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Home Health & Hospice Week

Regulations:

Help Is On The Way For Homebound Demo

Published on Thu Sep 02, 2004

OASIS, SCICs also discussed in latest open door forum.

The Oct. 4 implementation date for the homebound demonstration is fast approaching, and some home health agencies are getting nervous. But information will be coming your way soon.

So assured the Centers for Medicare & Medicaid Services in the Aug. 25 Open Door Forum for home health providers. CMS is launching the pilot project, which loosens homebound criteria for Medicare coverage, in Colorado, Massachusetts and Missouri (see Eli's HCW, Vol. XIII, No. 25, p. 197).

CMS is asking all HHAs in those states to participate in the demo, which the agency has rechristened the "Home Health Independence Demonstration." And if lawmakers like what they see, they may change the homebound criteria for the overall Medicare home health benefit.

HHAs will fulfill a "gatekeeper role" in the project, CMS confirmed in the forum. In light of that responsibility, demo project contractor Abt Associates will begin outreach activities, namely open door meetings, with agencies in the last three weeks of this month. After convening with HHAs, Abt will conduct meetings for referral sources, senior advocacy agencies and the interested public, the CMS official explained.

Once the project is up and running in October, Abt will man a to-be-announced toll free helpline for HHAs. The general public can get information on the demo from 1-800-MEDICARE and a forthcoming CMS Web site dedicated to the project, CMS said.

Other topics addressed in the forum include:

  • Pressure ulcers. Although the changes to OASIS pressure ulcer coding went into effect Sept. 1 (see Eli's HCW, Vol. XIII, No. 30, p. 234), CMS has not yet included the changes in the OASIS User Manual's Chapter 8, a CMS official explained. The new coding guidance will go in with the next revision, the staffer said.

  • SCICs. You may be able to pare your OASIS workload a bit starting next month. New rules will go into effect Oct. 1 that will allow agencies to scrap the followup OASIS assessment (RFA 4) when a resumption of care assessment (RFA 3) must be filled out for a patient returning from the hospital in the last five days of her prospective payment system episode, CMS reminded the 247 forum participants.

    Starting then, HHAs can claim a significant change in condition (SCIC) and set the reimbursement level for the next episode by just using the RFA 3, CMS announced back in April (see Eli's HCW, Vol. XIII, No. 16, p. 122).

    But be careful to avoid therapy billing problems, experts warn - you'll have to correct billing by hand if the answer to M0825 is "yes" in the current episode and "no" in the subsequent episode.

  • Outcomes. The new HHA outcomes the National Quality Forum has proposed are far from a done deal. NQF says CMS - and thus agencies -must adopt any new measures the organization finalizes through its consensus-building procedures (see Eli's HCW, Vol. XIII, No. 27, p. 210). But CMS is under no obligation to accept them, a CMS official said in the forum.

    The agency would "look very closely" at NQF's recommended measures and would try to incorporate them into Home Health Compare if feasible, the CMS source indicated.

    At least some new outcomes do look likely. But if agencies currently don't collect the data that would be needed for certain proposed outcomes, "that will be taken into consideration," the official said.

  • OASIS Q&A. Looking for those elusive OASIS questions and answers that used to be on CMS' Web site? Now they are all in one place: www.qtso.com/hhadownload.html.

    CMS removed many of the 380 Q&As from its site last year because it wanted only "really hot" Q&As on the main site, a CMS official explained. Due to agency demand for the guidance, OASIS contractor Iowa Foundation for Medical Care is now posting the retired items.

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