Medicare Compliance & Reimbursement

No need to reassess all Medicaid patients in 5-day window, CMS says.

Home health agencies have been laboring to update all of their Medicaid patients' assessments in the last five days of their 60-day episodes, but they just got some good news.

Now any patients who are exempt from OASIS are also exempt from the five-day window requirement for the update to their comprehensive assessments, the Centers for Medicare & Medicaid Services clarifies in a Sept. 9 letter to surveyors (S&C-04-45).

Home health agencies do not have to wait until the 55th to 60th day "to perform another comprehensive assessment on non-Medicare/non-Medicaid patients, or for pediatric patients, maternity patients and those patients receiving personal care only services even when Medicaid is the payor source," CMS stresses in the letter. Agencies can perform the assessments any time in the episode up to the 60th day.

"This additional caveat is very helpful," says Mary St. Pierre with the National Association for Home Care & Hospice. CMS issued a letter to surveyors in April saying agencies still must perform comprehensive assessments even when OASIS isn't required. After that, surveyors started citing agencies for not conducting those non-OASIS assessments in the OASIS timeframes, St. Pierre notes.

That's what happened to Texas HHAs, says Rachel Hammon of the Texas Association for Home Care. Before the April letter, "the five-day window requirement was never enforced for those clients not subject to OASIS data collection," Hammon notes.

Agencies cried foul once surveyors began applying the five-day window to all Medicaid patients for several reasons, notes Chicago-based regulatory consultant Rebecca Friedman Zuber. Many Medicaid programs have more involved requirements for recertification, such as having physicians' signatures on the orders before the recert period. In those cases, agencies need to start the recertification process with a comprehensive assessment at least a few weeks before the end of the episode, Zuber explains.

Because these patients didn't generate OASIS data, there was no reason for CMS to require the assessment in the OASIS timeframe, NAHC has argued to CMS.

And enforcing the five-day window added extra, unnecessary visits to HHAs' workloads, says consultant Judy Adams with Charlotte, NC-based LarsonAllen Health Care Group. Now agencies "can do the reassessment as part of a scheduled visit that might be earlier than the five-day window, and thus avoid additional - and often non-billable - visits just for the reassessment," Adams cheers.

Editor's Note: The survey letter is at www.cms.hhs.gov/medicaid/survey-cert/sc0445.pdf.