Here are some home health-related updates for this week:
Amity Healthcare Group is excited to announce a recent approval by CDPHE as a provider of home health/home care Administrator/Manager Training and Education.
Please follow our weekly email for additional announcements or call 303-690-2749 for additional questions.
The next available CNA/HHA is Tuesday, February 9, 2021, and Thursday, February 11, 2021, and Skilled Nursing Competency on Tuesday, February 16, 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.
CHAP Updates Home Health Standards
Attention providers accredited by CHAP: CHAP has published updated Home Health Accreditation Standards. Revisions to Home Health Standards are based on the CY 2021 Final Rule and include new standard addressing remote monitoring and telemonitoring, the expansion of standards to include “allowed practitioner” addressing the expanded role of Nurse Practitioners and/or Physician Assistants in Home Health, as well as the removal of the requirement of a test OASIS submission for initial agencies and more. Updated Home Health Standards are now available for download.
CMS Responds to Home Health Questions
CMS has provided the following responses to several questions submitted by the National Association for Home Care & Hospice (NAHC) in response to requests for clarification from its members.
There is confusion based on the regulations below. Section 424.22(a)(v) (A)(2) states that an NP, PA, or a CNS may conduct the F2F encounter when collaborating with certifying physician whether in a facility or in the community.. However, 424.22(a)(v) (C) (1)and (2) seem to limit who may conduct the F2F encounter when an NP, PA, or CNS is certifying beneficiaries admitted to home health from the community. Section (C) reads as though the NP, PA, or CNS may only conduct the F2F encounter if they are the certifying practitioner. These sections are conflicting and seem to prohibit NPPs who are not certifying but are working in collaboration with a certifying physician to conduct the F2F encounter for beneficiaries admitted to home health from the community.
- 424.22(a)(v)(A) and (C)
(A) The face-to-face encounter must be performed by one of the following:
(1) The certifying physician (as defined at §484.2 of this chapter) or a physician, 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.
(2) The certifying nurse practitioner (as defined at §484.2 of this chapter), certifying clinical nurse specialist (as defined at §484.2 of this chapter), or a nurse practitioner or a clinical nurse specialist who is working in accordance with State law and in collaboration with a 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.
(3) A certified nurse-midwife (as defined in section 1861(gg) of the Act) as authorized by State law, under the supervision of a 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.
(4) A certifying physician assistant (as defined at §484.2 of this chapter) or a physician assistant under the supervision of a 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.
(B) The face-to-face patient encounter may occur through telehealth, in compliance with section 1834(m) of the Act and subject to the list of payable Medicare telehealth services established by the applicable physician fee schedule regulation.
(C) The face-to-face patient encounter must be performed by the certifying physician or allowed practitioner unless the encounter is performed by:
(1) A certified nurse-midwife as described in paragraph (a)(1)(v)(A)(4) of this section.
(2) A physician, physician assistant, nurse practitioner, or clinical nurse specialist with privileges who cared for the patient in the acute or post-acute facility from which the patient was directly admitted to home health and who is different from the certifying practitioner.
CMS Response: The statute states only that the certifying physician must document that the physician or NPP has had a face-to-face encounter prior to certification. It does not prevent a community-based physician from conducting the F2F, when he/she is not the certifying physician. Therefore, this would not limit the F2F (conducted by a community physician or allowed NPP) to only the certifying physician or allowed practitioner. We will consider proposing conforming regulation text changes in future rulemaking to make this clear.
Per NAHC’s further clarification, “in their response, CMS is referring to the statutory language from the CARES Act. A provision in the CARES Act replaced a section in the Social Security Act at 1814(a)(2)(C), which eliminated the requirement that the certifying physician himself or herself, or an NPP collaborating with the certifying physician, had a face-to-face encounter with the beneficiary. The revised statutory language permits a certifying practitioner to document that any allowed practitioner has conducted the F2F encounter regardless of whether they are the certifying practitioner or collaborating with certifying practitioner.”
NAHC is seeking clarification on whether the MACs have received any instructions regarding CMS’ position related to the changes in the statute.
I am assuming the section regarding private duty nursing under Medicaid was not changed to reflect NPPs ordering services since the statute was specific to home health services I am receiving questions from members and want to be sure that is the case rather than an oversight.
- 440.80 Private duty nursing services.
Private duty nursing services means nursing services for beneficiaries who require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of the hospital or skilled nursing facility. These services are provided—
(a) By a registered nurse or a licensed practical nurse;
(b) Under the direction of the beneficiary’s physician; and
CMS Response: The changes allowing allowed practitioners to certify and order services were made under Medicaid HH as well; however, we cannot speak to private duty nursing under Medicaid. Please reach out to MMCO for advisement regarding this question.
NAHC has reached out to the Medicare and Medicaid Coordination Office for clarification.
OSHA Issues Stronger Worker COVID-19 Safety Guidance
On January 29, 2021, OSHA issued stronger worker safety guidance to help employers and workers implement a coronavirus protection program and better identify risks that could lead to exposure and contraction.
Please take a moment to review “Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace” document, as it contains a reference to useful resources and tools and provides updated guidance and recommendations, and outlines existing safety and health standards.
Pediatric Long-Term Home Health (PLTHH) and Private Duty Nursing (PDN) Providers
PLTHH and PDN providers were previously notified that the PAR requirement for these services would be suspended as of July 1, 2020. It has been determined to keep the 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. It is still anticipated for the resumption of the PAR requirement for these services to be done in a phased-in manner. The Colorado Department of Health Care Policy and Financing plans to collaborate with providers to develop the plan for each phase of PAR submissions.
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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)