Home Health & Hospice Week

The regulatory change that no longer requires a physician to estimate the length of time home care services will be needed for a recertification has hit the books — as well as one averting the potential advanced directive crisis.

Change #1: Change Request 11104 imple- ments the elimination of the requirement, which was included in the 2019 Home Health Prospective Payment System final rule and effective as of Jan. 1. “Eliminating this requirement would reduce denials that result solely from when this estimate is missing from the recertification statement,” the Centers for Medicare & Medicaid Services notes in the transmittal issued March 22.

The transmittal updates the Medicare Benefit Policy Manual and Medicare Program Integrity Manual, notes HHH Medicare Administrative Contractor Palmetto GBA in a message to providers. “This CR also updates the Medicare Benefit Policy Manual (Pub. 100-02), Chapter 7, to reflect Condition of Participation changes finalized in the Medicare Home Health Conditions of Participation Final Rule,” CMS adds in the transmittal.

Change #2: Among multiple CoP-related changes is this one, points out the National Association for Home Care & Hospice: “The plan of care must include the identification of the responsible discipline(s) and the frequency and duration of all visits as well as those items listed in 42 CFR 484.60(a) that establish the need for such services.”

In other words: NAHC “has confirmed with CMS that the policy requires the plan of care (POC) contain elements within §484.60(a) that support medical necessity, but the POC does not need to include all the items in §484.60(a) if not material for payment.” And that means “agencies do not need to re-bill claims if all of the items listed in §484.60(a) are not on the POC, as long as the item is not required to support medical necessity, for example, the patent’s advanced directives. Although, all of the items in §484.60(a) must be included on the POC for compliance with Conditions of Participation, all of the items may not be necessary as a condition for payment,” NAHC advises.

Around the turn of the year, NAHC had warned that the CoP change requiring advanced directive info on the POC might require mass claims corrections (see Eli’s HCW, Vol. XXVIII, No. 2).

That applies to any claim submitted since the Jan. 13, 2018, effective date for the revised CoPs, NAHC adds.

Links to the CR and accompanying MLN Matters article are online at www.cms.gov/Regulations -and-Guidance/Guidance/Transmittals/2019-Transmittals-Items/R870PI.html.