Home Health & Hospice Week

Get ready to personally deliver notices every single time services are reduced or end. Home health agencies dodged a bullet when the ABN workload turned out lighter than they feared. But now that bullet may hit the industry squarely between the eyes with the notice of exclusions from Medicare benefits (NEMB). In the June 16 Federal Register, the Centers forMedicare & Medicaid Services proposes the new form and seeks Office of Management and Budget approval of the NEMB. "Whenever a Home Health Agency reduces or terminates home health services in situations ... for which a Home Health Advance Beneficiary Notice is not appropriate; the home health agency must give the beneficiary notice," CMS says in its OMB submission, posted June 29. The new form arose out of litigation accusing HHAs of abandoning patients under the interim payment system, Healey v. Thompson, notes the National Association forHome Care & Hospice. As part of the settlement of that case, CMS is crafting this notice that HHAs must issue every time Medicare services are reduced or terminated and an ABN doesn't apply. A chief difference between the ABN and NEMB is that agencies must issue the NEMB even when a physician orders the reduction or termination. "Agencies must prepare and deliver to the beneficiary, or authorized representative, an NEMB-HHA whenever they reduce or terminate home health services, regardless of whether the reason for that change is a Medicare coverage determination, lack of physician certification, or the HHA's unwillingness to provide services for business reasons unrelated to coverage," CMS says in instructions on how to fill out the proposed form. HHAs must personally deliver the notice to beneficiaries, CMS adds. (See the proposed form.)

If the proposed form becomes final, "this would cause additional paperwork," worries nurse Kathleen Saucier with Vital Link in Mandeville, LA. It's just "another form to be completed and another form to be tracked," Saucier tells Eli. Most HHAs would agree with the underlying principle beneath the form -- that beneficiaries should be informed about their Medicare services, says Bob Wardwell with the Visiting Nurse Associations of America. But the bureaucratic way in which CMS wants to implement the notice is confusing and burdensome, charges Wardwell, a former CMS official. Some of that is no doubt due to the legal proceedings driving the requirement, Wardwell acknowledges. HHAs are stuck in the middle of CMS and the beneficiary plaintiffs. CMS isn't exactly highly motivated to avoid extra work, since it will fall squarely on HHAs' shoulders. "I'm much more willing to compromise away something you have to do than something I have to do," Wardwell notes. NAHC says it "has serious concerns about the form and the instructions for its use [...]