removing items not currently used by CMS for payment, quality, or risk adjustment. The draft also adds one new item M1011 (Inpatient diagnosis) at Recertification/Follow-up for the purposes of potential case-mix adjustment.

Comments on the draft OASIS-C1 must be received by August 20, 2013. When commenting,  reference the document identifier or OMB control number (OCN). To be assured consideration, comments and recommendations must be submitted in any one of the following ways:

  1. Electronically.

You may send your comments electronically to http://www.regulations.gov. Follow the instructions for ‘‘Comment or Submission’’ or ‘‘More Search Options’’ to find the information collection document(s) that are accepting comments.

  1. By regular mail.

You may mail written comments to the following address:

CMS, Office of Strategic Operations and Regulatory Affairs,

Division of Regulations Development,

Attention: Document Identifier/OMB Control Number__ Room C4–26–05,

7500 Security Boulevard, Baltimore,

Maryland 21244–1850.

The revised instrument, a table that compares the OASIS-C (Current Version) to the OASIS-C1 (Proposed Data Collection), and the supporting documentation can be found on CMS Paperwork Reduction Act (PRA) listing page, click here and scroll to CMS-R-245.

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.

 

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National Provider Call: Activation of PECOS Edit May 1

Register for the National Provider Call on Wednesday, March 20; 3-4pm

CMS will hold a national provider call on March 20 from 3-4pm ET on the “Implementation of Phase 2 Edits on the Ordering/Referring Providers in Medicare Part B and Part A -Home Health Agency Claims.”

Effective May 1, 2013, CMS will instruct contractors to turn on Phase 2 denial edits; checking Medicare claims for home health services ordered by physicians who are not enrolled in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). If physicians are not enrolled these claims will be denied.

In order to receive call-in information, you must register  on the CMS website CMS Upcoming National Provider Calls. During the registration process, advanced questions may be posted

National Provider Call Agenda:

  • Provider Types Eligible to Order/Refer
  • Action Steps for Billing Providers
  • Action Steps for  Providers Who Order/Refer
  • Resources

Return to www.thinkhomecare.org.

NAHC Holding Virtual Lobby Day on Feb 6

The National Association for Home Care & Hospice (NAHC) is holding a virtual lobby day for its members on Wednesday, February 6 to continue the mission to keep issues important to home health on the minds of elected leaders. Virtual lobby days are essentially using phone calls and emails to advocate for important issues without traveling to the nation’s capital.

The virtual lobby day is centered around potential co-pays to Medicare home health services, which remain on the table as deficit talks continue. There have been a range of proposals since recent federal budget deficit talks began. They include a uniform 20 percent copay for all Medicare services, which NAHC estimates would amount to as much as $600 to access a Medicare episode of home health services. Other proposals include one by the Medicare Payment Advisory Commission (MedPAC) of $150 per Medicare episode and another from President Obama in a past year’s budget blueprint that was $100 per episode, but not preceded by a hospital or nursing home stay and beginning in 2017 for newly eligible Medicare beneficiaries.

NAHC members can help fight these proposals by sending a message using the NAHC Legislative Action Network (LAN). Click here for a sample message opposing home health copays and payment cuts. The message will be more impactful if you personalize it with your background and experience and describe the harm that copays and payment cuts will cause patients and providers in your state and district. For hospice messages, click here and here.

You may also deliver the message by phone. You may obtain contact information here: Contact Your Elected Officials. When calling, ask the receptionist to connect you with the staffer who handles health care issues. For talking points on home health copays, go here; for payment cuts, go here. For hospice, go here and here.

For those who are not members of NAHC, you can still contact your US Senators and Representatives through their respective websites. If you need assistance finding who represents you, go to www.wheredoivotema.com.

NAHC also hosts a facebook page called “No Sick Tax” that is meant to bring advocates and home care agencies together around the issue of fighting copays.

Return to www.thinkhomecare.org.

CMS Clarifies Titling and Dating F2F

Good News for HHAs…

Face to Face (F2F) changes finalized in the 2013 Home Health PPS update Federal Register notice are effective for episodes ending on or after 1/1/2013.  In this notice the Centers for Medicare & Medicaid Services (CMS) wrote: “We are finalizing regulatory text changes as proposed. The regulation text will be changed to not be prescriptive as to what entity needs to date and title the face-to-face documentation, but will still require the same content and the certifying physician’s signature.”

The National Association for Home Care & Hospice (NAHC) in an effort to clarify the intent of changes related to titling and dating F2F encounter documentation, asked the CMS to confirm whether home health agencies are now permitted to title and date F2F encounters, and to clarify what “date” the change is referring to.

In the response received by NAHC, CMS wrote: “the new regulations are not prescriptive as to what entity may date/title the encounter documentation.” CMS further qualified this statement saying “to comply with documentation requirements, the face-to-face encounter document has to have two dates: the date of the encounter and the date of the documentation. Our new regulations are not prescriptive as to who can title or date the form, but the form must be signed by the physician. As such, the HHA may add the title and the date of the documentation if this was not done by the physician.”

CMS also reported to NAHC that, “if the physician does not date next to his/her signature, then it would be acceptable for the HHA to date the documentation and consider it the “date of documentation.” This date does not need to be the date that the physician affixed his/her signature in cases where the physician did not date the form at the time of signing.”

This change in the regulation will ease the burden for home health agencies for all the times when they needed to return the F2F document back to the physician  because of a missing date.  In the near future, CMS plans to update its Manuals and F2F Questions and Answers to address the F2F regulatory and policy changes detailed in the 2013 Home Health PPS update Federal Register notice.

Return to www.thinkhomecare.org

January 31- Deadline for Submission of Structural Measure Data for Hospice

Reminder:   The deadline for attestation and submission of structural measure data for the Hospice Quality Reporting Program (HQRP) is Thursday, January 31, 2013.

Hospice providers that have not already created a user account and begun structural measure data entry should do so immediately. The link to the data entry site is available on the Data Submission portion of the HQRP website at the bottom of the webpage under “Related Links.” For step-by-step guidance on account creation, account activation, data entry and data submission, refer to the Technical User’s Guide for Hospice Quality Reporting Data Entry and Submission

For any questions about using the Hospice Quality Reporting Data Entry and Submission Site  contact the QIES Technical Support Office Help-desk by phone at 1-877-201-4721 or email at help@qtso.com

Technical Help-Desk hours are 8:00 a.m. through 8:00 p.m. ET.

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HIPAA Final Rule Brings Changes to Health Care Industry

On January 17, 2013 the U.S. Department of Health and Human Services (HHS) announced the release of the HIPAA final omnibus rule, which was years in the making. It modifies the HIPAA privacy, security and enforcement rules and breach notification. The regulation is effective March 26, 2013 with a compliance date of September 23, 2013, for both covered entities and business associates.

Features of the regulation:

  • Expands an individual’s right to receive electronic copies of his or her PHI
  • Restricts disclosures to a health plan concerning treatment for which the individual has paid out of pocket in full.
  • Requires covered entities to modify certain elements of their notice of privacy practices and redistribute those revised forms.
  • Holds business associates liable for certain HIPAA requirements.
  • Clarifies requirements for when a breach must be reported to authorities.
  • Adopts increased and tiered civil monetary penalties of up to $1.5 million per violation
  • Strengthens the limitations on the use and disclosure of protected health information for marketing and fundraising purposes
  • Prohibits the sale of protected health information without individual authorization.
  • Prohibits most health plans from using or disclosing genetic information for underwriting purposes, as required by the Genetic Information Nondiscrimination Act.

Stay tuned-the HCA is working on an educational program for our members on these HIPAA changes.

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HIPAA Breaches Must be Reported to Secretary of HHS by March 1, 2013

Breaches involving less than 500 individuals

For breaches of unsecured protected health information involving less than 500 individuals, a home health agency must maintain a log or other documentation of these breaches. The agency must also provide notification of breaches to the Secretary of HHS by March 1, 2013. (no later than 60 days after the end of the calendar year)

This notice must be submitted electronically (Instructions for Submitting Notice)  and all information must be completed on the Breach Notification Form. A separate form must be completed for every breach that has occurred during the calendar year.

For specifics of the federal regulation see Notification in the Case of Breach of Unsecured Protected Health Information

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