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:: NAHC Report
NAHC Report: Issue# 2343, 12/30/2013
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NAHC Recommends CMS Develop a PECOS Crisis Management Plan
Medicaid and the Council: A Year in Review
For Your Information: Hospice Item Set (HIS) Trainings – Save the Date!
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NAHC Recommends CMS Develop a PECOS Crisis Management Plan

On January 6, 2014, the Centers for Medicare and Medicaid Services (CMS) will trigger a home health services claims edit that will deny any claim where the certifying physician is not enrolled in Medicare. This action comes more than three years after the Affordable Care Act banned payment of any claim that did not involve a duly enrolled physician. The delays in implementation were due to a combination of CMS system problems and the slow speed of physician enrollment.

During those delays, CMS has done everything possible to facilitate physician enrollment. Likewise, the home health community has tried to assist physicians nationwide to understand the need for them to enroll. Great progress in that regard has been made. However, it appears that for whatever reason, the physicians have not fully complied. The VA physicians are particularly deficient – apparently because they still, mistakenly, believe that they do not need to enroll as they are not paid by Medicare for physician services.

To address problems that are expected to surface, NAHC recommended that CMS put in place a communication process to deal with the inevitable fallout that will start in January. While it is hoped that the problems will be limited in number, there is a near guarantee that there will be some. Home health agencies will have three bad choices when receiving care orders from a non-enrolled physician. First, they can accept the orders and provide care with neither Medicare reimbursement nor the ability to charge the patient. Second, they can deny admission to the patient. Third, they can help the patient find a new physician who is Medicare enrolled. In these circumstances, the treating physician may finally take steps to enroll, but enrollment would not be effective for several weeks.

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Hospice Item Set (HIS) Trainings – Save the Date!

The Centers for Medicare & Medicaid Services (CMS) has announced plans for provider training related to the Hospice Item Set (HIS) and advises hospices to mark their calendars for the upcoming CMS provider trainings. CMS will host a series of provider trainings for the HIS in February and May 2014.
Beginning July 1, 2014, hospices will be required to submit two HIS records for each patient admission – a HIS-Admission record and a HIS-Discharge record.
Trainings will be divided into two sessions:

  • HIS data collection training: will be held over two half-day sessions on February 4 in the afternoon and February 5, 2014 in the afternoon.
    • This training will be geared towards teaching hospice providers how to complete the HIS-Admission and HIS-Discharge. The training will cover each item in the HIS, including instruction on how to complete each item, examples for each item, and a question and answer session.
    • The training will be video-streamed live online on February 4th and 5th. The training will also be videorecorded and will be posted on the CMS HQRP website at a later date for provider viewing and download. Limited on-site attendance at this training will also be available. 
  • HIS Technical training: will be held in May 2014, exact date TBD.
    • This technical training for hospice providers and vendors will cover topics such as registration, obtaining user IDs, submitting files to the QIES ASAP system, and reviewing final validation reports. 
    • Details about the date, time, and delivery method of this training are not yet available. Providers should check the CMS HQRP website (link below) for updates.

Further details about HIS training registration processes will be posted on the CMS HQRP website as they become available. Providers should visit the CMS HQRP website here on a regular basis for the most up-to-date information.

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Medicaid and the Council: A Year in Review

The National Council on Medicaid Home Care (the Council) looks back on 2013’s major developments for both Medicaid and the Council, a NAHC affiliate:

Medicaid Expansion: Several states continue to expand traditional fee for service Medicaid under the Affordable Care Act. A growing number of states are seeking permission from CMS for alternative methods of expansion using commercial insurance and managed care plans, incorporating principles such as premium assistance. Iowa is the third state, after Arkansas and Michigan, to adopt such a model, with Pennsylvania and Tennessee currently in negotiations with CMS to do the same.

Managed Long Term Services and Supports and Duals Demonstrations: More states are moving away from fee-for service LTSS and towards managed long-term services and supports (MLTSS). Despite delays and criticisms, states continue to sign on to duals demonstrations with CMS. Both MLTSS and the duals demonstrations create strong opportunities for rebalancing.

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