Issue date: April 2nd 2024

Amity Healthcare Group News

Skilled Nursing Competency

Are you looking for a solution for a comprehensive and robust nursing competency program?



The “virtual” Skilled Nursing Competency program offered by Amity Healthcare Group, LLC is designed to assist agencies in meeting initial and/or annual competency requirements for Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/LVNs) in the home health care setting.

Please note that our skilled nursing competency program is certified by Accreditation Commission for Health Care (ACHC) (learn more here).

For more information, questions, or registration for Amity’s home health skilled nursing competency program, please go to https://amityhealthcaregroup.com/nursing-competency/.

ICD-10 Coding and Clinical Documentation Review

Did you know that Amity Healthcare Group provides ICD-10 coding and clinical documentation review for home health providers? If you are seeking to outsource your clinical documentation review and/or ICD-10 coding process on a long-term or temporary basis, please reach out to us for assistance. Our services include:

• ICD – 10 Coding
• OASIS Review + ICD – 10 coding
• OASIS Review + POC (Plan of Care) Review
• OASIS Review + ICD – 10 Coding + POC (Plan of Care) Review
• Episodic documentation review
• Quality Trends Analysis and QAPI Development

For more information, please visit us at https://amityhealthcaregroup.com/services/coding-and-documentation/.

With questions, please contact us at 303-690-2749 or email at ig@amityhealthcaregroup.com.

OASIS – E Corner

We wanted to highlight the following OASIS related question in this newsletter:

In this issue, we would like to bring your attention to OASIS item M2401 Intervention Synopsis (completed at Transfer and Discharge from agency).

The intent of this item is to identify if specific interventions were BOTH included on the plan of care AND implemented as part of the care provided at the time of or at any time since the most recent SOC/ROC assessment.

In our quality assurance reviews of both transfer and discharge OASIS, we have frequently noted that the clinician will indicate the response YES for an intervention and yet there is no corresponding documentation to support that the intervention was included on POC and/or implemented as part of the care provided since the most recent SOC/ROC.

Remember, if the documentation does not support the interventions being included on the plan of care and being implemented as part of the care provided, then the answer must be NO or NA.

Coding instructions for this item:

Code Yes only if the Plan of Care includes the interventions listed in each row, AND there is evidence of implementation in the clinical record, by the time the Discharge or Transfer assessment was completed.

Code No if the interventions are not on the Plan of Care OR if the interventions are on the Plan of Care but the interventions were not implemented by the time the Discharge or Transfer assessment was completed, unless “NA” applies.

Code NA according to the instructions in the last column of the item, for each row.

Dash is not a valid response for this item.

NATIONAL NEWS

CMS Revives Appendix B

On March 15, 2024, the Centers for Medicare & Medicaid Services (CMS) has issued revisions to the Medicare State Operations Manual, Appendix B, also referred to as the Interpretive Guidelines for the home health Conditions of Participation(CoPs).

According to CMS memorandum, in the revised Appendix B CMS:

• Revises the Level 1 standards that surveyors must assess during a standard survey.
• Adds three Emergency Preparedness tags to Level 1 standards. (A partial extended survey is conducted when noncompliance is identified in any Level 1 Standard).
• Adds a cross-reference to Appendix Z for the HHA emergency preparedness tags.
• No longer identifies specific Level 2 standards; instead, when noncompliance with a Level 1 standard is identified, all remaining standards within the relevant CoP are evaluated, and a determination will be made as to the compliance with the condition.
• Revises tags to reflect updated regulatory language based on final rules and adds interpretive guidance where appropriate.
• Consolidates tags to remove redundancy.
• Adds survey procedures to multiple tags to assist surveyors in assessing compliance with the regulatory requirements.
• Makes multiple technical and formatting revisions to fix regulatory citations, acronyms, and tag titles.
• Retires CMS memos that are no longer applicable or have been incorporated into Appendix B.
• Adds the survey protocol for HHAs to Part I of Appendix B. Appendix B replaces older CMS memos that we are retiring and describes the requirements and procedures for conducting an HHA survey.

Below, you will find several examples of the revisions:

§484.55(c) Standard: Content of the comprehensive assessment.

(c)(5) A review of all medications the patient is currently using … CMS has modified the guidance to no longer require the RN review the medication list in therapy cases, and states:

• “Each agency must determine the capabilities of current staff members to perform comprehensive assessments, considering professional standards or practice acts specific to the State. No specific discipline is identified as exclusively able to perform the medication review. However, only Registered Nurses (RNs), Physical Therapists (PTs), Occupational Therapists (OTs) and Speech-Language Pathologists (SLPs) are qualified to perform comprehensive assessments (see also §484.55(b)). While only the assessing clinician is responsible for accurately completing and signing a comprehensive assessment, the agency may develop a policy where clinicians may collaborate to collect data for all OASIS items. For example, to assess potential side effects and drug interactions, the agency may wish to have RNs or practical (vocational) nurses, as defined in §484.115, review the mediation lists.”

§484.60(a)(2) The individualized plan of care must include the following: (i) All pertinent diagnoses.

CMS revises the definition for pertinent diagnoses to not require all known diagnoses,

• “In general, pertinent diagnoses include, but are not limited to, the chief reason the patient is receiving home care and the diagnosis most related to the current home health plan of care. Additionally, comorbid conditions that exist at the time of the assessment, that are actively addressed in the patient’s Plan of Care, or that have the potential to affect the patient’s responsiveness to treatment and rehabilitative prognosis should be considered and documented.”

§484.80(g)(1) Standard: Home health aide assignments and duties.  

CMS clarifies that when both nursing and therapy services are involved, either skilled professional may assign home health aides and develop written patient care instructions.

§484.105(b)(1) Standard: Administrator. The administrator must: (i) Be appointed by and report to the governing body.

CMS removed the definition for “reports to” that prohibited the administrator from using intermediaries when reporting to the governing board.

Please review a revised APPENDIX B. Please note that NAHC and Accrediting Organizations (AOs) are reviewing changes to the Appendix B and will continue to inform providers of any corresponding changes to AOs standards and/or survey protocols. NAHC is also working on developing a crosswalk between the current version and the revised version of the Appendix B in addition to other educational offerings.

OIG Issues Annual Medicaid Fraud Control Unit Report

On Thursday, March 14th, the Office of Inspector General (OIG) at the Department of Health and Human Services released a report detailing the 2023 outcomes from the State Medicaid Fraud Control Units across the country. The report identifies several areas of interest for home health and personal care providers and demonstrates the OIG’s focus on compliance in health care industry.

Specifically, the OIG report discussed:

• Criminal convictions for incidents of abuse or neglect
• Criminal convictions for fraud
• Ongoing open investigations for fraud

The full report is available HERE.

Updated COVID-19 Isolation Guidelines

On March 1, 2024, the Centers for Disease Control and Prevention (CDC) announced update to its COVID-19 guidance and is no longer recommending that individuals who test positive for COVID-19 isolate for five days.  Instead, CDC is now offering a “unified approach” to management of respiratory viruses that include flu and RSV along with COVID-19.


In the light of the revised guidelines, individuals who develop various respiratory virus symptoms, including fever, chills, fatigue, cough, runny nose, and headache should monitor themselves and are recommended to “stay home and away from others”, but also advised that they can return to normal activities if their symptoms are improving and they have not had a fever without the use of fever-reducing medication for at least 24 hours. The CDC’s recommendations do not include any minimum isolation period.

As the new guidance is “intended for community settings”, including senior living communities, and does not apply to healthcare settings, including nursing homes, the revised guidance raises a valid question of how the guidance encompasses home care that operates in patients’ homes.

Home Health agencies are encouraged to review their COVID-19/Infection Control policies, as may be appropriate, while the industry experts recommend for the employer to take the following steps:

1. Review Time-off Requirements: Employees who are actively symptomatic with a respiratory virus should be encouraged not to come to work, both for their own health and to avoid spreading the virus to patients and other staff members.  Active COVID-19 will generally qualify for paid sick time in all state and local jurisdictions with general paid sick time requirements. Employees may also be eligible for paid family leave or kin care leave to tend to ill family members, and serious cases of COVID-19 may qualify an employee for unpaid leave under FMLA or analogous state provisions.
2. Prepare for Accommodations: employers should be prepared to address potential accommodation requests from staff members with active COVID-19 and/or other respiratory virus.
3. Review Industry and State Requirements: employers in health care setting should continuously monitor state guidelines for any changes/revisions as they may be subject to special workplace safety and health requirements related to the management of communicable diseases, including respiratory viruses. For example, California still has a requirement for a COVID-19 Prevention Program, and employers must still comply with these requirements until those regulations sunset.
4. Recommend COVID-19, Flu and RSV Vaccination and Boosters: the CDC emphasizes vaccination as the “core strategy” for reducing the risk of severe illness from respiratory viruses. Employers that have been providing onsite flu vaccination clinics may consider whether to make updated COVID-19 boosters available to employees as well.

Implementing HIPAA Security Rule: A Cybersecurity Resource Guide

The Department of Health & Human Services (HHS) Office for Civil Rights (OCR) and the National Institute of Standards and Technology (NIST) announced the publication of the final version of Special Publication (SP) 800-66 Revision 2, Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: A Cybersecurity Resource Guide. This revised publication includes resources for HIPAA covered entities (most health care providers, health plans and health care clearinghouses) and their business with the law and improve security.

The publication provides an overview of the HIPAA Security Rule, strategies for assessing and managing risks to electronic protected health information (ePHI), suggestions for cybersecurity measures and solutions that HIPAA covered entities and business associates might consider as part of an information security program, and resources for implementing the Security Rule.

The following sections of the document deserve specific attention:

1. Risk assessment guidance.
2. Risk management guidance.
3. Security safeguards (awareness, training, incident reporting procedures, business associate agreements, etc.).

In addition to the publication itself, NIST has also provided supplementary content (Appendix F: HIPAA Security Rule Resources) to further assist HIPAA covered entities and business associates with strategies to improve their cybersecurity in specific areas including:

1. Telehealth/Telemedicine
2. Mobile Device Security
3. Ransomware & Phishing
4. Medical Device Security
5. Cloud Services
6. Internet of Things Used in Healthcare
7. Application Security
8. Supply Chain

NIST also updated its Cybersecurity and Privacy Reference Tool (CPRT). The CPRT shows HIPAA Security Rule regulations with links to additional NIST tools.

We recommend that you take into consideration the content from the revised publication and review your current practices and policies as well as level of vulnerability and preparedness to address a potential cybersecurity incident, especially, in the light of the recent Change Healthcare cyber-attack. We also recommend including cyber-attack as a potential man-made disaster in your Emergency Preparedness Plan and consider adding this aspect of operations into your compliance program.

CMS Issues Instructions on “Stay of Enrollment”

The Centers for Medicare & Medicaid (CMS) has issued Change Request (CR) 13449 that outlines CMS’ policies for a new Medicare provider enrollment status. One of these provisions involves the establishment of a new provider enrollment status labeled a “stay of enrollment”.

A stay of enrollment is a preliminary, interim status—prior to any subsequent deactivation or revocation—that would represent a “pause” in enrollment, during which the provider would remain enrolled in Medicare.

There are two requirements for a stay of enrollment implementation. Specifically, the provider:

1. Is non-compliant with at least one enrollment requirement; and
2. Can remedy the non-compliance via the submission of, as applicable to the situation, a Form CMS-855, Form CMS-20134, or Form CMS-588 change of information or revalidation application.

A stay of enrollment lasts no longer than 60 days from the postmark date of the notification letter, which is the effective date of the stay. A stay has a maximum length of 60 days and cannot be extended. However, CMS can impose a stay of less than 60 days. It is not required that each assigned stay period be 60 days.

Claims submitted by the provider with dates of service within the stay period will be rejected. However, if the provider comes into compliance with all Medicare enrollment requirements prior to the expiration of the stay period, claims may by be resubmitted for payment.

The CR, and subsequent Medicare manual updates, provide additional details regarding CMS’ policies around the stay of enrolment along with case study examples.

NAHC/HHFMA Medicare Advantage Survey

NAHC is embarking on a landmark survey focused on the operational and financial aspects of the relationship between home health agencies (HHAs) and Medicare Advantage (MA) plans.



Please complete the survey by Monday, April 15, 2024. 

The survey ties into early MA studies from NAHC that examined the relationships between 2014 and 2020. As such, the 2024 edition provides a crucial opportunity to compare today’s environment with those earlier benchmarks.

The data NAHC/HHFMA seek in this survey is essential to the advocacy efforts on behalf of HHAs and helpful to HHAs in their own business decisions.

Once the surveys are collected, NAHC/HHFMA will provide a webinar to review the data outcomes.

Survey link: www.surveymonkey.com/r/SHDB2TH

COLORADO NEWS

Long-Term Home Health Stakeholder Engagement Opportunities

HCPF is offering two new long-term home health stakeholder engagement opportunities that you will want to be a part of.

I.) Long-term Home Health (LTHH) Stakeholder Engagement Kickoff Meeting

The purpose of the LTHH Stakeholder Engagement Kickoff Meeting is for advocates, providers, members, case managers, and other interested stakeholders to collaborate with and advise HCPF as it develops ongoing opportunities for all stakeholders to share information about the Home Health Benefit. All interested stakeholders are welcome. For more information, email homehealth@state.co.us

II.) LTHH Policy Team Office Hours

The purpose of the LTHH Policy Team Office Hours is for advocates, providers, members, case managers, and other interested stakeholders to receive training, information sharing and technical assistance in an open forum working directly with HCPF staff.

LTHH Policy Team office hours will be held through all of 2024 on the second Tuesday of the month at 1 to 2 p.m. MT, beginning Tuesday, April 9, 2024. All of the meetings are posted on the OCL Stakeholder Engagement and Calendar webpage. For more information, email homehealth@state.co.us.

LTHH Policy Team office hours will be held starting Tuesday, April 9, 2024 1 to 2 p.m. MT

Emergency Preparedness-Virtual Training Opportunities

In partnership with HCPF, the Center for Inclusive Design and Engineering (CIDE) is offering several virtual emergency preparedness training opportunities. The trainings have been developed and tailored for two distinct groups – provider agency staff and individuals with access and functional needs (as well as their family members and caregivers).

These comprehensive sessions will cover essential topics such as maintaining agency operations during emergencies; training staff members to instruct their peers on agency emergency preparedness policy and procedures; utilizing backup battery systems during power outages; and empowering clients to be self-sufficient and prepared for any emergency, thus reducing reliance on community resources.

I.) Provider Agency Staff Trainings -Plan, Prepare, Respond

This interactive class is for decision makers (agency administrators, safety managers, EP plan development team) to develop and/or enhance an agency emergency preparedness and response plan.

Please note: this training takes place in 2 parts.

• Tuesday April 2, 8 a.m. to 12 p.m. (Part 1)
• Tuesday April 16, 1 to 5 p.m. (Part 2)
• Saturday April 13, 8 a.m. to 12 p.m. (Part 1)
• Saturday April 27, 1 to 5 p.m. (Part 2)

II.) Train the Trainer

This class is for all agency staff to increase their knowledge and understanding of the agency emergency preparedness plan and to learn their roles and responsibilities during an emergency response. Participants will also learn how to how to provide emergency preparedness trainings of their own.

• Wednesday, April 3, 1 to 5 p.m.
• Saturday, April 6, 1 to 5 p.m.
• Wednesday, April 17, 8 a.m. to 12 p.m.
• Saturday, April 20, 1 to 5 p.m.

III.) Provider Agency Staff & Member/Family/Caregiver Training

This training will help individuals (providers, patients, family members, caregivers, and community members) create a backup power plan for their life-sustaining medical equipment, including how to prioritize multiple devices that require power during a power outage, how to account for special considerations, and low tech solutions.

• Tuesday, May 21, 6 to 9 p.m.
• Tuesday, June 4, 6 to 9 p.m.

IV.) Member/Family/Caregiver Training

This training will provide basic information for individuals with access and functional needs, their families and their caregivers on how to prepare for and respond to disasters. Participants will learn how to make a plan, build a kit and stay informed.

Please note: this training takes place in 2 parts.

• Saturday, May 18, 9 a.m. to 12 p.m. (Part 1)
• Saturday, May 25, 9 a.m. to 12 p.m. (Part 2)
• Thursday, June 6, 6 to 9 p.m. (Part 1)
• Thursday, June 20, 6 to 9 p.m. (Part 2)

Get More Information & Register

Please direct any questions to Julia Beems or Zack Hersh.

We are excited about the opportunity to continue supporting Home Health agencies.
Amity’s newsletters will be archived on Amity’s Healthcare Group website at https://amityhealthcaregroup.com/resources  under  Resources/ Our Newsletter section.

Please do not hesitate to reach out for any assistance or questions via email, phone, or website at https://amityhealthcaregroup.com/resources

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Thank you,
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)
www.amityhealthcaregroup.com