CMS Open Door Forum Summary
August 29, 2016 09:20 AM
CMS held a Home Health, Hospice and DME Open Door Forum (ODF) on August 23. A summary of the call is below.
1. CMS contractor, Abt Associates, delivered a presentation - Home Health Payment Reform – The Home Health Groupings Model (HHGM). The HHGM is still being developed and a Technical Report will be released on it later this year. The HHGM addresses some concerns with the current Medicare home health payment structure, as identified by MedPAC (Medicare Payment Advisory Commission). The HHGM requires no change to how the OASIS is currently completed but uses 30-day time periods instead of 60 day periods. According to Abt Associates this would better align payment with costs since episodes have more visits on average during the first 30 days than the last 30 days. Under the HHGM, a HHRG is derived from
Referral source and timing of the episode (community or institutional/early or late)
Clinical groupings (six different groups)
The slides used in the presentation are available at the link above or by clicking here.
2. Home health Value Based Purchasing (HHVBP) – CMS indicated that the Quarterly Performance Reports were released in July, via the HHVBP Secure Portal, for the nine states that are part of the model.
3. HHCAHPS - Home Health Care CAHPS Survey – For HHCAHPS assistance, email HHCAHPS@RTI.ORG. The official HHCAHPS website is https://homehealthcahps.org. The email address for the Home Health APU reconsiderations mailbox is HHAPureConsiderations@cms.hhs.gov
4. IMPACT Act – CMS will host a Special Open Door Forum on September 15, 2016 from 2:00 PM – 3:00 PM Eastern. Instructions for participating in this ODF will be posted soon.
The hospice portion of the ODF included a summary of recent releases from CMS as outlined below.
1. FY2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Update (FY2017 Final Rule)
Click here for NAHC’s detailed summary of the FY2017 final rule.
2. Hospice Data Directory Update and HIS Date Specifications Update – This Directory provides the Hospice Agency dataset, which contains a list of all hospices certified by Medicare and high-level demographic data for each agency including:
CMS Certification Number (CCN)
Date of original CMS certification
Hospices are encouraged to review their information in the Directory for accuracy. If agecy data is not listed in the database, is incorrect, or has changed, contact your Regional Office (RO) Coordinator. A RO Coordinators list is also included with the Hospice Data Directory.
Also, the updated HIS Hospice Data Specs (v2.00.0) that are effective April 1, 2017 are now available on the HIS Technical Information webpage, Downloads section. Note that there were no changes from the previously posted draft version of these specifications.
3. Change Request 9590 - This CR creates a new condition code – 85 -- to be used when the hospice received the recertification of terminal illness later than 2 days after the first day of a new benefit period. This code is reported with occurrence span code (OSC) 77, which reports the provider liable days associated with the untimely recertification. CMS is implementing the new condition code 85 to identify a late recertification so that Medicare systems will be able to distinguish between whether the provider-liable days declared by the provider are due to a late certification or to a late Notice of Election (NOE), and to allow the hospice certification date (designated by occurrence code 27) to be included on the claim in conjunction with OSC 77 dates in cases where the NOE is untimely. The requirement becomes effective January 1, 2017.
Please note that until this CR becomes effective, the Medicare Administrative Contractors (MACs) have been instructed to override the edit that is currently occurring in error.
Also as part of CR 9590, CMS is correcting other systems problems related to the new hospice payment system for routine home care (RHC) and the service-intensity add-on (SIA). These system problems (which will also be corrected effective January 1, 2017) include:
Systems not counting all hospice benefit period days when the period is not separated by 60 days for purposes of determining whether a high or low RHC payment should be paid;
Systems not looking back at a prior month’s claim in some situations to determine if there are SIA-eligible visits that should be paid; and
Systems incorrectly recouping SIA payments in error if a provider subsequently adjusts the claim again.
4. Medicare Care Choices Model (MCCM) – CMS provided a review of the Model’s design. More information can be found at the CMS MCCM webpage.
5. Hospice Quality Reporting Program
For technical assistance with Hospice CAHPS, please contact the CAHPS Hospice Survey Project Team: hospicecahpssurvey@HCQIS.org or 1-844-472-4621
To communicate with CMS staff about implementation issues: email@example.com
For information about the CMS Hospice Quality Reporting Program (HQRP) Web site: http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/Hospice-QualityReporting/index.html?redirect=/Hospice-Quality-Reporting/
The next CMS Home Health, Hospice and DME ODF is scheduled for October 5, 2016.