As we reflect on 2024, Amity Healthcare Group would like to express our sincerest appreciation for the trust you have placed in us in the past year. We appreciate your loyalty and look forward to moving into the New Year together.
We wish you an incredibly Happy Holiday season and a peaceful and prosperous New Year!
Amity Healthcare Group Team
Greetings !
This week we have the following sections covered under this newsletter.
Be on the lookout for more Amity’s news in 2025!
As this is our last newsletter issue of 2024, we would like to remind you of the areas of compliance that will go into effect in January 2025.
CoP § 484.105i- Patient Acceptance-to-Service Police
Starting January 1, 2025, the Centers for Medicare & Medicaid Services (CMS) will implement a new standard for home health agencies (HHAs) under the Condition of Participation §484.105(i). This is a new Standard under Organization and Administration of services.
§484.105 Condition of participation: Organization and administration of services.
- HHA acceptance-to-service. An HHA must do both of the following:
- Develop, implement, and maintain through an annual review, a patient acceptance-to-service policy that is applied consistently to each prospective patient referred for home health care, which addresses criteria related to the HHA’s capacity to provide patient care, including, but not limited to, all of the following:
- Anticipated needs of the referred prospective patient.
- Caseload and case mix of the HHA.
- Staffing levels of the HHA.
- Skills and competencies of the HHA staff.
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- Make available to the public accurate information regarding the services offered by the HHA and any limitations related to types of specialty services, service duration, or service frequency.
- Review the information specified in paragraph (i)(2)(1) of this section as frequently as the services are changed, but no less often than annually.
- Develop, implement, and maintain through an annual review, a patient acceptance-to-service policy that is applied consistently to each prospective patient referred for home health care, which addresses criteria related to the HHA’s capacity to provide patient care, including, but not limited to, all of the following:
Outcome and Assessment Information Set (OASIS) E-1
Effective January 1, 2025, OASIS E-1 will replace the current OASIS-E tool.
The OASIS E-1 revision includes the following:
- Addition of one new item: item O0350-patient’s COVID vaccination is up to date.
- Removal of two items:
- M0110 Episode Timing
- M2200 Therapy Need
These items are no longer used in the HH Quality Reporting Program (QRP) or for other CMS purposes.
- Revision of three items:
- GG0130 Self Care
- GG0170 Mobility
These items are revised to remove the Discharge Goals - D0150 Patient Health Questionnaire
This item is revised to clarify the instructions
- Update to skip pattern M0102
-> Please refer to the updated OASIS E-1 Manual and review Appendix D for a detailed description of changes from OASIS E to OASIS E-1.
- Prior to January 1, 2025:
- Per the HH CoPs and OASIS guidance, Home Health Agencies (HHAs) are required to collect and submit OASIS assessments for all skilled Medicare and/or Medicaid patients, with some exemptions.
- Patients under the age of 18, patients receiving maternity services, and patients receiving only personal care, housekeeping services, or chore services are excluded from the requirements
- OASIS assessment time points include start of care, resumption of care, recertification, other follow-up, transfer, discharge, and death at home.
- January 1, 2025, through June 30, 2025:
- HHAs are to continue OASIS data collection and submission for all skilled Medicare and/or Medicaid patients
- OASIS data collection and submission are voluntary for:
- Non-Medicare/non-Medicaid patients who are not exempt from OASIS data collection, and who begin receiving home health care services with an OASIS start of care (SOC) M0090 date from January 1, 2025, through June 30, 2025.
- When OASIS data collection and submission are started for a non-Medicare/non-Medicaid patient with the SOC OASIS assessment, HHAs may but are not required to complete all subsequent OASIS time point assessments related to the patient’s home health stay (that is, resumption of care, recertification, other follow up, transfer, discharge, and death at home) including assessments completed on or after July 1, 2025.
- Beginning July 1, 2025:
- OASIS data collection and submission to the internet Quality Improvement Evaluation System (iQIES) are required for patients with any pay source who are not exempt from OASIS data collection, and who begin receiving home health care services with an OASIS SOC M0090 data on or after July 1, 2025. The requirement includes the SOC OASIS, and any subsequent OASIS time point assessments relevant to the patient’s home health stay (that is, resumption of care, recertification, other follow-up, transfer, discharge, and death at home).
- Patients under the age of 18, patients receiving maternity services, and patients receiving only personal care, housekeeping and/or chore services continue to be excluded from OASIS data collection and submission requirements.
- In addition, as noted in the CMS Home Health OASIS All Payer Q&As:
- When asked about how to complete OASIS for non-Medicare patients already on service, the HHAs were advised of the following:“All-payer data collection and submission is intended for any patient receiving skilled home health care service that would meet requirements for an OASIS assessment. As noted in the proposal, data collection at time points outside of start of care for patients already on home health care service before the implementation of mandatory all-payer data collection and submission will not be required.”
The National Alliance for Cre at Home just announced that on Friday, December 20, 2024, the U.S. House of Representatives passed the American Relief Act 2025, a Continuing Resolution (CR) which would fund the federal government through March 14, 2025, and extend key healthcare programs through March 31, 2025.
The law includes a short-term extension of the hospice face-to-face recertification, as well as extension of the waiver of the geographic and originating site restrictions allowing for the home health face-to-face to be performed via telehealth.
The Office of Management and Budget (OMB) has approved an updated Home Health Change of Care Notice (HHCCN) for 3 years. CMS did make plain language and information design changes to the form and form instructions. CMS has also provided the HHCCN in 3 additional languages with this package approval including Chinese, Vietnamese and Korean.
One of the other changes that you may notice is that the HHCCN form is now two pages. The National Alliance for Care at Home (the Alliance) sent a question to CMS with the following inquiry regarding this change:
- Alliance question: “It appears that the HHCCN form is actually 2 pages due to the PRA Disclosure Statement on the second page. However, in the directions, it states that the form should only be one page. Are agencies required to issue the form with PRA statement, this would make the form two pages if provided on letter size?.”
- CMS’ response: “It can be legal size to accommodate the disclosure statement or they’re fine as long as the main notice content is on just one page and the disclosure statement on another.”
Since the current HHCCN does not expire until 12/31/2024, you may continue to use the HHCCN (OMB expiration date of 12/31/2024) until 1/31/2025, however, you will be required to use the newly approved HHCCN (OMB expiration date of 11/30/2027) on 2/1/2025. The newly OMB approved HHCCN form (expiration date of 11/30/2027) may be found in the downloads section – FFS HHCCN.
The Office of Management and Budget (OMB) has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123). The NOMNC renewed notice contains updates which are applicable only to Medicare Advantage (MA) enrollees. Providers must use the current notice until December 31, 2024, and are required to use the new NOMNC beginning January 1, 2025.
The NOMNC has been modified to reflect regulations providing MA enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date.
The revised notices can be found on the Beneficiary Notice Initiative website in the download section.
Pediatric Home Health PARs
As we are entering 2025, home health providers should expect to receive more definite updates as related to the resumption of Pediatric PARs. The PAR Restart Work Group has been working on identifying the timeline and process of restart. The anticipated timeline was described as follows:
- Therapy (PT/OT/ST) Soft Launch: February 3, 2025
- Nursing/CNA Soft Launch: July 1, 2025
- Full implementation: April 6, 2026
Regardless of the status of the PAR resumption process, it is important for the providers to remember to assess medical necessity for services in determining patient’s plan of care and comply with the requirements of the Pediatric Assessment Tool (PAT) tool.
Additionally, if your agency offers Parent CNA services and a CNA is wishing to provide services outside of Colorado, we would like to remind you of the following guidance received from HCPF and CDPHE:
Under HCPF Home Health and Private Duty Nursing program rules, services can be provided in any setting where normal daily activities occur, including while traveling or on vacation. However, to remain compliant, the following needs to be taken into consideration:
- Licensing Requirements:
- The CNA must meet all licensing and regulatory requirements of the state or country where services will be provided.
- Supervision of Care:
- The Home Health Agency must ensure that supervision of care continues according to Home Health regulations.
- Documentation and Compliance:
- The patient’s care plan must reflect these arrangements, and the agency must document adherence to all regulatory requirements for out-of-state service provision.
Further clarification provided by CDPHE is as follows:
CNA certifications do not transfer between states, and a CNA would not be recognized as a qualified provider in a state where they do not hold valid certification.
Key Takeaways:
- Certification Validity:
- A CNA is only authorized to provide services in the state where their certification is valid.
- If a CNA provides care in a state where they are not certified, they are no longer considered a qualified provider, and billing for their services as a CNA would not meet regulatory requirements.
- Implications for Billing:
- Medicaid and other payers require services to be provided by licensed or certified individuals. If the CNA is not certified in the state where services are rendered, the care provided would not qualify for reimbursement.
- For HCPF billing, services provided out of state must meet the licensing and certification requirements of that state.
- Options for Out-of-State Services:
- Temporary Certification: Some states offer reciprocity or temporary certification for CNAs, but this process must be completed prior to providing care.
- Alternative Care Arrangements: Agencies may need to arrange for care to be delivered by qualified personnel certified in the state where the client is located.
- Home Health Agency Responsibility:
- The Home Health Agency supervising the CNA must ensure compliance with all licensing rules. If the CNA’s certification is not valid in the out-of-state location, the agency cannot bill for the services as CNA-provided care.
- Recommendation:
- The CNA should refrain from providing services in a state where their certification is not valid.
- Agencies should ensure proper staffing with individuals certified to work in the specific state or location.
- For clients traveling out of state, coordinate with local licensed providers to maintain care continuity and billing compliance.
- Please also remember the CNA visit cannot be longer than 4.5 hrs. in a row.
By following these guidelines, services can be delivered while ensuring compliance with both Colorado regulations and those of the destination.
Chapter 558:
It was previously anticipated that the Executive Council would release the 588 final rule in February of 2025. However, chapter 558 final rule timeline has been updated. There are no specific dates yet but per HHSC, the rules are now anticipated to go to the Executive Council and open for comment sometime closer to summer 2025.
The new emergency system, AlertMedia, has not been made available to providers yet, even though the original anticipated effective date was December 1, 2024. According to HHSC some of the AlertMedia system information is still being finalized. HHSC will offer a provider letter with instructions once the system is available for use.
TMHP Extends Revalidation Due Dates and Plans Retroactive Enrollment Period Effective Dates
TMHP released THIS NOTICE which details their planned actions to assist providers who have been negatively impacted by the revalidation process. Effective December 13, 2024, providers will receive an additional 180 calendar days to complete revalidations PEMS. TMHP and HHSC are also developing a process to address enrollment gaps for providers that have been disenrolled for failing to revalidate timely. These flexibilities are currently planned to last through May 31, 2025.
Per the notice, PEMS will automatically add 180 calendar days to the revalidation due date. This will be reflected in the Revalidation Due Dates found on the Provider Information page in PEMS.
If you’ve already been disenrolled, TMHP and HHSC are developing a process to modify enrollment period effective dates for providers that:
- Have been disenrolled for failing to revalidate timely between November 1, 2023, and December 12, 2024.
- Successfully reenroll in Texas Medicaid.
For providers that meet both of these criteria, the provider’s enrollment period effective date will be backdated up to 365 days to reduce or eliminate their enrollment gap.
TMHP and HHSC expect this process to be implemented in early 2025 and will provide additional information and timelines when available.
Amity’s newsletters will be archived on Amity’s Healthcare Group website at https://amityhealthcaregroup.
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Thank you,
Irina Gorovaya, RN BSN, MBA
Amity Healthcare Group, LLC
Home Health Consulting, Education and Outsourcing Services
713-564-5011 (Houston Office), 303-690-2749 (Denver Office), 720-398-6200 (fax)
https://amityhealthcaregroup.
