Home Health & Hospice Week

CMS backtracks on requirement for non-medical patients.

Much of the extra work brought on by the OASIS suspension for private pay patients is about to go away.

Until last April, most home health agencies didn't think they had to complete a comprehensive patient assessment for clients receiving non-medical services. But suddenly the Centers for Medicare & Medicaid Services insisted they had to collect the burdensome paperwork.

When clarifying the suspension of OASIS data collection on non-Medicare/non-Medicaid patients in an April 8 memo to state surveyors (S&C-04-26), CMS stated that the Medicare Conditions of Participation required agencies to complete a comprehensive assessment for all patients, "including patients receiving only chore and housekeeping services" (see Eli's HCW, Vol. XIII, No. 15, p. 114).

Providers protested this expansion of comprehensive assessments, and the National Association for Home Care & Hospice asked CMS to address the issue.

Result: In a response that should please providers, CMS agrees that an agency is not required to conduct a comprehensive assessment "on individuals where HHA services are entirely limited to housekeeping, chore, or certain other non-medical services," according to a Nov. 12 memo to surveyors (S&C-05-06). It doesn't matter whether the non-medical services are private pay or Medicaid-funded.

CMS says it won't consider non-medical service clients "to be a patient of the HHA in the traditional sense of the term." Thus, requirements that must apply to patients, such as the comprehensive assessment, "will not be required in such limited situations."

While federal requirements now allow you to discontinue comprehensive assessments on clients for whom you provide only chore/housekeeping services, don't be so sure about state and local rules, advises Mary St. Pierre with the National Association for Home Care & Hospice.

Watch out: Some non-medical services may be paid for by state or local governments or through a contract with another payer, St. Pierre explains. In that case, before discontinuing the assessments on these patients, HHAs should check to be sure the agreement with the payer doesn't require one, she tells Eli.

In its memo, CMS offers the following caveats:

  Define non-medical narrowly. If the agency provides any hands-on service, such as "personal care service, cueing, or activity that is in any way involved in monitoring the patient's health condition," that is considered a medical service, CMS says.   Understand the limits. As soon as the agency provides any Medicare service or "any standardservice permitted by Federal law under the Medicaid State Plan," the individual is receiving medical care and the COPs apply.   Educate patients. The HHA must explain to a patient being discharged from Medicare services, but who will continue to receive chore services, that Medicare doesn't pay for those services.   Look to state law. If the state law is more restrictive, [...]