Home Health & Hospice Week

Plus: Rule lays out home infusion therapy details, misses OT certification opportunity.

Newly enrolling home health agencies can remove one OASIS-related task from their ramp-up to-do list, if a new proposal gets finalized.

Old way: Currently, “Section 484.45(c)(2) of the home health agency conditions of participation (CoPs) requires that new home health agencies must successfully transmit test data to the Quality Improvement & Evaluation System (QIES) or CMS OASIS contractor as part of the initial process for becoming a Medicare-participating home health agency,” notes the Centers for Medicare & Medicaid Services in its home health payment proposed rule for 2021. Because “new HHAs do not yet have a CMS Certification Number (CCN) … they used a fake or test CCN in order to transmit test data to the [QIES] Assessment Submission & Processing (QIES ASAP) System or CMS OASIS contractor,” explains the rule published in the June 30 Federal Register.

New way: Now, the new Internet QIES data submission system “requires users to include a valid CCN with their Internet QIES user role request that will allow them to submit their OASIS assessment data to CMS; the new data system no longer supports the use of test or fake CCNs, making it impossible for new HHAs that do not yet have a CCN to submit test data,” CMS explains.

HHAs’ main motivation for submitting OASIS is that their claims can’t get paid if there is no matching OASIS assessment in the system for them. “This link to the payment process gives HHAs strong incentive to ensure that they can successfully submit their OASIS assessments in the absence of this regulatory requirement,” the rule says. Therefore CMS will remove the testing requirement from the CoPs.

“Anything that means less work related to OASIS makes this industry happy,” notes consultant and physical therapist Cindy Krafft with Kornetti & Krafft Healthcare Solutions.

“When you are opening an agency, any decrease in a requirement is helpful,” adds consultant Pam Warmack with Clinic Connections in Ruston, Louisiana.

“Start-ups have a lot on their plates,” notes Sharon Litwin with 5 Star Consultants in Camdenton, Missouri. “To have even this one item eliminated as they prepare for Medicare certification is helpful.”

But “this would be a very minimal thing for new agencies in testing the OASIS transmission,” judges consultant J’non Griffin, owner of Home Health Solutions in Carbon Hill, Alabama.

And the number of new agencies per year is relatively small. “I can’t see too many agencies being affected, but it’s helpful to reduce provider burdens when possible,” allows Joe Osentoski with Gateway Home Health Coding & Consulting in Madison Heights, Michigan.

Other issues addressed in the proposed rule include:

• Home infusion therapy. CMS spends over a third of the rule going through details of the home infusion therapy benefit that was created in the 21st Century Cures Act in 2016. CMS implemented a transitional benefit this year and will move to the permanent benefit in 2021 (see Eli’s HCW, Vol. XXIX, No. 39-40).

Commenters on last year’s proposed rule were not favorably disposed to the new benefit, calling for a per diem payment methodology instead, among other changes.

At least providers get more specifics in this regulation. The volume of home infusion therapy information was surprising, Litwin tells Eli.

“If you choose to be an infusion provider, [the rule] lays out in detail the requirements needed and how it needs to be applied and documented,” Osentoski says. “This should be helpful for those providers considering Home Infusion Therapy.”

• MIA. The comparatively short rule was missing elements that industry stakeholders were hoping for, partic­ularly for other COVID-19-related waivers.

For example: Therapy proponents would like to see CMS extend the waiver that allows therapists, including occupational therapists, “to admit even when nursing is ordered,” Krafft says (see Eli’s HCW, Vol. XXIX, No. 18). “There is no real reason to go backwards on that,” maintains Krafft, who encourages therapists and others to submit comments on the topic.

“There is bipartisan Congressional support for making this policy permanent: The Medicare Home Health Flexibility Act (S. 1725/H.R. 3127),” points out OT and consultant Karen Vance with BKD. Six Senators and 25 House represen­tatives have co-sponsored the legislation, Vance relates.

“Members of Congress believe this change is within CMS’ agency authority and would like CMS to take the initiative on the issue, since there are no formal statutory limitations,” Vance says.