HPC Releases Proposed ACO Standards for Comment

The Commonwealth of Massachusetts is in the midst of a massive initiative to transform MassHealth payment and care delivery through the creation of Accountable Care Organizations (ACO). MassHealth has convened eight separate work groups to provide input and recommendations on various aspects of this transformation. The Home Care Alliance is represented on six of those eight work groups.

In support of that initiative, the state’s Health Policy Commission (HPC) this week released a set of draft ACO certification standards.

According to the HPC, the purpose of the certification program is to “complement existing local and national care transformation and payment reform efforts, validate value-based care, and promote investments by all payers in efficient, high-quality, and cost-effective care across the continuum.”

The HPC’s proposed standards include criteria, documentation requirements and questions for public comment. HCA intends to comment, so any members with thoughts, suggestions or answers on any of the proposed criteria or questions should contact James Fuccione at the Alliance.

For those looking to submit comments independent of the HCA, a public hearing will be hosted by the HPC on January 6 and the overall submission deadline for written feedback is January 29. That may seem like a far-off deadline, but with the holidays and the state’s budget process kicking up, any comments submitted to HCA well before that date would be appreciated.

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Palliative, End-of-Life Care Options Regulation Finalized

A provision  included in the state’s 2012 Health Care Cost Containment Law (Chapter 224) on palliative and end-of-life care options is being realized through a final regulation issued by the Department of Public Health.

It is now a patients legal right to receive information about palliative care and hospice from a facility as well as their full range of options for treatment, if the condition warrants either approach. Massachusetts hospitals, clinics and long-term care facilities are expected to comply.

The Home Care Alliance helped advocate for the inclusion of this provision in the law and also commented with several other provider groups and organizations at a public hearing when the regulations were proposed. At that time, the definition of palliative care in the proposed regulation was more in line with hospice services. The Alliance, among many other groups, expressed concern that palliative care is a team-based approach to an advanced illness, but not necessarily linked to the expected outcome of that illness as with hospice.

DPH has released a guide explaining the right to these options in several languages for consumers, a summary of what was changed from the proposed to the final regulation, and the regulation language itself. The list of resources can be viewed here on a DPH webpage.

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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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Your Care, Your Choice – Now In Spanish!

Earlier this year, the Alliance published two brochures regarding patient choice after a hospitalization or stay in other medical facilities.

We’re pleased to announce the publication of a Spanish translation of the patient-orientated version, “Your Care, Your Choice,” which reminds patients of their right to choose their own providers, and empowers them to report facilities that attempt to violate these rights.

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In Choosing A Healthcare Provider, It’s “Your Care, Your Choice”

Last week, the Alliance published its “Keeping It Legal” brochure to educate health care providers about lawful referral practices.

This week, we’re following up with a companion guide on the subject, designed for patients and families titled “Your Care, Your Choice,” which reminds patients of their right to choose their own providers, and empowers them to report facilities that attempt to violate these rights.

To download the brochure, click the down arrow button immediately above this text.  Please feel free to distribute it to everyone who can benefit from it.

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Revised Publication Available for Reporting Fraudulent Home Care Referral Practices

In an effort to help home health agencies educate their partners in the provider community about lawful referral practices, the Home Care Alliance has revised and updated the first in a publication series called “Keeping It Legal.”

The document below is intended for distribution to hospitals, physicians, skilled nursing facilities and other sources that refer patients for Medicare-certified home health services. The Alliance has updated contact information for oversight entities so that providers, patients or the families of patients can accurately report fraudulent activity if they wish to do so. The document also lays out some of the basic examples of wrongful activity that should be reported.

With the help of HCA members and those they work with and work for, the Alliance hopes that this document will be passed along and posted prominently in an effort to promote home health services that are high-quality and ethical.

 

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HCA Promotes National Health Care Decisions Day

The Home Care Alliance supports National Healthcare Decisions Day (NHDD), which is April 16th, and was created to educate and empower the public about advance care planning – the ongoing process of discussing and clarifying the current state of a person’s goals, values and preferences for future medical care.  It has amassed a national following, with over 1,000 organizations participating each year, including the American Association of Retired Persons, the American Medical Association, and other state and local organizations.

The NHDD website has great information, including how to obtain an advance directive, legal resources that are available, and how to engage your family in these important conversations about one’s care.

In Massachusetts, it can’t be assumed that a spouse or other family member will be authorized to make medical decisions on their loved one’s behalf in all situations or settingsIn Massachusetts, if a person has lost the ability to make medical decisions (e.g. because of unconsciousness, coma, dementia or other mental limitations), it is their “health care agent” who is legally authorized to make medical decisions on their behalf.

To plan for future medical care, all adults ages 18 and older, whether they are healthy or sick, should name their health care agent by filling out and signing a legal form called a health care proxy form.

A health care proxy is the only legally authorized advance directive in Massachusetts. “Advance Directive” is a general term referring to a written document for future medical care in the event that a person loses capacity to make health care decisions.

For more information on Healthcare Decisions Day, visit www.nhdd.org.

Information on other state-specific resources are available on this mass.gov webpage.

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MOLST Technical Assistance Calls Planned for Certified Home Health Agencies

The Medical Orders for Life-Sustaining Treatment (MOLST) process and medical order form were developed to ensure that persons with advanced illness will have their decisions regarding life-sustaining treatments known, communicated and honored across Massachusetts.  Health care institutions throughout the Commonwealth are currently in various stages of implementing the use of MOLST with suitable patients.

In order to assist certified home health agencies to prepare for MOLST, the MOLST Team is scheduling technical assistance calls on the following dates:

  • February 25, from 1:00 – 2:00pm
  • March 18, from 12:00 – 1:00 pm

You may register for one of these calls by going to the MOLST website (www.MOLST-MA.org).  There you’ll also learn about the steps involved in MOLST implementation, and will find many tools for preparing your home care agency for the use of MOLST with patients.

The one-hour technical assistance conference call will provide participants with an opportunity to ask questions about MOLST, clarify concerns, and share with other callers whatever progress you’ve already made with MOLST implementation at your agency.

Registrants are strongly encouraged to review the MOLST Implementation Training available on line at http://www.molst-ma.org/molst-training-line and to download the Implementation Toolkit available at http://www.molst-ma.org/tool-kit-implementing-molst-institutions before participating in the conference call.

In order to have MOLST in place at your agency by the end of this year, now is the time to begin the implementation process.  Take advantage of this opportunity to learn more about MOLST, and register for an upcoming MOLST technical assistance call for certified home health agencies!

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Guest Post: Fraud and Abuse Tied to MD Face-to-Face Encounters

The following is a guest blog post on fraud and abuse issues by Robert W. Markette, Jr., CHC, Of Counsel for
Benesch Friedlander Coplan & Aronoff LLP. Mr. Markette’s primary areas of practice are health law and litigation and his wide range of health care clients includes home health, hospice and private duty providers.

Mr. Markette is also responsible for assisting the Home Care Alliance with its “Keeping it Legal in Home Care” resources on patient choice.

To view the entire article, click the link after the introduction:

As home health and hospice care continue to become more and more competitive and reimbursement continues to decline, referral sources are discovering new ways to leverage this for their own benefit. Two new examples include physicians requesting “administrative fees” to complete face to face paperwork and referral sources seeking “donations” from providers to defray the cost of capital equipment and other improvements. Providers need to understand the risks in these arrangements in order to avoid entering into arrangements that place them in violation of the Anti-Kickback Statute and/or the Stark Law.

The entire article from Mr. Markette is available here.

 

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Keeping It Legal, Part 2: Patient Choice

Building on a previous document called “Keeping It Legal” that focuses on what providers need to know when referring patients to home health care, the Home Care Alliance is releasing a series of documents on other legal issues related to the industry.

This new document in the series focuses on “Patient Choice” and what rights a patient has under the Medicare and Medicaid programs.

See the article: Respecting Patient Choice and the Rights of Medicare Patients

Drafted by Robert Markette, Jr., CHC – Of Counsel for Benesch Friedlander Coplan & Aronoff LLP, the Home Care Alliance is pleased to make this series of resource documents available. Agencies are encouraged to pass these documents along to partnering providers and pertinent agency staff to ensure that they are aware of the rules and regulations.

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