Issue date: July 8th 2024

• Amity Healthcare Group News
  • ACHCU Home Health Webinar
  • Skilled Nursing Competency
• OASIS – E Corner
• National News
  • CY 2025 Home Health Proposed Rule
  • Home Health Review Choice Demonstration Certifying Provider Change
  • RAC Audit Using COPs for Denial of Payment
  • Educational and Development Opportunities
• Colorado News
  • Fiscal Year 2024-2025 Provider Rate Adjustments
  • Private Duty Nursing Providers
  • Provider Training: OASIS-E: Section M – Skin Conditions
  • CDPHE-Tuberculosis (TB) Program

Amity Healthcare Group News

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.

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 ).

OASIS – E Corner
In this issue of OASIS-E Corner:

I) New Coding Tip for GG0170M 1 step, GG0170N 4 steps and GG0170O 12 steps

• When using a stair lift to ascend/descend stairs, code based on the type and amount of assistance the patient requires to ascend/descend the stairs, beginning once the patient is seated and ending when the patient is ready to transfer out of the seat.

II) New Response-Specific Instruction for J0510-J0530

• The time period under consideration or “look back” for the pain interview items includes the day of assessment in addition to looking back over the last 5 days. The day of assessment for these items is considered day 0.

III) Change Table for OASIS-E Manual 2024 Update.

• It appears that we included incorrect link to the Change Table for OASIS-E Manual 2024 Update in our last issue. Please see correct link here: https://www.cms.gov/files/document/change-table-oasis-e-manual-2024-update.pdf

NATIONAL NEWS
CY 2025 Home Health Proposed Rule

The biggest and most anticipated home health industry news is the CMS proposed Calendar Year (CY) 2025 Home Health Rule that became available on June 26, 2024 .

It is anticipated that this proposed rule will be posted in the Federal Register on July 3rd or 5th.

As anticipated, the proposed rule includes payment adjustment/payment cuts for home health providers as follows:

• CMS proposes an adjustment to the CY 2025 home health payment rate of -4.067%. According to CMS, this adjustment accounts for differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures due to the CY 2020 implementation of the PDGM and the change to a 30-day unit of payment.
  • CMS proposes a permanent adjustment to the base payment rate under the HH PPS to rebalance the Patient-Driven Groupings Model (PDGM) and make it budget-neutral.
    • Each of the 432 payment groups under the PDGM has an associated case-mix weight and LUPA threshold. CMS’ policy is to annually recalibrate the case-mix weights and LUPA thresholds using the most complete utilization data available at the time of rulemaking. In this proposed rule, CMS is proposing to recalibrate the case-mix weights – including the functional levels and comorbidity adjustment subgroups – and LUPA thresholds using CY 2023 data, to more accurately pay for the types of patients HHAs are serving.
• CMS proposes to:
  • update the fixed dollar loss (FDL) for outlier payments;
  • update the low utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity adjustment subgroups for CY 2025; establish a home health occupational therapy (OT) LUPA add-on factor; and update other LUPA add-on factors.
• This rule proposes to update the home health wage index and adopt the new labor market delineations from the July 21, 2023, OMB Bulletin No. 23-01 based on data collected from the 2020 Decennial Census. The July 21, 2023, OMB Bulletin No. 23-01 contains several significant changes. For example, there are new CBSAs, urban counties that have become rural, rural counties that have become urban, and existing CBSAs that have been split. The existing home health PPS regulations limit one-year wage index decreases to 5%, which will help mitigate the impact of CBSA changes on payment.

Other Highlights:

Home Health CoP Changes

CMS proposes the following changes to § 484.105:

• add a new standard at § 484.105(i) that would require HHAs to develop, implement, and maintain an acceptance to service policy that is applied consistently to each prospective patient referred for home health care. CMS proposes to require that the policy be reviewed annually and address, at minimum, the following criteria related to the HHA’s capacity to provide patient care: the anticipated needs of the referred prospective patient, the HHA’s caseload and case mix, the HHA’s staffing levels, and the skills and competencies of the HHA staff.
• at § 484.105(i)(1)(i) through (iv), HHAs would be required to include information regarding the HHA’s caseload and case mix (that is, the volume and complexity of the patients currently receiving care from the HHA), anticipated needs of the referred prospective patient, the HHA’s current staffing levels, and the skills and competencies of the HHA staff.
• at § 484.105(i)(2), that HHAs make public accurate information regarding the services offered by the HHA and any limitations related to the types of specialty services, service duration, or service frequency, and that HHAs review that information annually or as necessary.

Home Health Quality Reporting Program (QRP) 

There are no proposed changes to the expanded HHVBP Model for CY 2025.

However, CMS proposes to collect four additional items as standardized patient assessment data elements and replace one item collected as a standardized patient assessment data element beginning with the CY 2027 HH QRP.  The net effect of these proposals is an increase of four data elements at the start of care time point and a net increase in burden.  The four assessment items proposed for collection are:

• Living Situation
• Food Runs Out
• Food Doesn’t Last
• Utilities

CMS proposes replacing the current Access to Transportation item with a revised Transportation (Access to Transportation) item beginning with the CY 2027 HH QRP.

CMS has also been exploring several potential approaches for integrating health equity concepts into the expanded HHVBP Model developing other health equity measures that would more directly focus on certain disparities.

OASIS collection – all payer data collection

CMS is proposing to establish a change from data collection beginning with the OASIS discharge time point to using the start of care (SOC) time point. The SOC is the first assessment that can be submitted for a non-Medicare/non-Medicaid patient, either on or after January 1, 2025, for the phase-in (voluntary) period or on or after July 1, 2025, for the mandatory period.

Requests for Information (RFI) 

RFI Regarding Rehabilitative Therapists Conducting the Initial and Comprehensive Assessment

• CMS seeks public comments regarding whether CMS should shift its longstanding policy and permit all classes of rehabilitative therapists (PTs, SLPs, and OTs) to conduct the initial assessment and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care. CMS is soliciting comments specifically regarding the following:
  • What types of mentorships, preceptorship, or training do these disciplines have qualifying them to conduct the initial assessment and comprehensive assessment?
  • How do HHAs currently assign staff to conduct the initial assessment and comprehensive assessment? Do HHAs implement specific skill and competency requirements?
  • Do the education requirements for entry-level rehabilitative therapists provide them with the skills to perform both the initial assessment and comprehensive assessment?  Is this consistent across all the therapy disciplines? How does this compare with entry-level education for nursing staff?
  • What, if any, potential education or skills gaps may exist for rehabilitative therapists in conducting the initial assessment and comprehensive assessment?
  • What challenges did HHAs and therapists who conducted these assessments under the PHE waiver experience that may have impacted the quality of these assessments?
  • For the HHAs and therapists that conducted the initial assessment and comprehensive assessment under the PHE waiver, what were the benefits, and were there any unintended consequences of this on patient health and safety?
  • What challenges, barriers, or other factors, such as workforce shortages, particularly in rural areas, impact rehabilitative therapists and nurses in meeting the needs of patients at the start of care and early in the plan of care?

Plan of Care Development and Scope of Services Home Health Patients Receive

• CMS seeks public comments on factors that influence the services HHAs provide, the referral process, limitations on patients being able to obtain HHA services, such as rural location and availability of staff, plan of care development, and the HHA’s communication with patients’ ordering physicians and allowed practitioners. CMS is soliciting comments specifically regarding the following:
  • What factors influence an HHA’s decision on what services to offer as part of its business model and how often do HHAs change the service mix?
  • What are the common reasons for an HHA to not accept a referral?
  • How do physicians and allowed practitioners use their role in establishing and reviewing the plan of care to ensure patients are receiving the right mix, duration, and frequency of services to meet the measurable outcomes and goals identified by the HHA and the patient?
  • To what extent do physicians rely on HHA clinician evaluations and reports in establishing the mix of services, service frequency, and service duration included in the plan of care?
  • What are the patient and caregiver experiences in receiving nursing, aide, and therapy services when under the care of a home health agency?
  • What additional evidence is available regarding negative outcomes or adverse events that may be attributable to the mix, duration, and service frequency provided by HHAs, including, but not limited to, avoidable hospitalizations?
  • In what ways can referring providers and HHAs improve the referral process?
  • What other factors may influence the provision of services that impact the timeliness of services and service initiation?
  • What additional areas should CMS consider addressing HHA patient health and safety concerns?

We encourage you to carefully review the rule and submit your comments as follows:

Comments must be received at one of the addresses (please see below) no later than 5 p.m. EDT on August 26, 2024.

In commenting, please refer to file code CMS-1803-P. Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments to https://www.regulations.gov. Follow the instructions under the “submit a comment” tab.
2. By regular mail. You may mail written comments to the following address ONLY:
   Centers for Medicare & Medicaid Services,
   Department of Health and Human Services,
   Attention: CMS-1803-P,
   P.O. Box 8013,
   Baltimore, MD 21244-8013.
3. By express or overnight mail. You may send written comments via express or overnight mail to the following address ONLY:
   Centers for Medicare & Medicaid Services,
   Department of Health and Human Services,
   Attention: CMS-1803-P,
   Mail Stop C4-26-05,
   7500 Security Boulevard,
   Baltimore, MD 21244-1850

Home Health Review Choice Demonstration Certifying Provider Change | Link

Since then, Palmetto’s memo has been taken down and Palmetto GBA and other MACs confirmed that they are not applying the “hand off” requirement as part of RCD or medical review of claims.

CMS as well as Palmetto GBA has indicated that all MACs will be posting a revised memo and it is anticipated that any reference to a physician-signed “hand off” will be removed from it.  No expected timeline has been given in regards to revisions.

According to NAHC, Home health agencies that have had claims denied due to the lack of a “hand off” should appeal those denials. Likewise, home health agencies participating in the pre-claim review option for RCD that have had non-affirmations for this reason, should submit the Document Control Number (DCN) to Palmetto GBA for correction.This memo caused a tremendous amount of concerns and questions from providers. These questions and concerns reached the National Association for Home Care and Hospice (NAHC). NAHC was able to further explore the matter with CMS  and  was able to confirm that there is not a requirement for a physician-signed “hand off” under any circumstance in home health.

RAC Audit Using COPs for Denial of Payment

Multiple providers have been reporting RAC audit payment denials based upon a Start of Care (SOC) date that occurred 48 hours after the referral.

The denial statement includes the following:“After review of the submitted record, the billed services were denied for reason(s) as follows:
The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician-ordered start of care date. An HHA that is unable to complete the initial assessment within 48 hours of referral or the patient’s return home, shall not request a different start of cate date from the ordering physician to ensure compliance with the regulation or to accommodate the convenience of the agency. In instances where the patient requests a delay in the start of care date, the HHA would need to contact the physician to request a change in the start of care date and such change would need to be documented in the medical record.”

This matter has been brought to the attention of the National Association for Home Care and Hospice (NAHC). While NAHC is addressing the matter with Performant, the providers are being reminded of the following rule from the Medicare Program Integrity Manual, chapter 3, section 3.1 that might help with appeals for the timely initiation of care denials.

Medicare Program Integrity Manual (cms.gov)

3.1 – Introduction

A. Goal

The Medicare Fee For Service Recovery Audit program is a legislatively mandated program (Tax Relief and Health Care Act of 2006) that utilizes Recovery Auditors to identify improper payments paid by Medicare to fee-for-service providers. The Recovery Auditors identify the improper payments, and the MACs adjust the claims, recoup identified overpayments and return underpayments.

MAC, CERT and Recovery Auditor staff shall not expend Medicare Integrity Program (MIP)/ MR resources analyzing provider compliance with Medicare rules that do not affect Medicare payment. Examples of such rules include violations of conditions of participation (COPs), or coverage or coding errors that do not change the Medicare payment amount.

The COPs define specific quality standards that providers shall meet to participate in the Medicare program. A provider’s compliance with the COPs is determined by the CMS Regional Office (RO) based on the State survey agency recommendation. If during a review, any contractor believes that a provider does not comply with conditions of participation, the reviewer shall not deny payment solely for this reason. Instead, the contractor shall notify the RO and the applicable State survey agency.

NAHC is urging providers who received denials based on the Start of Care date to exhaust all levels of appeal.

Educational and Development Opportunities

• Home Health Outcomes (this distinction will allow your organization to validate excellence in meeting measurement-based quality standards established by the Centers for Medicare & Medicaid Services (CMS).
• Age-Friendly Care (this distinction recognizes agency’s ability to deliver care to meet age appropriate care needs, support independence, and align with patient preferences).

For more information, please go to: https://www.achc.org/new-hh-hsp-distinctions/#hho

II) Remote Patient Monitoring Certificate Program Coming Fall 2024

Department of Veterans Affairs offers free Remote Patient Monitoring Certificate Program

Enrollment for this program will open on August 12, 2024, and courses will become available on September 12 for 98 days.

Developed by the U.S. Department of Veterans Affairs and University of Florida College of Nursing, the Remote Patient Monitoring Certificate Program is a free program aimed to equip health care professionals across the industry with the essential information they need to navigate the dynamic landscape of RPM.

For more information, sign up to receive email updates on the program, registration, and certification opportunities.

If you have questions, contact Rita Kobb, MSN, APRN GERO-BC, Telehealth Training and Outreach Lead at the VA Quality and Training Division/Connected Care by emailing rita.kobb@va.gov

III) 2024 Home Health & Hospice MAC Collaborative Summit

Registration for 2024 Home Health & Hospice MAC Collaborative Summit Perfecting Performance By Breaking Down Barriers is now open! This event is being held live, in-person at the Flamingo Las Vegas Hotel & Casino in Las Vegas, Nevada, October 2, 3 & 4, 2024.

National Government Services, Inc. (NGS), Palmetto GBA and CGS Administrators have designed this unique collaborative educational opportunity for HHH providers from every state and Medicare jurisdiction.

For more information and registration, please go to: https://web.cvent.com/event/017c4501-c8db-406d-8d74-f18eb18cedc4/summary

COLORADO NEWS
Fiscal Year 2024-2025 Provider Rate Adjustments

If you are unable to attend the virtual training, the course is available as a self-study training on Train. Select the link or search on Train.org for Course ID: 1121329 or the title “OASIS-E: Section M: Skin Conditions”.

The complete offering of training opportunities for providers can be found at:  HFEMSD Provider Training Catalog

Other questions? Contact wendy.castro@state.co.us
or cdphe_mds_colorado@state.co.usThe training focuses on the ability to accurately identify and assess the presence of pressure ulcers/injuries, stasis ulcers, and surgical wounds and provides insight and tips to aid in the accurate coding of the OASIS assessment.

A web-based training will be available on Tuesday, July 9th, 2024, from 10 a.m. to 12 noon. Select the link to register for the virtual training, Course ID: 1121509.

CDPHE-Tuberculosis (TB) Program

The Colorado Department of Public Health and Environment is reminding providers of the Board of Health TB reporting requirements specified in 6 CCR 1009-1.

Per rule 6 CCR 1009-1, providers must report all suspected and confirmed TB disease cases to the appropriate local public health agency (where the patient resides) or CDPHE within one (1) business day. A report should be made if TB is in the differential and TB testing is being performed, regardless of the level of suspicion.CDPHE requests that you also report individuals who are suspected to have TB and tested for tuberculosis disease. The local public health agency must have time to review and discuss the patient’s treatment plan and coordinate adequate follow-up between health care providers and public health to ensure continuity of care.

Collaboration is imperative to case management and patient safety.

Link to report a person with potential or confirmed TB disease

• Report persons in the respective county where they reside (local public health agency).
• Providers may also contact our Colorado Tuberculosis Program.
• Report for persons residing in the Denver metro area (adults and children living in Adams, Arapahoe, Boulder, Broomfield, Denver, Jefferson, and Douglas counties) to:
  • Denver Metro Tuberculosis Clinic, 303-602-7240

Long-term Home Health (LTHH) Policy Team Office Hours

Just a reminder for an opportunity to join LTHH Policy Team office hours on the second Tuesday of the month, 1 to 2 p.m. MT, through all of 2024. The meeting will be held:

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. All interested stakeholders are welcome.

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/resourcesIf you wish to forward this email to your colleague or friend, please feel free to do so. If you received this message as a forward, we invite you to subscribe to our communications at https://amityhealthcaregroup.com (look for “Subscribe to Listserv” in the top corner). If you wish to unsubscribe from this email distribution list, please email to eg@amityhealthcaregroup.com

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