Here are some home health related updates for this week:
REGISTRATION IS NOW OPEN FOR VIRTUAL SKILLED NURISNG COMPETENCY PROGRAM!
To register, please go to: https://amityhealthcaregroup.com/virtual-nursing-competency/
Our Virtual Competency Program is accessible via Zoom video conferencing. It consists of a live lecture, written exam, and skills demonstration and observation. The information is delivered to participants by a qualified clinical educator in a synchronous manner. Participants are able to interact with the instructor as well as perform return skills demonstration utilizing a skills set kit that will be mailed to participants prior to the scheduled competency. Upon completion of the competency, participants will also be awarded CEUs.
Please read our article “Why Home Health is Going Virtual with Direct Care Staff Competency Training” in Home Health Care News at https://homehealthcarenews.com/2021/03/why-home-health-is-going-virtual-with-direct-care-staff-competency-training/
Please call 303-690-2749 for additional questions.
Next available in-person CNA/HHA is Tuesday, March 9, 2021 and Thursday, March 11th, 2021 and in-person Skilled Nursing Competency on Tuesday, March 9, 2021.
If you would like to register your Skilled Nurses and/or HHAs/CNAs for a competency, please follow the links below:
Skilled Nursing Competency: https://amityhealthcaregroup.com/services/nursing-competencies/
HHA/CNA Competency: https://amityhealthcaregroup.com/services/cna-hha-competency/
Let Amity Healthcare Group to assist you with staying compliant with competency and ongoing training/continued education requirements in a worry-free manner.
For more information, please call 303-690-2749 or email: firstname.lastname@example.org or schedule a meeting at https://calendly.com/ig–3/30-min-free-consultation.
NAHC Receives Clarification on CMS Policies for Home Health Agencies
The National Association for Home Care & Hospice ( NAHC) has received additional clarification on Medicare coverage policies for home health agencies and posted the following communication:
Earlier this month NAHC reported on responses from the Centers for Medicare & Medicaid Services (CMS) on several key outstanding question. In that report NAHC noted follow-up was needed on two of CMS’ responses.
Question #1: addressed the inconsistency in the regulations and the statute for the face- to- face requirements for home health certifications. CMS recognized that the statutory language in the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides more flexibility than the regulations on who may conduct the face- to- face encounter, however, the regulations and manual instructions have not been updated to reflect these flexibilities. As the result, NAHC conducted an additional inquiry of the Medicare Administrative Contractors (MACs) regarding which policies are being followed when reviewing for compliance with the F2F encounter.
NAHC determined that according to all three MACs, they continue to follow the manual instructions in the Medicare Benefit Policy Manual, chapter 7, section 22.214.171.124 which states:
126.96.36.199 – Face-to-Face Encounter
1. Allowed Provider Types As part of the certification of patient eligibility for the Medicare home health benefit, a face-to-face encounter with the patient must be performed by the certifying physician or allowed practitioner himself or herself, a physician or allowed practitioner that cared for the patient in the acute or post-acute care facility (with privileges who cared for the patient in an acute or post-acute care facility from which the patient was directly admitted to home health) or an allowed non-physician practitioner (NPP).
NPPs who are allowed to perform the encounter are:
- A nurse practitioner or a clinical nurse specialist working in accordance with State law and in collaboration with the certifying physician or in collaboration with an acute or post-acute care physician, with privileges, who cared for the patient in the acute or post-acute care facility from which the patient was directly admitted to home health;
- A certified nurse midwife, as authorized by State law, under the supervision of the certifying physician or under the supervision of an acute or post-acute care physician with privileges who cared for the patient in the acute or post-acute care facility from which the patient was directly admitted to home health;
- A physician assistant under the supervision of the certifying physician or under the supervision of an acute or post-acute care physician with privileges who cared for the patient in the acute or post-acute care facility from which the patient was directly admitted to home health.
NPPs performing the encounter are subject to the same financial restrictions with the HHA as the certifying physician, as described in 42 CFR 424.22(d)
NAHC recommends that HHAs follow the manual instructions until such time that CMS revises the regulations and manual instructions to conform with the provision in the CARES Act for the home health F2F encounter.”
Question #2 required further clarification related to whether allowed NPPs may order private duty nursing under Medicaid. CMS clarified that the statutory changes only addressed the home health benefit under Medicaid and not the private duty nursing benefit. Subsequently, NAHC submitted the following question to CMS seeking clarification regarding an apparent conflict in the Medicare Manual related to a who may sign the home health plan of care.
In the following manual section from the Medicare Benefits Policy Manual, CMS limits who may sign the POC to practitioners in a group practice. However, not all practitioners work within a group practice and/ or may prefer to authorize other practitioners to sign orders.
The second manual section, excerpted from the Medicare General Information, Eligibility, and Entitlement manual, permits such, in that one physician may authorize another physician to sign the POC in his/her absence. This has always been understood to apply to the original POC (absent the certification for eligibility statement) and any interim orders .
The two manual sections raise several questions.
1) Should section 30.1 in the Medicare General Information, Eligibility, and Entitlement Manual be revised to include “allowed practitioners” ?
2) How do HHAs reconcile the different manual instructions related to who is permitted to sign the home health POC?
3) Since the “POC” includes interim orders may any practitioner authorized by the practitioner who established the POC sign interim orders?
Medicare Benefits Policy Manual , chapter 7,
30.5.3 – Who May Sign the Certification or Recertification
The physician or allowed practitioner who signs the certification or recertification must be permitted to do so by 42 CFR 424.22. A physician or allowed practitioner in the same group practice as the certifying physician or allowed practitioner who established the home health plan of care and the certification/recertification statement, may sign in place of the physician or allowed practitioner when he/she is unavailable. The HHA is responsible for ensuring that the physician or allowed practitioner who signs the plan of care and certification/recertification statement practices in the same group practice as the physician or allowed practitioner who established the plan of care and completed the certification. The physician or allowed practitioner that performed the required face-to face encounter must sign the certification of eligibility, unless the patient is directly admitted to home health care from an acute or post-acute care facility and the encounter was performed by a physician or allowed practitioner in such setting
Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4 – Physician Certification and Recertification of Services.
30.1 – Content of the Physician’s Certification
Certifications must be obtained at the time the plan of care is established or as soon thereafter as possible. The physician must sign and date the plan of care (POC) and the certification prior to the claim being submitted for payment; rubber signature stamps are not acceptable. The plan of care may be signed by another physician who is authorized by the attending physician to care for his/her patients in his/her absence. While the regulations specify that documents must be signed, they do not prohibit the transmission of the POC, oral order, or certification via facsimile machine. The HHA is not required to have the original signature on file. However, the HHA is responsible for obtaining original signatures if an issue surfaces that would require verification of an original signature.
CMS noted the conflict in the policy manual and responded with the following:
We note that Chapter 7 of the Benefit Policy Manual does include erroneous language regarding who may sign the POC. We do plan on correcting this language as soon as possible, as well as updating the language in Chapter 4 of the Medicare General Information, Eligibility, and Entitlement manual.
In the meantime you can refer providers to the FAQs found in the program guidance and information on the CMS.gov website about our response to COVID-19. We state that the home health conditions of participation do not prohibit home health agencies (HHAs) from accepting orders from multiple physicians, and now with the recent statutory change, nurse practitioners, physician assistants, and clinical nurse specialists (i.e., allowed practitioners). The HHA is ultimately responsible for the plan of care, which includes assuring communication with all physicians and allowed practitioners involved in the plan of care and integrating orders from all physicians/allowed non-physician practitioners involved in the plan to assure the coordination of all services and interventions provided to the patient. This responsibility extends to a physician or other allowed non-physician practitioner, other than the certifying physician or allowed non-physician practitioner who established the home health plan of care, who signs the plan of care or the recertification statement in the absence of the certifying physician or allowed non-physician practitioner. This is only permitted when such physician or non-physician practitioner has been authorized to care for his/her patients in his/her absence. The HHA is responsible for ensuring that the physician or allowed non-physician practitioner who signs the plan of care and recertification statement was authorized by the physician or allowed non-physician practitioner who established the plan of care and completed the certification for his/her patient in his/her absence. Our regulations at 42 CFR 424.22(a)(1)(v)(A) require that the physician or allowed practitioner that performed the required face-to-face encounter also sign the certification of eligibility, unless the patient is directly admitted to home health care from an acute or post-acute care facility and the encounter was performed by a physician or allowed practitioner in such setting.
Please note that this does not limit who may sign the POC to practitioners in the same group practice. This FAQ can be found at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf.
NAHC will continue to seek clarification from CMS where there are conflicts and confusion in the statute, regulations, and manual instructions.
Pulse Oximeter Accuracy and Limitations: FDA Safety Communication
On February 19, 2021, FDA informed patients and health care providers that although pulse oximetry is useful for estimating blood oxygen levels, pulse oximeters have limitations and a risk of inaccuracy under certain circumstances that should be considered.
For a complete article, including recommendations for health care providers and description of limitation, please go to: https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication
Pediatric Long-Term Home Health (PLTHH) and Private Duty Nursing (PDN) Providers Continued Suspension of the Prior Authorization Requirement
In our February 12th newsletter, we announced that it has been determined to keep the PLTHH and PDN PAR requirement suspended through winter 2020/2021, and to resume the submission of PLTHH and PDN PARs to the Utilization Management (UM) Vendor no earlier than April 1, 2021. The Department announced an additional continued suspension of the PAR requirement.
At this time, the plan is to resume PLTHH and PDN PARs to the new Utilization Management (UM) Vendor (Kepro) no earlier than May 1, 2021.
Note: HCPF is in the process of transitioning the utilization management from eQHealth Solutions, Inc. to Keystone Peer Review Organization (KEPRO). Kepro will be the UM Vendor responsible for reviewing these PARs when the program is restarted. According to the HCPF’s announcement, “the Department is committed to ensuring there is sufficient notice and training prior to re-starting this requirement so that providers may learn the new UM Vendor’s PAR system.”
Note: This PAR suspension does not affect Long Term Home Health PARs for Adults (members aged 21 and over)
KEPRO Provider Training Information
As mentioned above, Kepro will be replacing eQHealth Solutions, Inc. and will begin to receive Prior Authorization Requests (PARs) no earlier than May 1, 2021. Kepro will be offering provider training on their Atrezzo Provider Portal for providers who submit PARs for all fee-for-service Health First Colorado Benefits (Colorado Medicaid Program) that eQHealth Solutions, Inc. currently authorizes.
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Irina Gorovaya, RN BSN, MBA
Amity Healthcare Group, LLC
Home Health Consulting, Education and Outsourcing Services
720-353-7249 (cell) 303-690-2749 (office) 720-398-6200 (fax)