Issue date: May 28th 2024

Table Of Contents: –

Amity Healthcare Group News

• • ACHCU Home Health Webinar
• OASIS – E Corner
• National News
  • Review Choice Demonstration Extended
  • Home Health Review Choice Demonstration Certifying Provider Change
  • CMS Issued Updates to Home Health Claims Processing
  • HHS Finalizes Non-discrimination Rule for Individuals with Disabilities
  • HHS Issues Final Rule on Non-discrimination in Health Care
  • iQIES Inactive User Policy
• Colorado News
  • Community Providers in a School Setting
  • Power Outage and Emergency Planning

Amity Healthcare Group News

ACHCU Home Health Webinar

Join Amity’s Kelly Pineda as she is scheduled to host a webinar with ACHCU Academy on the topic of Development and Implementation of a Workplace Violence Prevention Program for Home Care Organizations on 07/23/2024 at 12:00 pm EST.

In this webinar, Kelly will examine risk factors related to workplace violence in home care, discuss the OSHA General Duty Clause as it relates to workplace violence, and outline key components of a workplace violence prevention program that is designed to eliminate or reduce workplace violence and safeguard the wellbeing of staff and patients in the home care setting.

Register HereIn this newsletter issue, we explore all significant regulatory developments affecting home health providers that were introduced in May 2024.

OASIS – E Corner

News Regarding OASIS User Manuals:

2024 Updates

CMS updated the OASIS-E Manual for 2024 and developed an associated Change Table to summarize the 2024 updates to OASIS-E Guidance Manual.

Please see below for the updated OASIS-E Manual for 2024 effective January 1, 2024 and the associated Change Table for your review:

1. OASIS-E Manual 2024 Update https://www.cms.gov/files/document/oasis-emanual2024-update.pdf
2. Change Table for OASIS-E Manual 2024 Update https://www.cms.gov/files/document/oasis-emanual2024-update.pdf

2025 Updates

CMS also recently posted draft Version E1 of the OASIS data set effective January 1, 2025.

Please see links to OASIS-E1 Instrument and OASIS Guidance Manual effective January 1, 2025 below for your review:

1. OASIS E1 Instrument Effective January 1, 2025 https://www.cms.gov/files/zip/draftoasis-e1instruments.zip
2. OASIS Guidance Manual Effective January 1, 2025 https://www.cms.gov/files/document/draft-oasis-e1-manual-04-28-2024.pdf

NATIONAL NEWS

Review Choice Demonstration Extended

On May 17th, 2024, the Centers for Medicare & Medicaid Services (CMS) posted a notice on the Home Health Review Choice Demonstration (RCD) webpage announcing that the demonstration that was set to expire on May 31, 2024 is being extended for five (5)years. States currently in the demonstration – Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma – will continue in their current review cycle and follow their regular cycle timelines. CMS did not mention in the notice whether the demonstration will extend to other states.

As part of the extension, CMS is removing Choice 3: Minimal Review with 25% Payment Reduction from the initial choice selections.

With this in mind, Palmetto GBA intends to proactively reach out to impacted providers to coordinate a new review choice selection. Current Choice 3 providers will be required to select between the other two initial review choice options: Pre-Claim Review or Post- payment Review according to the following dates:

• Choice selection period start date: June 17, 2024
• Choice selection period end date: July 1, 2024
• Cycle effective date:  July 15, 2024

Providers who do not make an initial review choice selection will default to participate in Choice 2: Post- payment Review. Providers with less than 10 reviews at the conclusion of the current cycle will have their results included in the next cycle’s results.

Any providers who feel it is a hardship to continue participation in their current review choice selection and would like to modify their choice selection should notify Palmetto by June 14, 2024, to ensure their desired choice selection is updated.

Home Health Review Choice Demonstration Certifying Provider Change

To continue on the subject of Palmetto and Review Choice Demonstration, on May 14, 2024 Palmetto sent out the following notice to providers:

“Beginning May 20, 2024, home health agencies must submit a hand-off from any original certifying provider to a subsequent provider. If one physician or nonphysician practitioner (NPP) performs the original certification, and a different physician or NPP is recertifying, Medicare needs to see the hand-off between practitioners.”

For example, if “Dr. A” signed the initial certification and “Dr. B” signed the recertification, there should be documentation signed by “Dr. A” that the patient was handed off to “Dr. B.” This is acceptable.

If multiple physician/NPP changes have occurred, Medicare needs documentation for each hand-off. In this example, let’s assume “Dr. A” signed the initial certification, and “Dr. D” signed the fourth recertification. There is documentation of a hand-off to from “Dr. A” to “Dr. B” present, but it is signed by “Dr. C.” This is unacceptable as there must be a hand-off of care between each physician or NPP in the chain.

There is no designated format or form that must be used to show the hand-off. Documentation can include, but is not limited to, progress notes, orders to change primary physician or NPP, or anything that shows the change(s) in certifying provider.

So far, there have been no communication from other MACs regarding the hand-off requirement. We will be on lookout for additional information and will share it with you when it becomes available.

Meanwhile, take advantage of the next Home Health Review Choice Demonstration (HH RCD) Monthly Provider Webinar on June 5, 2024 at 11:45 PM ET.

Register Here

CMS Issued Updates to Home Health Claims Processing

The Centers for Medicare & Medicaid Services (CMS) has released Change Request 14543 that reenforces the requirement for home health agencies (HHAs) to report county codes on claims and makes clarifications on the Notice of Admission (NOA) timeliness exceptions, reporting for telehealth visits, and diagnosis code reporting: 

County Codes

A recent report from the Office of Inspector General (OIG) noted that county code reporting on home health claims was incomplete and recommended Medicare edit claims to ensure the county code is present on all claims. The CR creates such an edit in the Fiscal Intermediary Shared System (FISS) to require the presence of value code 85 and a Federal Information Processing System (FIPS) county code on all claims with Type of Bill 032x effective October 1, 2024.

Exceptions to the NOA

CMS clarifies the criteria for requesting an exception to the NOA. The Medicare contractors shall grant an exception for the late NOA if the HHA is able to provide documentation showing:

• When the original NOA was submitted;
• When the NOA was returned for correction or was accepted and available for correction and;
• Evidence the HHA resubmitted the returned NOA within two business days of when it was available for correction or cancelled an accepted NOA within two business days and submitted the new NOA within two business days after the date that the cancellation NOA finalized.

The HHA should provide sufficient information in the Remarks section of its claim to allow the contractor to research the case. If the remarks are not sufficient, Medicare contractors shall request documentation. Documentation should consist of printouts or screen images of any Medicare systems screens that contain the information shown above.

Telehealth Service Reporting

CMS clarifies telehealth reporting requirements for HHAs.

1. HHAs must submit services furnished via telecommunications technology in line-item detail and with covered charges.
2. This is a new instruction and a new requirement that will require HHAs to report all services furnished via telecommunications technology as covered charges.
3. Two occurrences of G0320 or G0321 on the same day for the same revenue code shall be reported as separate line items with the same date of service and with service units reporting 1. Services furnished via telecommunications technology are not considered by Medicare systems when enforcing requirements for matching visit dates on home health claims.
4. This is an already implemented exclusion CMS made last year. CMS later added this information to the narrative for Reason Code 31755 in FISS, requiring that the revenue code 0023 line-item date of service must match the date of service for the first in-person home health visit on the claim, however they did not issue a transmittal, nor did they update the manual at that time. This new language serves as a clarification and updates the manual with the appropriate instruction.

Diagnosis Coding

CMS provides clarification on home health claim processing when ICD diagnosis codes are updated each year on October 1 and April 1.

While the claim describes the patient’s condition as of the From date, if the claim Through date spans across an ICD update, the codes that are valid after the update are reported on the claim.

For example, the HHA submits a claim spanning September 15, 2023 to October 14, 2023, for a patient that has Parkinson’s Disease as a secondary diagnosis, The code in effect on September 15, 2023 is G20 (Parkinson’s Disease) but effective October 1, the code that applies to the patient’s condition changed to G20.C (Parkinsonism, unspecified). The G20.C code is reported on the claim.

The version of the HH Grouper logic applied to each claim is based on the claim From date. In the case of a claim with a From date of September 15, 2023 and Through date of October 14, 2023, the Grouper applies the logic and codes in effect for dates of service before September 30, 2023 and not the logic and codes effective October 1. When a diagnosis code changes as describe above, the HH Grouper maps the new code back to its predecessor code to correctly determine the case-mix scoring and the HIPPS code for the claim (e.g. maps G20.C back to G20 and uses the G20 code to assign the HIPPS code).

CMS also clarifies that when diagnosis codes change between one 30-day claim and the next, there is no absolute requirement for the HHA to complete an ‘other follow-up’ (RFA 05) assessment to ensure that diagnosis coding on the claim matches to the assessment. However, the HHA would be required to complete an ‘other follow-up’ (RFA 05) assessment when such a change would be considered a major decline or improvement in the patient’s health status.

HHS Finalizes Non-discrimination Rule for Individuals with Disabilities

On May 1, 2024, the U.S. Department of Health and Human Services (HHS) issued the final rule: Non-discrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance. The intention of the rule is to strengthen protections for people with disabilities under Section 504 of the Rehabilitation Act.

ALL recipients of the federal financial assistance (Medicare/Medicaid) are subject to the rule.

The final rule takes effect 60 days from publication in the Federal Register (May 9, 2024)-July 8, 2024.

Several key provisions of the Rule that are applicable to health care providers, including home health, are as follows:

Communications: Recipients of the federal financial assistance must ensure effective communications with individuals with hearing, vision, and speech disabilities through the provision of auxiliary aids and services. Such aids and services may include qualified interpreters or readers, assistive listening devices or systems, text telephones, captioning, and information in Braille, large print, or electronically for use with a computer screen-reading program. These requirements align with the recently issued rule for non-discrimination in healthcare programs -section 1557 of the Affordable Care Act (please see article below).

Integration: The existing Section 504 regulation requires programs and activities to be administered in the most integrated setting appropriate to the needs of a person with a disability. The final rule provides more detail about the right to be served in the most integrated setting appropriate for individuals with disabilities.

According to NAHC, “the provisions related to integration raise concerns for Medicare and Medicaid providers of care in the home, particularly for State Medicaid programs. HHS is focusing on the integration mandate from Olmstead as a fundamental requirement for recipients of HHS funding – which includes all State Medicaid programs. This will create an interesting dynamic particularly when waiver waiting lists are involved. This seems to be an intensification of the Olmstead requirements and a hint that HHS is going to get more aggressive around ensuring that there is equal access to HCBS in Medicaid as there is to institutional care. This could also have implications for Medicare home health providers.”

Limitations: Recipients of the federal financial assistance need not take actions if those actions would result in a fundamental alteration in the nature of their program or in undue financial and administrative burdens.  A recipient must still take other action that would not result in such alteration or burdens but would nevertheless ensure that people with disabilities receive benefits or services to the maximum extent possible.

According to HHS’ response to comments and reference to the §84.76(d) (4), States and other recipients cannot dismiss their obligation to provide community services on the basis that services may require changes to the recipients’ methods of administration.

The regulatory language reads:

§84.76(d) (4) Failure to provide community-based services that results in institutionalization or serious risk of institutionalization. This paragraph (d)(4) includes, but is not limited to planning, service system design, funding, or service implementation practices that result in institutionalization or serious risk of institutionalization. Qualified individuals with disabilities need not wait until the harm of institutionalization or segregation occurs to assert their right to avoid unnecessary segregation.

HHS Issues Final Rule on Non-discrimination in Health Care

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”.

Early this month, the U.S. Department of Health and Human Services (HHS) has also issued a Final Rule implementing Section 1557 of the Affordable Care Act (ACA) (the updated regulatory text begins on p. 172 of the rule), which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.

The rule applies to every health program or activity that receives HHS funding or is administered by HHS, such as the Medicare and Medicaid programs. The rule equally applies to both in-person and telehealth care and clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools. 

The final rule takes effect 60 days from publication in the Federal Register (May 6, 2024)-July 5, 2024.

The final rule:

• Holds HHS’ health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
• For the first time, HHS will consider Medicare Part B payments as a form of Federal financial assistance for purposes of triggering civil rights laws enforced by the Department, ensuring that healthcare providers and suppliers receiving Part B funds are prohibited from discriminating based on race, color, national origin, age, sex, and disability.
• Requires covered health care providers, insurers, grantees, and others, to proactively let people know that language assistance services are available at no cost to patients.  Providers must inform patients that language assistance services and auxiliary aids are available at no cost if needed.
  • The notice must be provided in the top 15 languages spoken by individuals with limited English proficiency (LEP) in the relevant state(s) where the entity operates. Click here for the Office of Civil Rights (OCR)-prepared sample notices in English and 47 other languages.
  • The notice must be communicated to individuals with disabilities as effectively as they are to individuals without disabilities.
  • The notice must be displayed in prominent locations both physically and on the covered entities’ websites and must be made available upon request.
• Requires covered healthcare providers, insurers, grantees, and others to let people know that accessibility services are available to patients at no cost.
• Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities.
• Protects against discrimination by codifying that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.
• Respects federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS.
• The final rule reaffirms that a covered entity may rely on applicable Federal protections for religious freedom and conscience, and any provisions under this final rule are not required when such protections apply.
• The final rule also includes an administrative process for covered entities to seek an assurance of exemption in writing from OCR.
• Respects the clinical judgment of health care providers.

There are also several procedural requirements that effected organizations, including home health providers, will need implement as described below: