Arizona Governor, Doug Ducey is ending the state's COVID-19 Declaration of Emergency based on the state reaching thresholds established by the Arizona Department of Health Services that show the virus is no longer as widespread as it once was.  The termination takes effect March 30, 2022, and follows the recent signing of Senate Bill 1309, providing an extension of temporary professional licenses for more than 2,000 critical health care workers through Jan. 1, 2023.

View Governor's proclamation here.

This ETS applies to all employers with a total of 100 or more employees at any time the ETS is in effect.

However, the requirements of this ETS do not apply to:

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This interim final rule with comment period revises the requirements that most Medicare - and Medicaid-certified providers and suppliers must meet to participate in the Medicare and Medicaid programs by establishing COVID-19 vaccination requirements for staff at Medicare- and Medicaid certified providers and suppliers.

The IFC directly applies only to the Medicare-and Medicaid-certified providers and suppliers listed in the IFC, which does include home health agencies and hospices, among others.

For more information visit, https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

OSHA is revising its previous enforcement policy for recording cases of coronavirus. Under OSHA’s recordkeeping requirements, coronavirus is a recordable illness, and employers are responsible for recording cases of the coronavirus, if the case:

• Is confirmed as a coronavirus illness;
• Is work-related as defined by 29 CFR 1904.5; and
• Involves one or more of the general recording criteria in 29 CFR 1904.7, such as medical treatment beyond first aid or days away from work.

Under the new policy issued today, OSHA will enforce the recordkeeping requirements of 29 CFR 1904 for employee coronavirus illnesses for all employers. Given the nature of the disease and community spread, however, in many instances it remains difficult to determine whether a coronavirus illness is work-related, especially when an employee has experienced potential exposure both in and out of the workplace. OSHA’s guidance emphasizes that employers must make reasonable efforts, based on the evidence available to the employer, to ascertain whether a particular case of coronavirus is work-related.

Recording a coronavirus illness does not mean that the employer has violated any OSHA standard.

Following existing regulations, employers with 10 or fewer employees and certain employers in low hazard industries have no recording obligations; they need only report work-related coronavirus illnesses that result in a fatality or an employee’s in-patient hospitalization, amputation, or loss of an eye.

Note:  This is a federal waiver; a state waiver for Arizona is being coordinated and we will advise when it has been approved by the state - until that time, please continue to follow the existing regulations.  

CMS has updated its FAQs to allow PTs and SLPs to also perform initial and comprehensive assessments for home health patients when both nursing and therapy are ordered.

Please see the revised FAQ below.

Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients. (Revised since 4/30 Release)

CMS is waiving the requirements in 42 CFR § 484.55(a)(2) and § 484.55(b)(3) that rehabilitation skilled professionals may only perform the initial and comprehensive assessment when only therapy services are ordered. This temporary blanket modification allows any rehabilitation professional (OT, PT, or SLP) to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. The existing regulations at § 484.55(a) and (b)(2) would continue to apply; rehabilitation skilled professionals would not be permitted to perform assessments in nursing only cases. We would continue to expect HHAs to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. Therapists must act within their state scope of practice laws when performing initial and comprehensive assessments, and access a registered nurse or other professional to complete sections of the assessment that are beyond their scope of practice. Expanding the category of therapists who may perform initial and comprehensive assessments provides HHAs with additional flexibility that may decrease patient wait times for the initiation of home health services.

For more information, review this document from CMS: referenced section is on Pages 18-19

https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

Courtesy of the National Association for Home Care & Hospice (NAHC) www.nahc.org

The Department of Health & Human Services has begun releasing additional funds to health care providers impacted by the COVID-19 pandemic.

The CARES Act legislation provides relief to American families, workers, and the healthcare providers on the frontline of the COVID-19 outbreak. Among its provisions, the Act appropriated $100 billion for distribution to health care providers impacted by the ongoing public health emergency. 

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View FDA Guidance here.

PHOENIX⁠ —Governor Ducey today issued an Executive Order requiring health care insurance companies to expand telemedicine coverage for all services that would normally be covered for an in-person visit. The order helps ensure that Arizonans who may be sick or under quarantine can access care from their homes and avoid potentially risky trips to a health care provider. It remains in effect until the termination of the declared public health emergency.

“Access to health care is crucial at a time like this,” said Governor Ducey. “This order will ensure that Arizonans can access care without having to leave homewhile freeing up much needed capacity for our health care providers and hospitals. It’s commonsense and helps ensure our most vulnerable continue to have access to care in a way that protects them and public health.”

Yesterday, Governor Ducey took steps to free up physicians for other needed medical services and ensure access to health care for kids and vulnerable Arizonans receiving care through KidsCare and AHCCCS.

Today’s Executive Order prevents insurers from charging more for a telemedicine visit thanthey would for an in-person visit. In addition, the order:

• Requires all Medicaid plans in the State of Arizona to cover all health care services that are covered benefits to be accessible by telemedicine to AHCCCS members, while prohibiting those plans from discounting rates for services provided via telemedicine;
• Includes all electronic means of delivering telehealth including telephone and video calls;
• Ensures that a patient’s home is considered an approved location to receive telemedicine services;
• And prohibits a regulatory board from requiring a medical professional who is authorized to write prescriptions to conduct an in-person examination of a patient prior to the issuance of a prescription.

View the Executive Order HERE.

• Members*, click here to view a summary of the Memorandum provided by Elizabeth E. Hogue, Esq.

Not a Member? Join Today!

*requires Member Login; this benefit is available to Provider and Vendor Members.  

PEPPER has been available to home health agencies since July of 2015, and to hospices since 2012.  We would like to encourage providers to access this free comparative billing report and utilize it as a tool to support their auditing and monitoring efforts.  With that in mind, would you consider sharing the attached item, via e-mail or newsletter? 

Please note that the PEPPER team has developed maps that display the PEPPER retrieval rate for PEPPERs accessed via the PEPPER Resources Portal for each state/territory.  States on the interactive map are color-coded according to their retrieval rates.  Users can click on a state to obtain details such as the number of PEPPERs available in the state via the portal, the number of PEPPERs accessed via the portal, the retrieval rate, and a link to the data file for all states/territories in the nation.

Map of Home Health Agency PEPPER Retrievals by State                             

If you have any questions, please feel free to contact me.  

Cindy Hunter, M.Ed., CCM, HACP, CPHQ

Health Services Consultant II

TMF Health Quality Institute

Bridgepoint I, Suite 300

5918 W. Courtyard Drive

Austin, TX   78730-5036

(512) 334-1732

cindy.hunter@area-b.hcqis.org

The new CoPs include some important changes for home health agencies, such as Quality Assurance Performance (QAPI), as well as ensuring that patients receive written information about medication, treatment, and care instructions performed by the patients and caregivers.

New home health conditions of participation (CoPs) under Medicaid and Medicare will be delayed for six months, according to a final rule issued by the Centers for Medicare and Medicaid Services (CMS) on July 7.

The CMS decision delayed the date of home health providers’ CoPs by six months, from July 13, 2017 to January 13, 2018. This decision is a significant win for the home health care community and came after intense lobbying by staffers and members of the National Association for Home Care & Hospice (NAHC).

The CMS admitted the new CoPs “contain numerous changes that require time for planning, testing, training, and implementation. In order to assure that (home health agencies) have adequate time for all preparation activities, we are finalizing the 6 month delay.”

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During the period covered by the ETS, covered employers, which include all home-care based care providers, are required to develop and implement a COVID-19 plan to identify and control the potential COVID-19 hazards in the workplace.

Information and Resources are available on OSHA's website: https://www.osha.gov/coronavirus/ets.

Select resources, including the Plan Template and Checklist have been uploaded to the AAHC Regulatory Center (member login required) as well as the Coronavirus Resource Center (login not required) available here.

AAHC Provider & Associate Members who have questions about this regulation are welcome to contact the AAHC Office at (480) 491-0540 or submit a Question through the AAHC Regulatory Center.

1. Review the Secure PEPPER Access Guide.
2. Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number (UB04 form locator 03a) or medical record number (UB04 form locator 03b) from a claim for a traditional Medicare FFS beneficiary with a claim "from" or "through" date between October 1 - December 31, 2017, will be required.
3. Visit the PEPPER Resources Portal.
4. Complete all the fields.
5. Download your PEPPER.

Medicare Advantage plans may allow home care aid/personal care services as a supplemental benefit beginning in 2019, according to a final rule issued April 2, 2018 by the Centers for Medicare & Medicaid Services (CMS). The rule is the first time CMS has permitted supplemental benefits that include daily maintenance in Medicare Advantage plans.

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The freeze date for the Hospice Item Set (HIS) data that will be included in quality measure calculations for the February 2018 Hospice Compare refresh is November 15, 2017. The February refresh will include HIS data from Q2 2016 to Q1 2017 (4/1/16-3/31/17). All HIS records, including modifications/corrections and inactivation’s, need to be submitted and accepted by the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system by 11:59:59 p.m. E.D.T. 11/15/17 to be reflected in the Hospice Provider Preview Report that will be available on December 1, 2017.

For more information about the freeze date, preview reports, and key public reporting dates for providers, please see the Hospice Quality Public Reporting webpage.

Members: click here* to access information and resources for complying with this new rule.

*Requires login.  Not a Member? Join Today!

The proposed changes to home health prospective payment rates are within NAHC’s expectations given the 4-year phase-in of rate rebasing that started in 2014. CMS is capped at reducing the base episode rate by no more than $80.95 which is equal to 3.5% of the 2010 base rates. The proposal imposes such a cut offset by the annual Market Basket Index (MBI) and the annual Productivity Adjustment which started in 2015. While the proposal does not reference the 2% sequestration, it is definitely expected that such will continue in 2017.  Read More

Originally published by NAHC on June 3, 2015

The Centers for Medicare & Medicaid Services (CMS) has issued two new transmittals pertaining to home health providers.

Change Request (CR) 9198 instructs the Medicare claims processing contractor on several changes planned for the home health Pricer.  The new Pricer contains updates to allow processing of type of bill 032Q or 033Q, as required by CR 8581 related to automatic claim re-openings.  It also corrects errors affecting the payments on 2015 claims.

The Pricer currently contains two payment errors:
1) It uses a table that contains incorrect case-mix weights for all Health Insurance Prospective Payment System (HIPPS) codes beginning with 4.  The weights for all codes beginning with 4 are using the weight for the corresponding code that begins with 2 (e.g., a claim submitted with HIPPS code 4AFKS is being paid using the weight for 2AFKS).

2) There is an error with HIPPS codes beginning with 1 or 2 that are submitted with 20 or more therapy visits and must be re-coded to a HIPPS code beginning with 5.  If the clinical severity value encoded in the treatment authorization code was a D, the claim is re-coded into a higher case-mix group in error.

This CR corrects the weight table and the re-coding logic in the Pricer.  It also instructs MACs to adjust claims to correct payments.  The Implementation date for the changes in the Pricer is October 5, 2015.  The contractors must complete all the adjustments within 60 days after the implementation date.

A second transmittal, CR 9192, issued by CMS provides the quarterly update of Healthcare Common Procedure Coding System (HCPCS) codes used for home health consolidated billing.  The new HCPCS codes in the CR replace current HCPCS codes; therefore, there are no new supplies or therapy services that have been added to the home health consolidated billing list.

The following HCPCS code changes are as follows:

A7048 - Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each

This code replaces HCPCS code A7043 - Vacuum drainage bottle and tubing for use with implanted catheter.  A7043 is deleted from the HH consolidated billing non-routine supply code list.

The following HCPCS codes are added to the HH consolidated billing therapy code list:

97607 - Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

97608 - Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters

These codes replace HCPCS codes:

G0456 - Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters

G0457 - Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters

G0456 and G0457 are deleted from the HH consolidated billing therapy code list.

Originally published by NAHC on June 22, 2015

The Centers for Medicare & Medicaid Services (CMS) this week hailed a home-based health care demonstration project that resulted in Medicare savings during its first year as evidence of the benefits of caring for patients in their homes. In an announcement Thursday, CMS stated that the Independence at Home Demonstration, implemented under the Affordable Care Act, saved over $25 million during the demonstration’s first performance year.

In addition to the cost savings, the demonstration project resulted in fewer hospital readmissions and higher quality care.

Independence at Home Demonstration tests a service delivery and payment incentive model using home-based primary care teams to treat Medicare beneficiaries with chronic conditions. Directed by physicians and nurse practitioners, the teams are measured and provided incentives based on their performances improving health outcomes and reducing expenditures. The performance results and incentives payments for each of the 15 participating providers can be viewed here.

In announcing the results, CMS Acting Administrator Andy Slavitt stated the demonstration proves that caring for those with chronic conditions in their homes is higher quality and more affordable. “These results support what most Americans already want—that chronically ill patients can be better taken care of in their own homes. This is a great common sense way for Medicare beneficiaries to get better quality care with smarter spending from Medicare,” said Slavitt. “The Independence at Home Demonstration is one of the tools of the Affordable Care Act that can bring down the long-term cost of care in a patient-centered manner.”

Val J. Halamandaris, President and CEO of the National Association for Home Care & Hospice (NAHC), commended the Independence at Home Demonstration for focusing on and highlighting the benefits of caring for people in their homes. NAHC supports the Independence at Home Demonstration model, while also advocating for an expanded focus on chronic care management with a broader population than covered under Independence at Home.

“The results provide more evidence that home is the center of health care,” said Halamandaris. “I commend CMS for recognizing that caring for those with chronic conditions in their homes saves money and improves care. This demonstration is a good step in what needs to be an increased focus on home- and community-based care. Based on the results, Congress should take the next step and establish a separate care management benefit under Medicare for those with chronic conditions.”

NAHC recommends that Congress establish a separate care management benefit under Medicare for certain chronically ill patients, including those with chronic obstructive pulmonary disease, congestive heart failure, diabetes, and certain neurological disorders. In order to ensure a discipline-integrated, community care-based approach to care management, the service should be provided by professional nurses and others within home health agencies, under the guidance and supervision of the patient’s attending physician as a member of the care team. The services should include: 1) An interdisciplinary team approach to care management that includes physicians, nurses, therapists, medical social workers, and pharmacists; 2) Evidence-based care plan development; 3) Direct patient care services in the home setting; 4) The application of telehealth services for appropriate remote monitoring as needed by the individual patient; 5) Care counseling, care coordination, medication management, and oversight of services related to activities of daily living; 6) The use of interoperable electronic health care records and efficient electronic-based communication tools; 7) Patient education and support; and 8) Integration and support of informal caregivers such as family members.

As previously reported, in an indication of Congressional support for caring for those with chronic illness in their homes, the Senate and House Ways & Means Committee recently passed legislation extending the demonstration project for another two years beyond the time-frame provided under the ACA.

Learn more about the Independence at Home Demonstration here.

Originally published by NAHC on June 25, 2015

The National Association for Home Care and Hospice (NAHC) recently sent a letter to officials at the Centers for Medicare & Medicaid Services (CMS) highlighting some unique issues home health agencies will face with the transition from iCD-9 to ICD-10. NAHC Report previously reported that NAHC intended to send the letter in last week’s article providing tips for ICD-10 preparation.

The letter highlights concerns expressed by the home health care community regarding the transition. NAHC states in the letter to CMS that the “home health community has expressed concerns regarding the transition” of which NAHC believes CMS should be aware. The letter further states: “The concerns surround the uniqueness of home health care relative to ICD-10 coding for claims that span October 1, 2015, and the potential consequences for home health agencies related to inaccurate coding with the ICD-10. Also, the absence of educational efforts by CMS towards home health providers suggests a lack of understanding with how home health agencies will be impacted by the ICD-10 conversion.”

In the letter, NAHC recommends that CMS, in order to address these concerns, should: 1) provide a grace period sufficient enough for agencies to increase proficiency in ICD-10 coding; 2) provide education programs and resources aimed specifically towards home health providers; 3) conduct end-to-end testing exclusively for home health agencies; and 4) ensure home health referrals from providers and physicians include complete documentation.

To read the full letter, please click here.

Originally published by NAHC on May 7, 2015

The Centers for Medicare & Medicaid Services issued Change Request (CR) 9119, which updates the Medicare Benefit Policy Manual, chapter 7, relating the requirements for physician certification and recertification. This CR also updates the timeframe required for therapy functional reassessments. All of the new provisions in the manual were discussed in the 2015 HH PPS Final Rule published on November 6, 2014. However, the CR leaves questions for providers regarding CMS’ expectation for implementing some of the new provisions. The National Association for Home Care & Hospice (NAHC) is seeking answers from CMS.

CMS reiterates it has eliminated the narrative requirement from the face to face (F2F) encounter document. However, the certifying physician is still required to certify that a F2F patient encounter occurred. The encounter document must include the date of the encounter, be related to the primary reason the patient requires home health services, and performed by an allowed provider type.

In the manual revision, CMS affirms a new requirement for documentation that was stated in the 2015 HH PPS Final Rule. When the patient is admitted to home health directly after discharge from an acute/post-acute care setting and the physician that cared for the patient in that setting is the certifying physician, but will not be following the patient after discharge, the certifying physician must identify the community physician who will be following the patient. CMS claims the addition documentation is needed in order for the certifying physician to meet the requirement that the patient be under the care of a physician. NAHC is seeking clarification from CMS regarding whether there is specific a format or location within the medical record this information must be located.

CMS maintains its policy thatthe certification must be completed prior to the home health agency bills Medicare; however, they also reiterate that it is not acceptable for HHAs to wait until the end of a 60-day episode of care to obtain a completed certification/recertification. CMS does not address   good faith efforts made by the agency to obtain the certification and what the implications are for agencies if they are not able to obtain the certification until the “end” the episode.

The certifying physician’s medical record and/or the acute/post-acute care facility’s medical records (if the patient was directly admitted to home health) is to be used as the basis for certification of patient eligibility. CMS includes in the manual update a provision from the Final Rule that permits the agency to provide the certifying physician with information from their assessment of the patient, for which the physician would sign and incorporate into his/her medical record. This information may be used to support the patient’s eligibility for home health services. However, the information must be corroborated by other medical record entries in the certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient.

Included in the manual update, which was also stated in the Final Rule, is the requirement from the regulation at §424.22 (b)(2) for home health recertification. The regulation states the physician’s “recertification statement must indicate the continuing need for services and estimate how much longer the services will be required”. This requirement has been in the regulation for many years but has never been incorporated into the Medicare manual. CMS’ policy for this portion of the regulation is stated in the manual as follows:

The physician must include an estimate of how much longer the skilled services will be required and must certify (attest) that:

• The home health services are or were needed because the patient is or was confined to the home as defined in §30.1;
• The patient needs or needed skilled nursing services on an intermittent basis (other than solely venipuncture for the purposes of obtaining a blood sample), or physical therapy, or speech-language pathology services; or continues to need occupational therapy after the need for skilled nursing care, physical therapy, or speech-language pathology services ceased. Where a patient’s sole skilled service need is for skilled oversight of unskilled services (management and evaluation of the care plan as defined in §40.1.2.2), the physician must include a brief narrative describing the clinical justification of this need as part of the recertification, or as a signed addendum to the recertification;
• A plan of care has been established and is periodically reviewed by a physician; and
• The services are or were furnished while the patient is or was under the care of a physician. Medicare does not limit the number of continuous episode recertifications for beneficiaries who continue

Therefore, it is unclear whether the estimated duration for services can be stated as a physician order or must it be included in the recertification statement. NAHC is seeking clarification on this issue as well.  

Finally, CMS updates the manual to reflect the change in policy for the therapy function reassessments timeframes to at least every 30 day, eliminating the 13/19th therapy visit threshold reassessments.  

NAHC has expressed to CMS that agencies are genuinely trying to ensure they have adequate processes in place to comply with the F2F requirement.  However, confusion and concerns remain surrounding CMS’ expectations. NAHC continues to seek clarification from CMS on the home health certification and recertification requirements.

Click here to view CR 9119