Home Health & Hospice Week

Watch for this issue in next year’s rulemaking cycle.

The 2020 proposed rule for home health is chock full of plans that will make your reimbursement tighter and your regulatory burden heavier — including some provisions you may have overlooked.

For example: Amid the sections on Patient-Driven Groupings Model implementation, the 8 percent behavioral adjustment cut, RAP elimination, Notice of Admission creation, and more, you may have missed the Centers for Medicare & Medicaid Services’ solicitation of comments on collecting OASIS data for all patients — not just Medicare patients.

“The reporting of all-payer data under the [Home Health Quality Reporting Program] would add value to the program and provide a more accurate representation of the quality provided by HHAs,” CMS says in the proposed rule it published in the July 18 Federal Register. “Collecting OASIS data on all patients regardless of payer will allow us to ensure data that is representative of quality provided to all patients in the HHA setting and therefore, allow us to better determine whether HH Medicare beneficiaries receive the same quality of care that other patients receive.”

CMS lists this drawback of failing to collect all-payer data. “It is the overall goal of the IMPACT Act to standardize data and measures in the four PAC programs to permit longitudinal analysis of the data. The absence of all payer data limits CMS’s ability to compare all patients receiving services in each PAC setting, as was intended by the Act.” Long-term care hospitals and hospices already collect this type of data, and it’s proposed for the skilled nursing facility and inpatient rehabilitation facility settings for 2020, CMS adds.

Not if, but when: “We plan to propose to expand the reporting of OASIS data used for the HH QRP to include data on all patients, regardless of their payer, in future rulemaking,” CMS declares in the proposed rule. CMS maintains this intention despite receiving comments opposing the change in the 2018 rulemaking cycle, it notes.

CMS solicits comments on the plan, and specifically five questions addressing topics such as outcome differences between Medicare and non-Medicare patients and potential burden levels.

As in 2018, numerous commenters on the 2020 proposed rule oppose the idea of collecting OASIS data for all patients, regardless of payer.

“If the managed care insurer does not require OASIS, then it is a burden to require agencies to capture it for CMS use only,” says Candy Bartlett with Aegis Therapies, in the chain’s comment letter. “Reimbursement with these plans is already often lower than Medicare reimbursement, and adding a significant amount of time to gathering the information required to complete the comprehensive assessment creates undue burden on the provider without a resultant improvement in patient care,” Bartlett tells CMS.

Requiring HHAs to collect OASIS data on all patients would result in apples-to-oranges comparisons, multiple providers cautioned in their letters. “Patients where OASIS collection is not presently required are usually younger with shorter lengths of stay, have a healthier baseline and have more acute care needs than the population for which the OASIS collection and reporting currently applies,” highlights Pat West with Pioneer Home Health Care Inc. in Bishop, California.

“Medicaid programs and commercial payers often have different coverage standards than Medi- are,” says Lisa Harvey-McPherson with health system Northern Light Health based in Brewer, Maine. “Commercial payers have prior authorization requirements that limit both visit frequency and covered services often impacting the functional outcomes achieved by our patients. Simply having OASIS data on non-Medicare patients without concurrent definition of the benefit design and limitations on visits would result in misleading information that we believe would harm our agency and agencies across the country,” Harvey-McPherson explains.

Bottom line: “CMS should not require the OASIS data set be collected on all patients served by the agency regardless of payer,” urges the National Association for Home Care & Hospice in its comment letter.

If CMS does decide to move ahead over the industry’s objections, it “must modify its Home Health Compare and star ratings system to reflect the impact of that increased patient population on outcomes,” NAHC emphasizes. “Just as patients with different diagnoses or functional status can have different outcomes, patients of non-Medicare payers can be affected by the payer’s scope of benefits, benefit administration, and care management,” the trade group says.

What About Patient Privacy?

The change raises privacy concerns as well. “Every insurance plan we contract and provide care to patients have their own quality verification/gathering system,” points out Brian Vamstad with health system Allina Health based in Minneapolis. “We are apprehensive of patient information from all payers going to the agency that is not enrolled in a CMS program.”

And the proposed expansion would have a negative impact on agencies that furnish private pay services, as well as their patients. “It would be exceptionally burdensome and expensive to private duty agencies with respect to providing the extensive training to private duty nurses that would be required for accurate OASIS completion,” says Jean Gonyner. “The proposal would also be burdensome and intrusive to private pay patients, who already must endure a 90-minute admission visit. If CMS does decide to go forward with the proposal, my agency would request that an exemption be allowed for private pay patients,” Gonyner says in her letter.

Watch for: Unlike most of the provisions in the 2020 rule, HHAs shouldn’t expect to see a decision on the matter in the final rule expected in late October or early November. Instead, a formal proposal and ultimate decision on the matter is most likely to appear in next year’s rulemaking cycle, experts predict.

Note: The rule is at www.govinfo.gov/content/pkg/FR-2019-07-18/pdf/2019-14913.pdf.