Legislation Introduced To Expand Access To Remote Monitoring & Telehealth

Bipartisan legislation has recently been introduced to the House that would expand access to remote monitoring and telehealth. The Telehealth Enhancement Act of 2015 would make significant changes in federal laws pertaining to remote monitoring and telehealth. The legislation builds off a previous bill, the Telehealth Enhancement Act of 2013, which sought to adjust Medicare home health payments to account for remote patient monitoring and to expand coverage to all critical access and sole community hospitals.

The major provisions in the bill include the following:

  • Incentives for Medicare’s hospital readmission reduction program;
  • Ensuring the use of telehealth in health homes and medical homes;
  • Allow flexibility in ACO coverage of telehealth; and
  • Add additional sites to be considered originating sites for purposes of payments for telehealth services under Medicare such as a ‘home telehealth site.’

Click here to read more.


CMS Issues Home Health Coverage Manual Updates

CMS has updated the Medicare Benefit Policy Manual, Chapter 7, with Change Request (CR) 9119, relating the requirements for physician certification and recertification. This CR also updates the timeframe required for therapy functional assessments. The CR, however, leaves questions for providers regarding CMS’ expectation for implementing some of the new provisions. NAHC is currently seeking answers from CMS.

CMS states it has eliminated the narrative requirement from the face-to-face (F2F) encounter document. However, the certifying physician is still required to certify that a F2F patient encounter occurred. The encounter document should include the date of the encounter, be related to the primary reason the patient requires home health services, and be performed by an allowed provider type.

In the updated manual revision, CMS affirms a new requirement for documentation that was stated in the 2015 HH PPS Final Rule. When a patient is admitted to home health directly after discharge from an acute or post-acute care setting and the physician who cared for the patient in that setting is the certifying physician, but will not be following the patient after discharge, the certifying physician must identify the community physician who will be following the patient. CMS says the certification must be completed prior to when the home health agency bills Medicare. CMS reiterates that is not acceptable for HHAs to wait until the end of a 60-day episode of care to obtain the completed certification/recertification.

Click here to view CR 9119.

Click here for more detailed information regarding CR 9119 from NAHC.

May 7 Online Forum Will Explain New Home Health Rating System

CMS is holding a one-hour, web-based open door forum on May 7 at 1:30-2:30 p.m. EST to explain the new set of star ratings for the Home Health Compare website. CMS will use the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey results to create Patient Survey Star Ratings for the Home Health Compare website.  The forum will describe the rationale and overview of the patient survey star ratings.

Click here to read more.

Home Health Care Planning and Improvement Act Reintroduced In Senate

The Home Health Planning Improvement Act of 2015 (S.878) was recently introduced in the Senate. The bill seeks to allow healthcare professionals (other than physicians) sign home health plans of care. S.578 will allow physician assistants (PA), nurse practitioners (NP), clinical nurse specialists, and certified nurse midwives to order home health services for Medicare beneficiaries. NPs, PAs, and clinical nurse specialists are currently unable to order less costly and less intrusive home healthcare services, although they are able to perform many other services for Medicare beneficiaries. In order to see these medical professionals as primary care providers, seniors and disabled citizens often require an extra office visit with an unknown physician. The extra visit leads to an extra administrative and paperwork burden and creates an unnecessary step that fails to recognize current training and scope-of-practice guidelines, according to NAHC. As a result of this requirement, patients in need of home healthcare are either place in more expensive care settings or experience delay in receiving the care they need. NAHC strongly supports S.878 and encourages its members to contact their lawmakers to urge them to support the legislation.

Click here to read more.


NAHC Completes Its 2015 Legislative Blueprint

Every year, the policy staff at NAHC develops its Legislative Blueprint for the coming year. This year’s Legislative Blueprint has been completed. To help develop these blueprints, NAHC’s policy staff sought input from the organization’s Membership and affiliated organizations. As issues develop throughout the year, NAHC gathers additional ideas for these agendas from members, state association affiliates, advisory committees, and the NAHC Board of Directors. With big changes on the legislative and regulatory horizon this year for Capitol Hill, NAHC is planning ahead with strategies to protect the continued viability of home care and hospice.

Click here to view NAHC’s 2015 Legislative Blueprint for Action, as well as Blueprints from past years.

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CMS Develops Pilot Program To Better Estimate Home Health Agency Fraud

CMS is developing a pilot program to determine how many Medicare fraud cases are taking place in home health agencies. A contractor search is currently underway to help implement the new initiative. Many Medicare fraud experts are commending the endeavor, believing the move to be positive in an industry with long-standing allegations of fraud.

Between 2010 and 2014, there were nearly $1 billion in improper Medicare payments and fraud identified relating to the home health benefit, according to the OIG. Statistically valid estimates of the rate of fraud in Medicare does not currently exist for home health agencies. The new contractor will focus on developing a methodology to estimate the extent of probable fraud of home health agencies in the Medicare fee-for-service program. The initial pilot will focus on agencies in Florida, which accounted for $2.1 billion of total Medicare home health spending in 2013.

Contractors will begin by reviewing 130 home health claims in the Miami-Dade County area. As part of the review process, the contractor will interview beneficiaries and their medical providers and make unannounced visits to the offices of onsite home health agencies. Any formed methodology is expected to be replicated later for a larger, nationwide program. CMS hopes the new initiative will help it better allocate its resources.

Click here to read more.

Clarification On Physician Certification & F2F

When CMS refers to the certifying physician, they are referring to the physician who is certifying that the patient is eligible for home health services. There are five things the physician certifies to:

  1. The home health services are or were needed because the patient is homebound.
  2. The patient needs or needed skilled services on an intermittent basis.
  3. A plan of care has been established and is periodically reviewed by a physician.
  4. The services are or were furnished while the patient is or was under the care of a physician.
  5. The patient had a face-to-face encounter within the prescribe time frame, was related to the primary reason for home health services, and was conducted by a physician or allowed non-physician practitioner (NPP).

A physician who is not signing the POC is permitted to certify the patient only when the patient has been cared for by a physician in an acute or post-acute facility. Therefore, it is possible for the physician in the facility to conduct and complete the F2F encounter documentation and certify the patient without signing the POC. The facility physician may also choose to complete the encounter documentation and not certify the patient (does not complete all five elements of the certification). The facility physician would send the encounter findings to the physician in the community to complete the certification and sign the POC.

*Information above has been provided by NAHC.