Home Health & Hospice Week

But the expedited review notices aren't yet ready for prime time, experts protest. Get ready to ready, set, GO on the new termination notice requirement starting July 1.

The Centers for Medicare & Medicaid Services has issued reams of new information on the notices, which it's now calling expedited review notices. But you have only a few short days to wrap your head around them before the implementation date arrives.

As proposed last November, CMS is requiring home health agencies and other providers to issue these notices every time a patient's Medicare-covered services end, Tony Culotta, director of CMS' Medicare En-rollment and Appeals, said in a June 20 special Open Door Forum that drew a staggering 2,000 callers

The Office of Management and Budget approved the forms June 20 and CMS posted them June 22. However, providers can use the proposed forms rather than the finalized ones until Oct. 1 in any case.

The new requirement is an administrative hassle and a big cost to home health agencies, fumes Gene Tischer with trade group Associated Home Health In-dustries of Florida. (For an outline of the two-step notice process, see the insert article at the end of this issue.) "This is going to cost agencies a bundle," Tischer says.

The requirement "just isn't in the real world," laments Burtonsville, MD-based health care attorney Elizabeth Hogue. "They're trying to cram a square peg in a round hole."

The notices are just one more thing Heritage Home Care of Broward Inc. in Davie, FL, has to monitor, notes Administrator David Rodriguez. The HHA plans to change its computer system to track these forms, Rodriguez says.

The requirement will add more "paper shuffling," and agencies could have trouble giving the notices on time, worries consultant M. Aaron Little with BKD in Springfield, MO. Tell Doc He's Wrong, CMS Instructs The new expedited review notice requirement dumps a whole new paperwork burden in HHAs' laps with a plethora of logistical problems and unanswered questions, experts protest. One of the most pressing concerns is lack of physician orders. A chief complaint on the proposed rule was that agencies can't furnish home care without a physician's orders, so how can they continue care during the 72-hour expedited review period, or longer, when ordered care ends after 48 hours?

HHAs can't furnish care without a physician's orders, CMS confirms. But in CMS' instructions to intermediaries in Transmittal 577 (Change Request 3903) issued June 3, the agency says the QIO should work with physicians if it decides Medicare will cover prolonged care. The QIO "should contact an ordering physician if this occurs, preferably the same physician who has been ordering care in the case under consideration," CMS says.

Then the QIO should "present to that physician its decisions [...]