Home Health & Hospice Week

HHAs can’t celebrate their independence from this hassle.

While not exactly what home care providers were hoping for, language in the Bipartisan Budget Act of 2018 directing Medicare officials to ease documentation burdens for home health agencies gave providers some encouragement that they may receive help in that area.

Now that idea is dead, thanks to the 2019 Home Health Prospective Payment System proposed rule released July 2.

What BBA 18 said: “For purposes of documentation for physician certification and recertification ... on or after January 1, 2019, and made with respect to home health services furnished by a home health agency, 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 (in the case that home health services were furnished to an individual who was directly admitted to the home health agency from such a facility), the Secretary may use documentation in the medical record of the home health agency as supporting material, as appropriate to the case involved.”

The problem was that the “may use” wording did not require the Centers for Medicare & Medicaid Services and its contractors to use HHA documentation. At the time, National Association for Home Care & Hospice President William Dombi told Eli it would “be taking full advantage of the rulemaking opportunity to convey to CMS that it should specifically establish a standard that requires all eligibility and coverage determinations to be based upon a combination of the physician and home health agency record.”

NAHC wasn’t alone in urging CMS to require medical reviewers to use HHA documentation in making an eligibility determination. But the agency has turned a deaf ear to those pleas.

“We believe the BBA of 2018 provisions are consistent with our existing policy in this area, which is currently reflected in sub-regulatory guidance in the Medicare Benefit Policy Manual (Pub.100-02, chapter 7, section 30.5.1.2) and the Medicare Program Integrity Manual (Pub. 100-08, chapter 6, section 6.2.3 ),” CMS says in the rule.

Those are the provisions that say for HHA documentation to be considered, physicians must sign the documentation into their own records, then agencies must get copies of those records for review purposes.

“We believe the provisions in section 51002 of the BBA of 2018 do not require a change to the current regulations because the provisions are consistent with existing CMS policy,” CMS says. But CMS will change its regulatory language to reflect the sub-regulatory guidance (on physicians signing HHA documentation into their own records) that it is currently following, it allows.

No sweat: Under this process, “no additional burden is incurred by either the HHA or the certifying physician,” CMS adds.

“As existing sub-regulatory guidance allows HHA-generated documentation to be used as supporting material for the physician’s determination of eligibility for home health services, we expect that most HHAs already have a process in place to provide this information to the certifying physician or the acute/post-acute care facility,” CMS says. “We welcome comments on this assumption.”

This is basically “CMS saying ‘we are not going to change anything,’” despite instructions from Congress to do so, believes attorney Robert Markette Jr. with Hall Render in Indianapolis. “CMS thinks it doesn’t have to listen to Congress,” Markette says.

Congress doesn’t take time to pass laws that say “keep doing what you’ve been doing,” Markette insists. “Why would Congress waste its time?”

Markette urges providers to focus on this element in their comment letters, due Aug. 31.

Note: See links to the 600-page rule, PDGM tools, and more at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulationsand-Notices-Items/CMS-1689-P.html.