Home Health & Hospice Week

No compliance leeway despite short notice on new forms.

You'd better be prepared to hit the ground running when the new termination notices go into effect July 1 or risk compliance trouble.

That's despite the fact that many home health agencies have never even heard of the soon-to-be-required termination notices - forms to be given out to every patient whose services are ending. And the Centers for Medicare & Medicaid Services thus far has furnished no educational efforts on the new forms.

CMS hasn't yet finalized the forms for the two-step termination notices, because the 30-day comment period for Office of Management and Budget approval closed at the end of May. But agencies can expect the final forms to remain generally unchanged from the proposed forms, CMS' Tom Kessler said in the May 25 Open Door Forum for home care providers.

HHAs worry they won't be able to comply with the July 1 deadline due to the time required to adapt and copy the forms, formulate policies and procedures around the notices and train staff, Mary St. Pierre with the National Association for Home Care & Hospice said in the forum.

"I can appreciate the lack of time," Kessler acknowledged. But the forms have been proposed since last November and CMS is moving ahead with July 1 implementation as planned, he noted.

"A lot of agencies can prepare to pull the trigger on printing" because any changes to the forms will be minor, CMS' Richard Lawlor added.

HHAs often will issue the new termination notices, which can trigger expedited review, instead of issuing an advance beneficiary notice (ABN) as they do currently, Kessler said. As CMS told Eli previously, the ABN isn't likely to take effect until after the termination notice already is in place, Kessler noted.

Other issues raised in the forum include:  Discharge orders. Unless an agency's own policy or state law requires a physician's order before discharging a patient, an HHA can discharge a patient without a physician's order when care is no longer reasonable and necessary because the patient's needs have been met, a CMS staffer said.

The clinical record should show the agency notified the physician of the discharge.

That clarification on discharge orders is undergoing the CMS clearance process and will go into the state operations manual, the CMS official noted.
  Adult day care demo. The new demonstration project that will pay five HHAs to furnish services to up to 15,000 patients in an adult day care setting is off to a slow start. CMS expected the project to begin by July, but now the request for proposal for the project probably won't come out until late June or July, pushing the demo's start date back further, CMS said.