CMS has released Transmittal 125, which revises the State Operations Manual (SOM), chapter 2, sections 2180 through 2202.19. These sections govern CMS’ policy for home health agencies. The transmittal updates the SOM with revisions to chapter 2 that were issued earlier this year in a Survey and Certification letter. The letter included instructions for home health agency alternate sanctions, which has been incorporated into the SOM as chapter 10, and revised Appendix B, Guidance to Surveyors-Home Health Agencies.
The revision to chapter 2 reflects CMS policy changes that have occurred over the years, and also includes structural changes and reorganization of sections for clarity. The following are some of the key changes:
Revised web sites and policy information;
Sections on HHA branches have been renamed and revised to clarify current CMS policy on branches;
Sections that are no longer applicable have been deleted;
The survey process information has been deleted from this Chapter and updated and moved to Appendix B Guidance to Surveyors – Home Health Agencies; and
The OASIS requirements in sections 2202-2202.18 have been updated to reflect current CMS policy and Federal regulations.
According to a newly released market analysis, reimbursement is shifting to home health care, consequently, hurting the finances of skilled nursing facilities. Between 2008 and 2013, the nursing care sector grew at an average annual rate of 1.6%. During the same period, home care grew at an average annual rate of 7.2%, which was the fastest rate of growth among all long term care sectors. Assisted living grew at an average annual rate of 5.6%.
In the summary of the report, researchers noted that the skilled care market is suffering from state efforts to reimburse lower cost home health care over higher priced nursing care. In addition, the report found that long term care, as a whole, has been in a period of “solid expansion.”
National Government Services has released its schedule of onsite Mobile Medical Review Team visits through September 2014. The one and a half day reviews can result in findings of non-compliance, recoupment and even pre-payment review. Non-compliance with F2F requirements has been a major finding in all audits conducted to date. Be prepared and ready to challenge adverse findings. For more information on correcting invalid or missing F2F documentation, click here.
Medicare’s contractors are expanding their respective post-payment reviews of claims as industry concerns about Medicare’s home health face-to-face physician encounter requirements continue to rise. The NAHC Board of Directors have already approved the filing of a lawsuit challenging the requirement that physicians provide sufficient narratives on a patient’s homebound status and need for skilled care. NAHC says the lawsuit is “ready to go” and has the intention of filing it in Federal District Court in Washington, D.C.
CMS has expressed a willingness to consider a resolution of the industry’s concerns without litigation. A meeting scheduled for May 8 will determine whether more discussions and negotiations are needed or whether the lawsuit should be filed immediately. During this time, NAHC recommends that home health agencies “continue to strive for compliance with the difficult face-to-face encounter documentation rules” and that “agencies preserve their rights to payment by filing administrative appeals on any questionable claim denials.”
CMS has issued a proposed rule for 2015 that reduces payment for readmissions and hospital-acquired conditions. The rule, however, does not provide any changes to the two-midnight rule.The rule will increase the payment rate for inpatient stays at general acute hospitals by 1.3 percent in fiscal year 2015, and 0.8 percent for long-term care hospitals. CMS officials say the aim of the proposed rule is to improve hospital performance and “create an environment for improved Medicare beneficiary care and satisfaction.”
New Medicare guidance aiming to stop the federal government from paying millions of dollars to hospice organizations and drug companies for the same prescriptions for seniors takes effect today. Experts say the changes could make it make it more difficult for hospice patients to get certain medications.
The new measure allows insurers to deny coverage for any prescriptions for hospice patients until they know that the drugs are not covered instead by the hospice provider. Medicare officials say the aim of the additional authorization is to “prevent duplicate payments for drugs covered under hospice benefit.”
According to a new World Health Organization (WHO) report, antibiotic-resistant bacteria now reach every part of the world, which could translate to more deaths from even minor infections. The WHO examined seven common bacteria that cause serious infections and found high levels of resistance all over the world. There was also significant gaps in tracking drug resistance.
Antibiotic resistance means that people can be sicker longer, with an increased risk of death, driving up the cost of healthcare.The WHO report also acknowledges the rise in deadly fungal infections.
The WHO recommends enhancing infection prevention and control at hospitals, prescribing antibiotics only when needed, and prescribing the correct antibiotics to treat illnesses.