To all the frontline healthcare workers and also to those who support and work beside you in the areas effected by hurricane Ida, thank you for your dedication and hard work! We are thinking of you!
Here are some home health related updates for this week:
New testimonials from our competency program participants this week:
“The instructor today was great! I learned some things I didn’t know or that I had forgotten in the last 26 years of nursing. Very informative and well worth the time it took to complete the session today.”
“This was awesome and informative!! Thank you for this learning experience today!”
Do not forget to schedule your in-person and/or virtual competencies at https://amityhealthcaregroup.com/virtual-nursing-competency/
Join Irina Gorovaya and Amity Healthcare Group for a presentation on Practical Guide to Home Health Competency Program at Home Care and Hospice Association of Colorado Annual Conference in beautiful Keystone, Colorado October 11-12, 2021.
Amity Healthcare Group, LLC authored the article “Look Beyond Revenue to Weigh Value of Telehealth’s Impact” that was featured in Home Health Line publication on August 23, 2021.
The copy of the article is attached to this newsletter.
CMS CY 2022 Proposed Rule
As you know, the CMS CY 2022 Proposed Rule targeted several reforms affecting the Medicare home health, including significant alterations to the PDGM case mix and reimbursement based on 2020 care data. CMS offered a comment period for the CY 2022 rule that closed on August 27, 2021.
The National Association for Home Care & Hospice (NAHC) has filed a 48 page comments document to the Centers for Medicare & Medicaid Services (CMS) on the CY2022 proposed rule, calling for no substantial changes to the PDGM payment system and pointing out that while hospitals and skilled nursing facilities received payment boosts during the COVID-19 pandemic, home health agencies (HHA) did not. NAHC’s comments were supported and co-signed by multiple home care association across the country.
NAHC’s recommendations included, but were not limited to:
- CMS should maintain the structure and design of PDGM for 2022.
- CMS should withdraw its proposal to recalibrate PDGM case mix weights based on 2020 care utilization data because it is unreasonable to assume the chaotic year of health care utilization in 2020 is an appropriate foundation for 2022. Home health care delivery in 2022 is likely to be very different than it was in 2020.
- CMS should replace its suggested methodology for assessing whether behavioral changes of HHAs resulted in PDGM achieved budget neutrality in comparison to the HHPPS HHRG payment model with a methodology that focuses on behavioral changes, not change in average case mix weight.
- To comply with Medicare law, CMS must apply a PDGM-related budget neutrality adjustment methodology that exclusively is focused on PDGM-triggered behavioral changes. The change assessment methodology proposed by CMS encompasses changes unrelated to HHA behavioral changes under PDGM.
- CMS should reconsider its decision to apply the new OMB geographic designations for core-based statistical areas (CBSAs) in the annual wage index. Alternatively, CMS should treat all provider types equally in the transition to an updated wage index by extending the 5% ceiling on negative changes in wage index values as it has done for inpatient hospitals. Otherwise, massive payment rate reductions in certain areas of the country will occur, jeopardizing access to home health care services as hospitals protected by the 5% cap will be able to have a more stable financial base, allowing them to recruit staff more successfully from the same pool of professionals that work in HHAs.
- CMS should establish a process and methodology to modify HHA payment systems and rates during a Public Health Emergency to address new costs triggered by the public health emergency or unpredicted limitations in payment models.
- CMS should not assess the late submission penalty for the NOA until the issues that
negatively impact HHAs are resolved.
- CMS should provide clear and timely instructions to HHAs related to the identified system
- CMS should include payer changes to the list of exceptions to the NOA timely submission
penalty. CMS should require the MACs to request an ADR if addition information is
required to decide on a payer change exception.
- CMS should include other providers overlapping in the CWF as a listed exception to the
NOA timely submission penalty. CMS should require the MACs to request an ADR if
addition information is required to decide on whether the HHAs was prevented from
submitting a timely NOA due other another provider’s actions.
- Instruct the MACs to not apply the timely submission penalty if the original NOA is
submitted timely but must be canceled and resubmitted.
For a complete document, please go to: https://www.nahc.org/wp-content/uploads/2021/08/National-Association-for-Home-Care-and-Hospice-comments-on-CMS1747P.pdf
New Waived Tests for Home Health
Home health agencies frequently perform tests that are considered waived under the CLIA, and as a result, are required to have a CLIA Certificate of Waiver. Waived tests include, but are not limited to:
- Blood glucose by glucose monitoring devices cleared by the FDA for home use
- Prothrombin time home tests (PT/INR)
- Dipstick or tablet reagent urinalysis
- Flu test
- Drug test
On August 9, 2021 CMS issued an MLN Matters Article with the latest tests the FDA approved as waived tests under CLIA (please see the list below):
- 80305 QW, October 9, 2020, American Screening LLC Discover Panel Dip Card TestsMOR 2000;
- 80305 QW, October 9, 2020, American Screening LLC OneScreen Plus Panel Dip Card Tests MOR300;
- 80305 QW, October 9, 2020, American Screening LLC OneScreen Plus Panel Dip Card Tests MOR2000;
- 80305 QW, October 9, 2020, American Screening LLC Reveal Panel Dip Card Tests MOR300;
- 0305 QW, May 3, 2021, Lendas UAB EXPLORO Highly Sensitive THC Test; and
- 80305 QW, May 5, 2021, Clinical Reference Laboratory CRLStat Multi-Drug Urine Test Cup.
For the full article, please go to: https://www.cms.gov/files/document/mm12381.pdf
For the full list of the waived tests, please go to: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/waivetbl.pdf
Attention Florida and North Carolina: CMS Revised Review Choice Demonstration Requirements
The Centers for Medicare & Medicaid Services announced Thursday, August 26, that it is modifying the Review Choice Demonstration (RCD) in Florida and North Carolina, so that only those claims with dates of service beginning on and after September 1, 2021 will be subject to additional development request (ADR)/prepayment review if they are submitted without a Unique Tracking Number (UTN)/pre-claim review decision.
NAHC has done a tremendous job in advocating for CMS to revise the FL and NC RCD implementation plans in the light of the multiple concerns expressed by providers, especially as related to the claims with dates of service on or after August 31, 2020 submitted on or after September 1, 2021 without a pre-claim review decision on file that could have been pulled for pre-payment review and subject to the 25% reduction.
Provider Enrollment Activities Resume in October
Beginning October 2021, CMS will resume some provider enrollment activities that were paused during the COVID-19 public health emergency, including:
- Application Fees – 42 C.F.R. 424.514
- Criminal background checks associated with fingerprint-based criminal background checks– 42 C.F.R. 424.518, as may be applicable
- Revalidation – 42 C.F.R 424.515
For more information, see COVID-19 Medicare Provider Enrollment Relief FAQs (PDF) 19, 20, 26, and 27.
Please also review Provider Enrollment Medicare Learning Network Article for a review of the enrollment process as well as addition of the site visit information to Enrollment, Step 3 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/EnrollmentResources/provider-resources/provider-enrolment/Med-Prov-Enroll-MLN9658742.html
2021 Home Health and Hospice Medicare Summit: September 15 to 17, 2021
Registration for the 2021 Home Health and Hospice Medicare Summit, Operation Collaboration: We Are All in This Together is now open! Please join NGS, CGS and Palmetto GBA for a live virtual education program. The 2021 Summit will consist of two full days and one-half day of education. Attendees will receive education from the home health and hospice MACs collaborating to address the most current Medicare federal regulations and issues.
For Registration and Schedule, please go to Register now
The COVID-19 Vaccination Mandates
The Colorado Board of Health met on August 31, 21 for an emergency rulemaking meeting regarding the healthcare worker vaccination mandate. The Board passed the emergency rule as drafted on a vote of 6-1.
The complete rule can be found at:
Under the rule, facilities, including employees of home care and home health agencies who have contact with clients/patients must develop their own policies for vaccinations to ensure 100% of their employees receive their first shot by September 30, 2021.
Please note the following:
- In instances where a parent or other family member is a paid employee of an agency (live-in caregivers), they are also subject to the rule.
- Reporting requirements:
- BEGINNING OCTOBER 1, 2021, EACH FACILITY SHALL REPORT ITS COVID-19 VACCINATION RATE TO THE DEPARTMENT ON THE 1ST AND THE 15TH DAY OF THE MONTH.
- THIS INFORMATION SHALL BE REPORTED IN THE FORM AND MANNER SPECIFIED BY THE DEPARTMENT.
- EACH FACILITY SHALL REPORT THE FOLLOWING INFORMATION TO THE DEPARTMENT:
- THE TOTAL NUMBER OF EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF, WHETHER OR NOT THE INDIVIDUAL IS SUBJECT TO THE REQUIREMENTS OF THIS PART 12.
- TOTAL NUMBER OF VACCINATED EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF AND THE TOTAL NUMBER OF EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF.
- NUMBER OF MEDICAL EXEMPTIONS CLAIMED BY EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF.
- NUMBER OF RELIGIOUS EXEMPTIONS CLAIMED BY EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF.
- NUMBER OF EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF IDENTIFIED BY THE FACILITY AS EXEMPT FROM THE REQUIREMENTS OF THIS PART 12.
- NUMBER OF EMPLOYEES, DIRECT CONTRACTORS, AND SUPPORT STAFF WHO HAVE LEFT EMPLOYMENT WITH THE FACILITY OR AGENCY DUE TO THE REQUIREMENTS OF THIS PART 12, SINCE THE LAST REPORTING DATE.
The rule also tasks facilities with defining and allowing for religious and medical exemptions and crafting a policy regarding the exemptions. The CDPHE will not be defining these exemptions, but indicates the following regarding supporting criteria for a medical exemption:
“A MEDICAL EXEMPTION SIGNED BY A PHYSICIAN, PHYSICIAN ASSISTANT, ADVANCED PRACTICE 147 NURSE, OR CERTIFIED NURSE MIDWIFE LICENSED IN THE STATE OF COLORADO STATING THAT 148 THE COVID-19 VACCINATION FOR THE EMPLOYEE, DIRECT CONTRACTOR, OR SUPPORT STAFF IS 149 MEDICALLY CONTRAINDICATED AS DESCRIBED IN THE PRODUCT LABELING APPROVED OR 150 AUTHORIZED BY THE FDA”
When it comes to religious exemptions, the common practice for an employer to consider sincerely held religious belief that is described by an employee in writing in the way that defines a specific religious belief or practice that necessitates the request for accommodation. For example, as per U.S. Equal Employment Opportunity Commission, sincerely held religious believes may include, but not limited to:
a Catholic employee needs a schedule change so that he can attend church services on Good Friday;
a Muslim employee needs a break schedule that will permit daily prayers at prescribed times;
an employee needs accommodation of a religious belief that working on his Sabbath is prohibited.
Temporary LPNs &CNAs Licenses
Emergency rules for multiple healthcare professions relating to the expansion of scope of practice during the pandemic are set to expire on September 4, 2021 under the Colorado COVID-19 Disaster Recovery Order, unless extended by the Governor.
Practical nursing applicants granted temporary licensure under the Governor’s Executive Orders must cease practice as a practical nurse if a full license to practice professional nursing in Colorado was not granted on or before June 30, 2021. New graduates of approved nursing programs for these license types who met all qualifications for licensure with the exception of successful completion of the required examination will no longer be issued a temporary license and must now successfully pass the examination prior to licensure as set forth in Section 12-255-109, Colorado Revised Statutes.
CNA graduates currently working on a temporary license based on provisions in previous Executive Orders will want to ensure completion and passage of the required test for full licensure before the December 31, 2021 expiration date. Skills examinations may be scheduled through Pearson Vue. It is important for employers to ensure their temporarily licensed staff schedule their exam as soon as possible to avoid any staffing gaps once the temporary licenses expire on December. 31, 2021.
Those CNA graduates whose temporary license was issued between December. 7, 2020 and April 5, 2021, and expired on June 30, 2021, may apply for a second temporary certification. These individuals must submit documentation of passage of the written exam and attest that they will register for the required skills exam within 60 days of availability in their regional area (within 250 miles). Those CNA graduates granted a temporary license who have failed the skills exam are not eligible for a second temporary certification.
This information above is the latest currently available and is subject to change based on any extensions/changes to the Disaster Recovery Executive Order.
Amity’s Friday emails (newsletters) will be archived on Amity’s Healthcare Group website at https://amityhealthcaregroup.com/resources/ under Weekly Newsletter section.
Please do not hesitate to reach out for any assistance or questions via email, phone or website at https://amityhealthcaregroup.com/resources/
If 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 firstname.lastname@example.org
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)