Home Health & Hospice Week

Don't miss the boat in gearing up for this fast-approaching deadline. A massive paperwork burden is set to hit home health agencies by the summer - will you be ready?
 
Unfortunately, firm details about the upcoming termination notices and expedited review of those notices are scanty, notes William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law.
 
The Centers for Medicare & Medicaid Services issued a final rule in November 2004 regarding the notices that HHAs will have to issue to every single patient they discharge (see Eli's HCW, Vol. XIII, No. 43, p. 338). But CMS is taking comments on the final rule until Jan. 25, and industry experts expect to see some substantial changes to the notice and appeal procedures outlined in the Nov. 26 Federal Register.
 
"Policy idealism" and litigation drove the rule more than "the realities of home health care and the way it is delivered," observes Bob Wardwell with the Visiting Nurse Associations of America. Industry trade associations are in talks with CMS to iron out some serious wrinkles with the process as finalized, Dombi says. Don't Jump the Gun "There are no easy answers" to many of the questions HHAs and their representatives are asking, Dombi cautions.
 
Agencies should "just sit tight for the time being," advises Burtonsville, MD-based health care attorney Elizabeth Hogue. There are "major unanswered questions," Hogue says. And you can't train staff on the new notices when CMS hasn't even issued the forms yet, Dombi and Hogue point out.
 
While you may not be able to work directly on the notice and appeals specifics, there are some preliminary steps you can take to pave the way for smooth implementation when the final details emerge:  1) Educate yourself. Top management should "become familiar with the published requirements," urges consultant Judy Adams with the LarsonAllen Health Care Group based in Charlotte, NC. Even though the final details may change, a firm grasp of the basic structure will allow leaders to quickly finalize their termination notice and review plan and convey it to HHA staff.  2) Review the basics. The new notices and appeals will be based on basic coverage decisions, which agencies already should be carrying out well, Dombi notes. The better your coverage decisions, the easier it will be to explain them in notices and stand behind them in review.

And the more complete and "predictive" agencies' plans of care are, the fewer expedited reviews they can expect, Wardwell predicts. When a POC terminates, "neither the patient nor physician [should have] any ambiguity about what is happening, when and why," counsels Wardwell, a former CMS top official.  3) Highlight ABNs. It may be too early to conduct [...]