We are thrilled to announce our partnership with Accreditation Commission for Health Care (ACHC). Accreditation Commission for Health Care (ACHC) and Amity Healthcare Group are dedicated to working together to provide the best possible experience to Amity Healthcare Group customers being able to offer customer discounts on ACHC education offerings and accreditation to organizations and healthcare professionals that seek accreditation and related services.
We are excited about our continued collaboration with ACHC and an opportunity to continuously help providers maintain regulatory compliance and improve business operations in an effective manner.
OASIS -E Corner
Part I: OASIS-E item C1310-Signs and Symptoms of Delirium
Question: How should item C1310 be coded when a patient is comatose at baseline and at the time of assessment?
Answer: If the patent was comatose at baseline and at the time of assessment, code as follows:
C1310A – Acute Onset of Mental Status Changes as Code 0 – No
C1310B – Inattention as Code 1 – Behavior continuously present, does not fluctuate.
C1310C – Disorganized Thinking as Code 0 – Behavior not present.
C1310D – Altered level of consciousness as Code 1 – Behavior continuously present, does not fluctuate.
C1310 identifies any signs or symptoms of acute mental status changes as compared to the patient’s baseline status and if there are any signs or symptoms of delirium present at the time of assessment.
Part II: OASIS-E Social Determinants of Health Items
CMS has developed a 4-minute, animated explainer video, Social Determinants of Health Items: Determining When a Proxy Response is Allowed for home health providers. This video was developed to assist providers in accurately determining when the use of a proxy response is allowed for Social Determinants of Health items: A1005. Ethnicity, A1010. Race, A1110. Language, A1250. Transportation, B1300. Health Literacy, and D0700. Social Isolation.
The video can be accessed through the following link: Social Determinants of Health Explainer Video
OSHA Finalizes Injury and Illness Log Submission Requirements
The Occupational Safety and Health Administration (OSHA) issued a final rule that amends its occupational injury and illness recordkeeping regulation to require certain employers to electronically submit injury and illness information to OSHA that employers are already required to keep under the recordkeeping regulation.
OSHA has developed a list (Appendix A) of Industries that will be required to continue to electronically submit Form 300A annually if they have 20 or more employees. OSHA also developed the second, new, list (Appendix B)that includes the industries that OSHA requires submission of Forms 300, 301, and 300A annually if they have 100 or more employees.
Please note that home health agencies are not on the lists and therefore are not included in the OSHA form submission requirements for organizations with less than 250 employees. However, because OSHA finalized the requirements for all employers/entities with 250 or more employees to electronically submit Form 300A-Summary of Work-Related Injuries and Illnesses on an annual basis, large home health organizations will be required to comply with this requirement.
The above is done with the intent to post the data from the annual electronic submission requirement on a public website after identifying and removing information that reasonably identifies individuals directly.
This final rule becomes effective on January 1, 2024.
New Edition of Form I-9
On August 1, 2023, U.S. Citizenship and Immigration Services (USCIS) published a revised version of Form I-9, Employment Eligibility Verification (PDF, 477.5 KB). Among the improvements to the form is a checkbox employers enrolled in E-Verify can use to indicate they remotely examined identity and employment authorization documents under an alternative procedure authorized by the Department of Homeland Security (DHS) described below.
Please note that only employers enrolled in E-Verify have the option to remotely examine their employees’ identity and employment authorization documents under a DHS-authorized alternative procedure. The employers will still be required to examine the documents, retain copies of all documents, conduct a live video interaction with the employee, and create an E-Verify case if the employee is a new hire.
Employers who were participating in E-Verify and created a case for employees whose documents were examined during COVID-19 flexibilities (March 20, 2020 to July 31, 2023), may choose to use the new alternative procedure starting on August 1, 2023 to satisfy the physical document examination requirement by August 30, 2023.
Employers who were not enrolled in E-Verify during the COVID-19 flexibilities must complete an in-person physical examination by August 30, 2023.
The revised Form I-9 (edition date 08/01/23) will have an expiration date of 07/31/2026. Employers can use the current Form I-9 (edition date 10/21/19) through October 31, 2023. Starting November 1, 2023, all employers must use the new Form I-9.
The new form will contain the following changes:
- Reduces Sections 1 and 2 to a single-sided sheet;
- Moves the Section 1 Preparer/Translator Certification area to a separate, standalone supplement that employers can provide to employees when necessary;
- Moves Section 3, Reverification and Rehire, to a standalone supplement that employers can print if or when rehire occurs or reverification is required;
- Revises the Lists of Acceptable Documents page to include some acceptable receipts as well as guidance and links to information on automatic extensions of employment authorization documentation;
- Reduces Form instructions from 15 pages to 8 pages; and
- Includes a checkbox allowing employers to indicate they examined Form I-9 documentation remotely under a DHS-authorized alternative procedure rather than via physical examination.
CMS Proposes New Provider Enrollment Provisions
As we have previously mentioned in one of our newsletters, in the CY 2024 Home Health proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposed several new regulations governing Medicare provider enrollment. These proposals apply to home health and hospice providers as follows:
Provider Screening Categories
During the COVID-19 PHE, CMS waived the fingerprint based criminal background check (FBCBC) requirement for newly enrolling providers that fall under the “high-screening” category for enrollment, such as HHAs. Now that the PHE has ended, CMS intends to request the FBCBC for these providers during revalidation but must incorporate this authority into regulation.
Because CMS is modifying when it may obtain the FBCBC for high screening providers, they are proposing to revise § 424.518(b)(ix) that would include within the moderate-risk category revalidating HHAs and hospices that underwent FBCBCs:
- when they initially enrolled in Medicare; or
- upon revalidation after CMS waived the FBCBC requirement provider or supplier initially
Provisional Period of Enhanced Oversight (PPEO)
CMS is codifying into the regulations at § 424.527 the definition of a new provider and is also changing the date for the enhanced oversight period from the first date of service to the date of the first claim submission.
- 424.527(a) New provider defined for provisional period of enhanced oversight (PPEO)
- A newly enrolling Medicare provider or supplier
- A certified provider or certified supplier undergoing a change of ownership
- A provider or supplier (including an HHA or hospice) undergoing a 100 percent change of ownership via a change of information.
- 424.527(b) The effective date of the PPEO’s commencement is the date on which the new provider or supplier submits its first claim rather than the date the first service was performed or the effective date of the ownership change.
CMS proposes to extend the maximum length of a reapplication bar under § 424.530(f) from 3 years to 10 years for provider enrollment application denials.
Proposes at § 424.542 that a provider or supplier that is currently subject to a reapplication bar under § 424.530 may not order, refer, certify, or prescribe Medicare-covered services, items, or drugs and may not be paid for any Medicare-covered services, items, or drugs while under the re-application bar.
CMS proposes to revise § 424.540(a)(1) to change the 12-month time frame to 6 months for deactivations related to non-billing. CMS may deactivate a providers’ billing privileges for several reasons, one reason is when a Medicare enrolled provider does not submit a claim to Medicare for greater than 12 consecutive months. For example, a Medicare certified home health agency that only serves Medicaid beneficiaries and therefore never submits a claim to Medicare.
CMS proposes in new § 489.52(b)(4) to codify its current policy that a provider may request a retroactive termination date, but only if no Medicare beneficiary received services from the facility on or after the requested termination date.
Provider Enrollment Revocations
- Revise 424.535(a)(1) to refer to title 42 rather than Part P for non-compliance.
- Revise 424.535(a)(16)(i) to include misdemeanors. CMS may revoke a provider’s or supplier’s enrollment if they, or any owner, managing employee or organization, officer, or director have been convicted) of a misdemeanor under Federal or State law within the previous 10 years.
- Add § 424.535(a)(15) that permits CMS to revoke the enrollment of a provider or supplier if the provider or supplier, or any owner, managing employee or organization, officer, or director has had a civil judgment under the False Claims Act (FCA) imposed against them within the previous 10 years.
- Under § 424.535(a)(17), CMS may revoke enrollment if the provider or supplier has an existing debt that CMS appropriately refers to the United States Department of Treasury.
Effective date for revocations
A new § 424.535(g)(3) would state that if the action that triggered the revocation occurred before the provider’s or supplier’s enrollment effective date, the revocation effective date would be the enrollment effective date that CMS assigned to the provider or supplier.
Timeframes for Reversing a Revocation
CMS proposes to revise § 424.535(e) to reduce the 30-day period to 15 days to terminate a relationship with a business partner that has been the cause of the revocation.
Enrollment Application Denial
CMS proposes to include the same reasons for enrollment application denials at § 424.530 as enrollment revocations.
- Refer to title 42 rather than Part P for non-compliance.
Deny a providers enrollment application for:
- False claim civil judgement
- Violation of standards or conditions
Stay of Enrollment
CMS proposes a new enrollment status labeled a “stay of enrollment.” This would be a preliminary, interim status, prior to any subsequent deactivation or revocation that would represent, in a sense, a “pause” in enrollment, during which the provider or supplier would still remain enrolled in Medicare.
There are two prerequisites for a stay’s implementation:
- The provider or supplier must be non-compliant with at least one enrollment requirement in Title 42. Mere suspicion of or information alleging non-adherence is insufficient.
- CMS ascertains that the provider or supplier can remedy the non-compliance via the submission of, as applicable to the situation, a Form CMS-855, Form CMS-20134, or 835 Form CMS-588 change of information or revalidation application.
During the period of any stay the provider or supplier remains enrolled in Medicare, but claims submitted by the provider or supplier with dates of service within the stay period will be denied.
The stay will last no longer than 60 days. Providers and suppliers have 15 days to submit a rebuttal.
Reporting Changes in Practice Location
- CMS is proposing to require practice location changes, additions, and deletions be reported within 30 days for all provider types.
- Clarify that that a change of practice location includes adding a new location or deleting an existing one.
The Office of Civil Rights HIPAA Enforcement Discretion Expired!
As we have previously discussed, the Office of Civil Rights (OCR) gave healthcare providers 90 days after the COVID-19 PHE ended to transition to HIPAA compliant telehealth technologies. The OCR published guidance on how providers can use remote communications technologies for audio-only telehealth in compliance with HIPAA rules, including when the notice of enforcement discretion is no longer in effect.
Just a reminder that health care providers must have been in compliance with the HIPAA rules with respect to telehealth effective August 9, 2023, at 11:59 p.m., when the 90-day enforcement discretion period expired.
Guidance: How the HIPAA Rules Permit Covered Health Care Providers and Health Plans to Use Remote Communication Technologies for Audio-Only Telehealth | HHS.gov
NHPCO and NAHC Boards Agree to Pursue Creation of a New, Combined Organization
On August 10, 2023, the Boards of Directors of the National Association for Home Care & Hospice (NAHC) and the National Hospice & Palliative Care Organization (NHPCO) signed a non-binding Letter of Intent to jointly explore the formation of a new, as-of-yet unnamed, organization that combines the strengths of NAHC and NHPCO, creating a better and more powerful advocate for the entire home care, hospice, palliative care, and serious illness community.
The joint announcement stated that “the purpose of combining the two leading organizations serving providers of care to America’s elderly, disabled, and dying is simple: to better serve you.” Both Boards voted for this course of action following the recommendations of a Steering Committee composed of member and staff leaders from both organizations.
Many details are still being determined and in the coming months, the NAHC and NHPCO Boards of Directors will work together, in consultation with member volunteers from both organizations, to determine how a consolidated organization could represent the best interests of the combined memberships. The organizations expect this process to take six to ten months.
ARPA 7.02 Member Emergency Preparedness
Just a reminder that there is still time to apply for ARPA 7.02- Member Emergency Preparedness Surviving In Place Battery Backup Power Supply Systems.
With funding made available through the American Rescue Plan Act (ARPA) and in collaboration with the Center for Inclusive Design and Engineering (CIDE), HCPF will be distributing Battery Backup Power Supply Systems to eligible Health First Colorado (Medicaid) members, assisting them in having the necessary equipment to be better prepared and in maintaining their health, safety, and independence.
If any of your patients may benefit from participation in this program or if you are interested in getting a Backup Power Supply System, please complete the application. Once received, the application will be reviewed, information verified, and a determination made if the applicant qualifies. There is a limited supply and a final decision will be made on eligibility and the availability of devices. All applicants will be notified of their results within two months of receipt of the application. All questions should be directed to Julia Beems at 303-315-1284 or email@example.com.
For more information about the project visit the Surviving in Place webpage.
Colorado Case Management Agency (CMA) Restructuring
In December 2022, HCPF issued a Request for Proposal (RFP) soliciting competitive, responsive proposals from experienced and financially sound organizations to perform as a Case Management Agency (CMA) in defined service areas across the State of Colorado. CMAs serve within a local area where a current or potential Long-Term Services and Supports (LTSS) member can obtain LTSS information, screening, assessment of eligibility, assessment of need, and referral to appropriate LTSS programs. CMAs also provide members who receive LTSS within their defined service areas with ongoing case management services.
As the result of the above, the current state of CMAs will be resigned and contracts will be awarded to new CMA organizations. HCPF is working with both incoming and outgoing agencies to determine individual agency transition timelines and will be providing communications to the stakeholders who will be impacted by these changes. HCPF communication is expected to go out to members by the end of September. Individual agency communications will be sent within specified timeframes within each phase of transition for CMAs.
Please refer to a complete HCPF MEMO here.
Attention Colorado HCBS Providers and Direct Care Workers!
- The Alzheimer’s and Dementia Caregiving at Home (available on Mondays and Wednesdays)
- Creating Safe Home Environment for People Living with Dementia and Alzheimer’s Disease (available on Fridays)
To register for your free course, please go HERE
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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)
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