CMS Open Door Forum May 6, 2015
May 12, 2015 08:36 AM
The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice and DME Open Door Forum (ODF) on May 6, 2015. During this ODF CMS reminded hospices of the HQRP (hospice quality reporting program) requirements and CAHPS hospice information.
CMS also summarized the FY 2016 hospice proposed rule (please see previous coverage in NAHC Report).
Hospices will note that there was a presentation by CMS on the prior authorization (PA) form for beneficiaries enrolled in Part D plans. The form, developed by the NCPDP in conjunction with the hospice industry, was first introduced in 2014. There were two comment periods on the form and after some revision the form was approved and released for use in late March 2015. While CMS does not mandate that the Part D plans utilize this form, CMS has strongly suggested that they do so, and may mandate use of the form in future rulemaking. The approval of the form is good for three years. This form includes a pre-authorization component but is, overall, an informational form. If hospices run into difficulty with Part D plans not accepting the Part D form to streamline the PA process for hospice beneficiaries, please feel free to contact Theresa Forster (firstname.lastname@example.org) or Katie Wehri (email@example.com).
The four primary uses of the form are:
To prospectively provide “unrelated” drug information to the Part D plan, thereby avoiding an A3 Reject for those medications
To provide information to override an A3 Reject (Coverage Determination)
To alert Part D plans of a change in hospice status
To report Plan of Care information
The Part D plans requested inclusion of a signature on the form, so this is included in the latest version. CMS clarified that the A3 override must be signed by the prescriber, beneficiary or representative and that different physicians can complete the form (depending on which physician is most familiar with the drug).
The form and instructions are available here under the Coordination of Benefits section, and the power point slides of the presentation are available here.
Home Health Star Rating System
CMS reminded participants that beginning in July a Star Rating System will be added to the Home Health Compare (HHC) web site. The star rating system will coincide with July HHC refresh.
CMS is currently testing language that explains the star rating system with consumers.
Click here for more information on the home health Star Rating System
The HHC July refresh will also include two new claims based measures: Re-hospitalization During the First the 30 Days and the Emergency Department Use Without Re-hospitalization During the First 30 days. These two measures have been endorsed by the National Quality Forum.
CMS officials reminded participants of the importance for home health agencies to ensure they are collecting the HHCAHPs data monthly and submitting the data according to the required submission dates. Agencies should be working closely with their HHCAHPS vendor and to notify the vendor and the HHCAHPS contractor if a problem with submitting the data is identified.
Click here for more information on the HHCAHPS