HHAs are Experiencing New Round of Targeted Probe and Educate

National Government Service (NGS) announces two new rounds of Targeted Probe and Educate (TPE) for home health agencies

Last month, the National Government Service (NGS) notified the Home Care Alliance of Massachusetts about two new rounds of Targeted Probe and Educate (TPE):

High therapy utilization. NGS will be reviewing documentation to ensure all CMS requirements have been met on therapy assessments and 30-day reassessments, as well as, medical necessity.

Documentation supporting homebound criteria. The second edit is specific to four diagnoses: Heart Failure, COPD, Dementia, and Diabetes and if the documentation confirms homebound status.

Many HHAs have contacted me over the past few weeks with questions about the TPE, so I thought I would review the rules because I am sure others have the same questions.

How Will the HHA be Notified: You will receive a letter from NGS stating the focus of the targeted probe: high therapy or homebound for one of the four diagnoses listed above. Expect to receive between 20–40 ADRs, although every agency targeted so far has received a request for the 40 records.

Additional Documentation Request: The Medicare system will generate ADRs and you have a total of 45 days to respond with the requested medical records. Note: It is best to send in at least 30 -35 days, as NGS considers their time to acknowledge receipt of the documentation into their system as part of the 45-day timeframe. If your ADR is one day late it is considered “no response” and counts as an error.

Calculation: NGS calculates the Percent Error Rate (PER) by taking the dollars Medicare would have paid the HHA versus the dollars denied obtaining a percentage. The PER must be 15 percent or below for the HHA to be released from the next round of TPE.

Results Letter: At the conclusion of a round of review, you will receive a letter outlining the TPE process, the reason for denials including the Medicare regulations, denial rates (PER), release or retention from medical review and offer for one-on-one education information.

Education: One-on-one education between NGS medical reviewers and the provider. It is very important to accept the education from NGS at the end of the audit; accepting the education demonstrates that you are trying to improve documentation and will help with the second round of TPE.

If you have any questions or concerns about TPE, it would be great to hear from you. Good Luck!

The Alliance Revamps Its Advocacy Action Center

The Alliance’s redesigned Advocacy Action Center makes it easier for members to communicate with their elected officials on the pressing issues facing their agencies.

HCA CapitolFor the first time in many years, the Alliance has redesigned its Advocacy Action Center website, offering members an enhanced advocacy experience so they can easily communicate with their elected officials on the pressing issues facing their agencies. This  post will highlight some of the key changes so that you are prepared to take action and make a difference!

Main-Page Scrolling Advocacy Feature

The main Advocacy Action Center page now features a scrolling banner of key advocacy initiatives that the Alliance and its members are working on. The banner has a functioning link which you can click on to bring you directly to the action center to quickly send an email to your elected official.

Main-Page Buttons

Under the scrolling banner, you will see three buttons linking to sub-pages. This organizes the Advocacy Action Center into three easily accessible topics: Legislative Priorities, Testimony/Comments, and Facts & Figures. Note: The Facts & Figures sub-page is currently being updated.

Legislative Priorities Sub-Page

Among the biggest of changes, is our newly designed Legislative Priorities page. For the first time, members now have a centralized landing page which organizes all of the Alliance’s legislative priorities in one place. You’ll see the page is split in half, organized by State and Federal priorities.

You’ll also see that each legislative issue has a brief overview of the issue and the solution that HCA supports. Underneath each blurb are links to download the fact sheets for, or take action on, the issue!

We hope that you will find our new advocacy center easier to use so that you can engage with your elected officials, while focusing on running your agency!

CMS Proposes Changes to HH Quality Reporting Program

Proposed Changes Could Result in Another Revision to OASIS in 2021! How will this impact you? HCA is looking for your input.

CMS is proposing several changes to the Home Health Quality Reporting Program (HHQRP) in the CY 2020 Home Health Proposed Rule.

The Rule proposes to eliminate one measure (OASIS Item M1242, Frequency of Pain Interfering with Patient’s Activity of Movement), add two new measures, and add several new Standardized Patient Assessment Data Elements (SPADEs) to the Outcome and Assessment Information Set (OASIS) in CY 2021. The revised OASIS for 2021 will be very different from the current OASIS data items collected by your clinical staff.

As required by the IMPACT Act, the proposed two new measures are:

    1. Transfer of Health Information to the Provider-Post-Acute Care (PAC)
    2. Transfer of Health Information to the Patient-Post-Acute Care (PAC)

These measures are designed to improve patient safety by ensuring that the patient’s medication list is accurate and complete at the time of transfer or discharge. These proposed measures also supposed to fulfill CMS’s strategic initiatives to promote effective communication and coordination of care, specifically in the Meaningful Use Initiative area of transfer of health information and operability.

In addition, CMS is proposing to adopt several standardized patient assessments (SPADEs) to the OASIS data set. CMS plans to implement three assessment screens for mental status, confusion/delirium, and mood. The special service, treatments, and intervention assessment require the agency to identify the services and treatment the patient is receiving and if they are taking any high-risk drugs. The assessment item for medical conditions and comorbidities checks for pain during specific activities and checks for hearing and vision impairments. Click click here to see the proposed Item Mockup for the “Transfer of Health” and the “SPADE”

According to the National Association of Home Care & Hospice (NAHC), the organization sees two possible approaches in addressing the proposed changes to the HH QRP.

    1. Recommend that CMS stagger the implementation of the assessment items over several HHQRP years. However, this would result in more iterations of the OASIS assessment tool, and any changes to the assessment tool carry its own burdens and costs; or
    2. Support the new assessment items with the condition that CMS issues a draft version of the revised OASIS data set no less than six months before the implementation date.

Please let the Alliance know how these changes will impact you.

Return to www.thinkhomecare.org.

Talking Home Care: Building (and Keeping) a Better Workforce with Technology

Pat Kelleher is joined by CareAcademy’s Helen Adeosun and HouseWorks’s Andrea Cohen to discuss tech solutions to the workforce issues challenging the home care industry.

Helen Adeosun, Andrea Cohen, and Pat Kelleher
Helen Adeosun, Andrea Cohen, and Pat Kelleher

For the 11th episode of the Talking Home Care podcast, we are joined by two home care leaders to talk about solutions to one of the industry’s biggest challenges: recruiting, educating, and retaining care givers in a competitive market.

Helen Adeosun and Andrea Cohen both started their careers in home care as caregivers. Later, Helen would launch CareAcademy, an online learning platform, while Andrea would found HouseWorks, one of the largest private pay home care agencies in Massachusetts. In addition to their personal insights on workforce issues, the two also discuss their companies’ recent collaboration.

(If you’re a return listener from iTunes, please re-subscribe to the podcast; we’ve moved the feed to a new location).

Listen on iTunes
Listen on Google Play Music

 

You may listen to the podcast by clicking either of the podcast images, clicking “play” above, or downloading it directly (Length: 39 minutes; Size: 31 MB). If you enjoy the podcast, please give us a five-star review so others can find it.

Specific topics include:

    • How agencies can attract and keep their best employees by offering a career path to all positions.
    • How a mobile education platform can serve a mobile workforce.
    • How online education streamlines on-boarding and makes time available for hands-on training.
    • How technology — whether for training or other purposes — can give agencies actionable data about their operations.

Host: Patricia Kelleher is the executive director of the Home Care Alliance of Massachusetts.

GuestsHelen Adeosun is the co-founder and CEO of CareAcademy. Based in Boston, CareAcademy is one of the most innovative online training platforms for the home care industry. Andrea Cohen is the CEO and founder of HouseWorks, one of the largest private care home care agencies in Massachusetts.

Return to www.thinkhomecare.org.

50th Anniversary Celebration Photos Now Available!

25 Emerging Stars Honored

HCA held a celebration for our 50th Anniversary on Wednesday, June 26th at the Venezia Waterfront Ballroom in Boston, MA. With close to 200 in attendance it certainly showed the great community the home health industry offers in the state of Massachusetts! The Home Care Alliance is honored to have so many supporting members, old and new.

Pictures from this great event are now available for viewing. A special thank you to Wellsky for sponsoring our photographer for the evening. We would also like to thank our other sponsors as through their support, we were able to hold such a memorable night. Drink sponsor, Axxess; Entertainment sponsor, Simione Healthcare Consultants; Favor sponsor, Hanover Insurance; Décor sponsors, Byram and Fred C. Church.

View pictures here

View the Memorabilia Program Book Here. Featured are throwback pictures, 50 original All-Star Honorees, and 25 Rising Stars!

Most of the HCA Staff (Left to Right): Jake Krilovich, Megan Fournier, Jon Ezrin, Tim Burgers, Pat Kelleher, Colleen Bayard, Michelle Burton, (Missing) Tom Meyer

Talking Home Care: NAHC’s Calvin McDaniel on the 2018 Midterm Elections

Calvin McDaniel of NAHC joins us to talk about the implications of the 2018 Midterm Election on the home care industry.

Kelleher and McDaniel

On this week’s edition of Talking Home Care, we are joined by Calvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC). Calvin oversees NAHC’s legislative priorities on Capitol Hill, and collaborates with the Alliance and other state associations on shared, industry-wide priorities.

Our discussion recaps the 2018 Midterm Elections and what to expect in the 116th Congress, which will be seated in January 2019. Enjoy!


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 29 minutes; Size: 23.2 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

GuestCalvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC).

2018 Midterm Elections Recap (Updated Monday, 11/19):

  • Democrats regained control of the US House of Representatives, gaining 37 seats so far and holding a majority of 233 seats to Republicans’ 198 seats.
  • Republicans held control of the US Senate picking up two seat as and expanding their Senate Majority to 52 seats to Democrats’ 47 seats. The Mississippi senate seat is heading toward a run-off election on November 27th.
  • On the state level: Democrats flipped nearly 400 state legislative seats nationwide, flipped seven Republican-held governor seats, and took full control of the legislature and Governors’ mansion in seven states.
  • Lastly, three states: Idaho, Nebraska and Utah voted to expand Medicaid. And a fourth state, Maine, elected a democratic governor, who will likely do the same.
  • Overall, nearly 116 million voters cast ballots, representing over 40% of eligible voters and represents the largest midterm voter turnout in 104 years.
  • It is expected that Representative Richard Neal (D-MA) will become the Chairman of House Ways & Means, and Representative Jim McGovern (D-MA) will become the new Chairman of the Rules Committee. This greatly increases the Massachusetts’ Congressional Delegation influence on Capitol Hill.

The most important takeaway from our conversation with Calvin is that HCA members should prepare for an incredibly active two years of advocacy. Take hold of your responsibility to engage your elected officials on behalf of your organization and join us in the fight on the many issues facing our industry. Be it an email to a legislator, inviting them to your offices for a tour or on a home visit, or taking time to join us in D.C. for one of the many fly-in events, it takes an army of voices to accomplish a common goal. To get involved, email Jake Krilovich.

Return to www.thinkhomecare.org.

Talking Home Care: Amanda Oberlies on “No on MA Ballot Question 1”

Amanda Oberlies of the Organization of Nurse Leaders joins us to discuss why her organization (and the Alliance) oppose Massachusetts Ballot Question #1.

The Alliance’s Pat Kelleher &
ONL’s Amanda Oberlies

Should health care facilities have their nurse-to-patient ratios defined by law? That’s the question put to Massachusetts voters this coming Tuesday. Amanda Oberlies of the Organization of Nurse Leaders joins us to discuss why her organization (and the Alliance) oppose Massachusetts Ballot Question #1. Their conversation covers:

  • Who’s behind the ballot question and why?
  • What is the intersection of staffing-ratios and quality?
  • How does California’s experience with a similar law correlate to the MA proposal?


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 30 minutes; Size: 24 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

Guest: Amanda Stefancyk Oberlies, PhD, MBA, RN, CENP, is the Chief Executive Officer of the Organization of Nurse Leaders (ONL).

Resources:


Talking Home Care LogoDon’t want to miss the next episode of Talking Home Care? Subscribe through iTunes, Google Play, or accessing its feed directly.

Return to www.thinkhomecare.org.