Home Health & Hospice Week

But make sure advanced directive info is in your patients’ POCs.

Medicare’s annual rulemaking cycle for home health often brings more burden and cost to home health agencies, but sometimes it also makes providers’ lives easier. That’s the case for one provision in the 2020 proposed rule.

In 2017, the Centers for Medicare & Medicaid Services finalized these two additions to the plan of care requirements at § 484.60(a), effective in January 2018:

• A description of the patient’s risk for emergency department visits and hospital readmission, and all necessary interventions to address the underlying risk factors; and
• Advanced directive information.

The problem: Comprehensive Error Rate Testing reviews found POCs supporting claims often lacked the advanced directive information, and a massive retroactive takeback seemed imminent. HHH Medicare Administrative Contractors then issued statements saying takebacks wouldn’t occur, but offering a range of advice including appealing any CERT denials based on the requirement (see Eli’s HCW, Vol. XXVIII, No. 28, No. 3).

The solution: Now CMS is proposing to change regulations at § 409.43 to say that “while these newly-added plan of care items at § 484.60(a) remain CoP, we believe that violations for missing required items are best addressed through the survey process, rather than through claims denials for otherwise eligible periods of care,” the rule says.

With this change, “CMS recognized that denying reimbursement for any violation of the POC was unfair,” applauds attorney Robert Markette Jr. with Hall Render in Indianapolis. “This change will formalize the backtracking CMS did last year over the auditors recouping money for agencies failing to address advance directives.

“It was great to see them take action in that regard,” Markette adds.

But HHAs still should stay vigilant in this area, warns Joe Osentoski with Quality in Real Time in Sterling Heights, Michigan. The regulations still will say that all the parts of 42 CFR 484.60(a) need to be on the POC, if changes are finalized. MACs “may continue to deny on this basis when such items as advance directives or hospitalization risks are not found on the plan of care,” Osentoski stresses.

And of course, surveyors can issue deficiency citations based on such missing information.