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 in-services for staff on the new notices and appeals, but you can refresh their memories on the very similar advance beneficiary notices, Adams suggests. And you can use the opportunity to alert staffers to expect that a new notice will be coming down the pike soon.

 4) Strengthen referral source communication. A physician can stop the whole expedited review process in its tracks if he declines to certify that terminating HHA services poses a significant risk to the patient's health. (Hospice expedited review has no such certification requirement.)
 
Keeping communication channels with referral sources "very clear" will minimize potential problems, Wardwell says.

 5) Buddy up with QIOs. If you haven't done so already, now is the time to establish close communication with your Quality Improvement Organization, Wardwell advises. QIOs will be conducting the expedited reviews. "Make sure the procedures developed there are clear and sensible," Wardwell recommends.

 6) Make a blueprint. While mapping out details of policies and procedures is premature at this stage, you can start thinking about some basics of how you'll deal with the new notices and appeals. For example, start eyeing candidates "who will be responsible for copying and sending records within the very limited timeframe required," Adams exhorts. HHAs will have to turn around records for expedited review the same day they learn of the request.
 
Perhaps most important will be setting up your system to avoid issuing termination notices late in the week or on weekends, Adams says. Eliminating same-day record requests on the weekend is imperative, she explains (see Eli's HCW, Vol. XIII, No. 44, p. 348).

 7) Keep the issue squarely in your sights. Termination notices and expedited reviews should be on the top of agencies' watch lists for the next six months, Dombi says. While too much preparation is futile at this point with so many gray areas left unclear, HHAs should be ready to hop on any final developments to make sure they're in compliance when the deadline rolls around, he urges.
 
"You don't want to leave it to the last day," Dombi says of preparation for the massive new regulatory requirement. 
 
Editor's Note: The final rule is at www.access.gpo.gov/su_docs/fedreg/a041126c.html.