Home Health & Hospice Week

Despite confusion, HHAs must comply with new notice requirement by July 1.

A massive new paperwork mandate requiring you to issue a notice to every single patient you discharge is ready to land in your lap this summer, and it's as confusing as ever.

The Centers for Medicare & Medicaid Services has submitted its new termination and expedited review forms to the Office of Management and Budget for approval, according to a CMS notice in the April 29 Federal Register.

The notices, which will tell beneficiaries their home health or hospice services are ending and make a new expedited review of the termination available to them, are virtually unchanged from the forms CMS issued in conjunction with its final rule on the matter last November (see Eli's HCW, Vol. XIII, No. 43).

CMS also issued new instructions for the home health advance beneficiary notice (HHABN), which requires HHAs to issue ABNs whether physicians agree with changes in care or not.

Warning: The new termination notices and the changes to the ABN will cause mass confusion, industry experts warn. "The double barrel of notices indicates that this will be a busy season for process changes," notes William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law. Problems With New Notices Abound HHAs are chagrined that CMS seems to have taken almost no notice of the grave concerns they raised in response to the final rule, which did allow comment submission. For example, health care attorney Elizabeth Hogue submitted a laundry list of serious problems with the new notices, "but apparently it's just been ignored," she fumes.

Here are top problems with the notices:  Physician orders. During the new 72-hour expedited review that the notice can trigger, CMS instructs HHAs and hospices to continue services for the three-day period. But home care providers can't furnish services without a physician's order under the Medicare Conditions of Participation, protests consultant Lynn Yetman with Reingruber & Co. in St. Petersburg, FL.

"CMS has failed to recognize that home care and hospice can not be delivered in the absence of appropriate orders," Yetman says. "CMS will have to address the problem."
  Appropriate usage. The instructions for using the new termination notices and the ABNs are highly confusing, experts agree. CMS has not clarified whether patients will sometimes receive termination notices, ABNs or both at the end of their care - and why.

The new ABN instructions "will only serve to confuse agencies even more about which form to use under what circumstances," charges consultant Judy Adams with LarsonAllen Health Care Group based in Charlotte, NC. "It destroys the differentiation be-tween the HHABN and the new non-coverage notice." CMS should consider eliminating one of the [...]