CMS Lifts Home Health Moratoria in FL, TX, MI & IL

According to the Centers for Medicare & Medicaid Services (CMS), “As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State or U.S. territories.”  CMS announced Wednesday that the provider enrollment moratoria on home health agencies in Illinois, Michigan, Texas, and Florida have expired. The notice from CMS can be read here.

ACHC is able to expeditiously conduct an Initial Medicare Certification Survey for home health agencies (HHAs) in these states. An organization may apply for accreditation if the following eligibility requirements are met.

The organization must:

  1. Be currently operating within the United States and/or its territories.
  2. Be licensed according to applicable state and federal laws and regulations and maintain all current legal authorization to operate.
  3. Have completed the Medicare Enrollment Application Form CMS-855A and had this form verified by the assigned Medicare Administrative Contractor (MAC), if applicable.
  4. Have established policies and procedures.
  5. Have successfully completed a test Outcome and Assessment Information Set (OASIS) transmission to the state repository, if applicable.
  6. Have met capitalization requirements, if applicable.
  7. Occupy a building in which services are provided/coordinated that is identified, constructed, and equipped to support such services.
  8. Clearly define the services it provides directly or under contract.
  9. Submit all required documents and fees to ACHC within specified time frames.
  10. Be providing home health nursing and at least one qualifying therapeutic service.
    1. The qualifying therapeutic services include physical therapy, speech therapy, occupational therapy, medical social services, and home health aide (Reference in Centers for Medicare and Medicaid Services (CMS) 42 CFR 484.105(f).
    2. A Distinction is a non-qualifying therapeutic service.
  11. Have provided care to a minimum of 10 patients requiring skilled care (not required to be Medicare patients). At least seven of the 10 required patients are receiving skilled care from the Home Health Agency (HHA) at the time of the initial Medicare survey. If the HHA is not able to meet the minimum number of patients required, the initial survey will not be conducted. If the HHA is located in a medically underserved area, they can contact the CMS Regional Office (RO). If the CMS RO determines that the HHA is located in a medically underserved area, the CMS RO may reduce the minimum number of patients from 10 to five. At least two of the five required patients should be receiving skilled care from the HHA at the time of the initial Medicare survey. It is the organization’s responsibility to notify ACHC if it is located in an underserved area.

 

For more information call (855) 937-2242 ext. 457

How Does the Fiscal Cliff Affect Your Business?

To start, President Obama signed the American Taxpayer Relief Act of 2012 into law to stave off the fiscal cliff, which left many home health organizations relatively unchanged for another year. Here are the highlights affecting Home Health and Hospice:

• There are no cuts to Medicare home health or hospice care benefits, payments, or payment rates

• Home Health will not see Medicaid cuts

• Protection against the Medicare outpatient therapy cap is in effect through the end of the year (2013)

Finally, the Senate bill created a Long Term Care Commission that will be in charge of developing a plan to meet the needs of the aging population. The commission will be a group of 15 members appointed by Mr. Obama, as well as other congressional leaders.

This is good news to start off the New Year for home health and hospice facilities, however community pharmacists may have gotten the rotten end of the deal. A provision in the bill stated that there will be a competitive bidding structure for diabetes test strips (which could save the Medicare program upwards of $600 million). This could seriously affect the industry and cause community pharmacists to stop providing diabetes test supplies to Medicare beneficiaries. John Coster, of the National Community Pharmacists Association (NCPA), stated his concern, “NCPA has repeatedly outlined to Congress and Medicare officials the shortcomings in such an approach. Round one of the competitive bid program has validated NCPA’s concerns, including waste in mail order and patients’ strong preference for a face-to-face health care experience with a local provider.”

What are your thoughts?  Please share below!

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Survey The Expert Podcast: Episode 3

Album cover for Survey The Expert: ACHC [iOS users]

[5:25]

In today’s Survey The Expert podcast, we’ll learn more about CMS’s recent ruling that will affect Home Health agencies. Julie Pazun, ACHC’s Home Health, Hospice, and Private Duty Clinical Manager, will highlight the key elements of the document.

However, it will be wise for all Home Health agencies to become familiar with the final ruling by going to www.federalregister.gov. Note that some of the ruling are not in effect until July 1, 2013, and others July 1, 2014.

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