Home Health & Hospice Week

There's still a chance to persuade CMS to make change mandatory.

Home health agencies would have liked to see the recent budget law make inclusion of HHA documentation in medical review a requirement instead of an option. But all is not lost quite yet.

In its 2019 rulemaking, the Centers for Medicare & Medicaid Services has the opportunity to rectify the "optional" problem. In its Feb. 28 Home Health Open Door Forum, a CMS official noted that the regulations implementing the change will be included in the Home Health Prospective Payment System proposed and final rules for 2018, scheduled for publication in late June and November, respectively. That rulemaking schedule dovetails with BBA 18's requirement to implement the change by Jan. 1, 2019.

"We will be taking full advantage of the rulemaking opportunity to convey to CMS that it should specifically establish a standard that requires all eligibility and coverage determinations to be based upon a combination of the physician and home health agency record," says National Association for Home Care & Hospice President William Dombi. "If CMS is serious about reducing regulatory and paperwork burdens, basing determinations on the whole record make the most sense. Also, it is the best way to end up with an accurate determination," Dombi tells Eli.

HHAs would have preferred CMS implement the change even earlier than the deadline outlined in the budget law, notes clinical consultant Anna Doyle with McBee Associates in Hilton Head, South Carolina.

There is much less prep time for implementing a change like this compared to, say, the revised Conditions of Participation, notes Joe Osentoski, reimbursement recovery & appeals director for QIRT in Troy, Michigan. "So to wait nearly a year does seem stretching it," he says. But the announcement about the provision's inclusion in the PPS rule appears to preclude the possibility of an earlier date of change.

Say It Loud

"A volume of comments similar to those voiced in relation to HHGM during the proposed rule comment period is an excellent place" to advocate for making the documentation standard mandatory, Osentoski exhorts. The HH PPS proposed rule for 2018 last year, which included the Home Health Groupings Model proposal, garnered more than 1,350 comment letters.

"If there is a chance of getting it changed, we should do everything in our power to do so," urges clinical consultant Pam Warmack with Clinic

Connections in Ruston, Louisiana.

Tip: Get specific with your comments, Osentoski advises. "Comments with actual content other than 'this doesn't change anything' will hold more value," he tells Eli. Explaining why the law's current wording "gives little relief in the main denial reason of medical review (after nonresponse to ADRs) is a key point to convey."

Plus: Add in "that since physicians have a long-established slower pace of changing practice to meet home health's needs, validating the ability of the agency to provide corroborating clinical content is something that actually would give some relief," Osentoski suggests. And the change would result in fewer home health denials on technical grounds and subsequently less appeals accumulating at the Office

of Medicare Hearings and Appeals.

Of course, many agencies are likely to comment on a larger change included in the upcoming proposed rule - payment reform, which is also required by BBA 18 (see Eli's HCW, Vol. XXVII, No. 8). The law requires that the reform model, which may or may not closely resemble HHGM, eliminate therapy from case mix and be budget neutral.

Don't let the payment reform comments you submit lead you to forget including documentation comments as well, the experts urge.

Watch for: CMS usually issues the HH PPS proposed rule in late June or early July.