Source: Home Health Line
On Friday, February 9, President Trump signed into law a bill designed to keep the federal government funded through March 23. The bill contains several home health provisions, including revisions to the face-to-face requirement and the addition of a new payment model similar to the Home Health Groupings Model (HHGM).
Among the home health-related items within the bill:
- A revised payment system launching Jan. 1, 2020. Similar to the past HHGM proposal, agencies will switch to a 30-day unit of payment for home health. Unlike the prior proposal, this payment system is budget neutral. It also eliminates the use of therapy thresholds in case-mix adjustment factors for calculating payments.
- Rural-add on payments are extended to continue in 2018, but beginning in 2019, will now depend upon population density and the area’s usage of home health services. The payments would be reduced over time.
- Revisions to the face-to-face requirement.
- Market basket reduction. The bill says the market basket “for 2020 shall be 1.5%.”
- Extending the Independence at Home Demonstration Program. The bill extends the Independence at Home program by seven years incentivizing delivery of primary care at home.
- No appeals settlement language. The House bill had language suggesting settlement amounts for appeals regarding denied claims, but the final version of the bill does not contain this language.
“This is a huge improvement from this past fall, but they still appear to be looking at the HHGM model as an option,” says attorney Robert Markette of Indianapolis-based Hall, Render, Killian, Heath & Lyman.
Providers need to review any information that comes out of CMS regarding payment reform, Markette says. The industry must be focused and consistent on providing frequent feedback “to avoid being saddled with a payment model that causes wide spread financial difficulties.”
Face-to face-documentation update
One thing the bill states that agencies are sure to like: Reviewers “may” use documentation in the medical record of the home health agency as supporting material to justify that the patient is homebound and requires skilled care.
This language lets reviewing entities know they should consider agency-generated documents as part of the totality of the record, says Joe Osentoski, reimbursement recovery and appeals director with Quality in Real Time (QIRT) in Troy, Mich.
The current requirement states that information from the agency must be corroborated “by other medical record entries” and align with the time in which services were rendered, he says. The certifying physician must review and sign off on anything incorporated into the medical record that’s used to support the certification of patient eligibility.
Many agencies don’t currently attempt to provide supplementary materials to physicians to corroborate information, Osentoski says.
The goal of the change would be for the physician to not have to sign off on and incorporate the agency’s documentation into the record, says Bill Dombi, president of the National Association for Home Care and Hospice (NAHC).
The bill states that “on or after January 1, 2019 . . . in addition to using documentation in the medical record of the physician who so certifies or the medical record of the acute or post-acute care facility … the Secretary may use documentation in the medical record of the home health agency as supporting material, as appropriate to the case involved.”
“This should be a help to agencies’ efforts to meet eligibility requirements,” Osentoski says.
While that’s true, it comes with a caveat that agencies must ensure their own clinicians do a good job documenting information that shows the patient is homebound and requires skilled care, says attorney Elizabeth Pearson of Pearson & Bernard in Edgewood, Ky.
“They really need to have some serious in-servicing of their clinicians and of their contracted therapists,” she says. “That’s the one that worries me the most, because you have very little control of those people.”
Documentation should clearly state the reason home health is necessary, such as that the patient is in need of physical therapy to assist with balance and strengthening to avoid future falls (HHL 4/11/16). It should specifically reference the patient’s physical condition and need for assistive devices.
The agency should make sure to include a statement that links the patient’s condition to the patient’s homebound status. For example, the agency could write, “Patient is homebound due to [patient condition], which requires [assistive device] and [further description of physical limitations which limits patient’s ability to leave the home].”
Bill would change rural add-on payments
Several Medicare policies expired without Congressional action by the end of 2017, including the 3% add-on payments for rural agencies.
The new bill continues the 3% add-on payments for 2018, Dombi says.
But beginning in 2019, rural add-on payments will change and be reduced over time.
Agencies in rural counties with the greatest usage of home health receive 1.5% add-on payments during 2019 and 0.5% add-on payments during 2020.
Agencies in counties with a population density of six people or fewer per square mile now receive 4% add-on payments in 2019, 3% in 2020, 2% in 2021 and 1% in 2022.
Agencies in other rural counties will receive 3% add-on payments in 2019, 2% in 2020 and 1% in 2021.
“You’re going to lose providers and access to providers in those rural areas because of those cuts,” Pearson contends.
The HHS Office of Inspector General (OIG) will submit to Congress a report that includes a recommendation about whether rural add-on payments should continue to be made based on county data. This will report will be submitted no later than Jan. 1, 2020, and annually thereafter through Jan. 1, 2024.