NAHC Regulatory Affairs

Mary St. Pierre, MGA, BSN, RN Vice President, Regulatory Affairs

The Regulatory Affairs division is responsible for keeping abreast of current federal regulations and government policies that affect an agency's day to day operations as well as its long term business planning. The regulatory staff is often the first to learn of regulatory changes that have both direct and indirect effects on the home health and hospice industry. This up to the minute tracking of key regulatory events enables members to stay ahead of the curve in a rapidly changing health care environment.

Providers have access to a knowledgeable and experienced team with whom they can interact on an individual basis to assist in understanding complex regulatory mandates.

Mary K. Carr, BSN, MPH Associate Director, Regulatory Affairs

Unraveling the complexities of OASIS, the home health prospective payment system, and most recently, the expedited determination process for original Medicare beneficiaries, are just a few examples of how the regulatory staff has assisted its members.

NAHC continues to work with officials at CMS to bring forth provider concerns on current and impending federal regulatory and policy issues and their impact on the home health and hospice industry.

Documents labled with a are viewable by NAHC Members only.

NAHC Resources

NAHC PECOS LookUp Tool Kit

Welcome to the National Association for Home Care & Hospice’s (NAHC) PECOS LookUp Tool. This tool contains the latest PECOS dataset along with the latest PECOS Pending dataset available to NAHC as supplied by CMS and will allow you to check your physician’s existence in the PECOS database.

NAHC PECOS LookUp Tool Kit

Red Flags Rule: NAHC Guidance and Sample Policy

This document offers a detailed overview of the Red Flags rule and guidelines on the requirements for health care organizations. The overview is followed by a sample policy for home health agencies, hospices, DME suppliers, and private duty agencies to use to implement the Red Flags Rule, consistent with the FTC guidance. The currently posted effective date for compliance is June 1, 2010. However, since the date has been changed several times we recommend confirmation of implementation on the FTC website.

Red Flags Rule: NAHC Guidance and Sample Policy

Medicare Influenza Vaccine Guide for Providers

Physician Payment for Home Health and Hospice Services Effective January 1, 2010 - May 31, 2010

NAHC is providing the current payment rates for physician services in home health and hospice free of charge to our members.

Legislation has eliminated the proposed negative 20% update to the Medicare Physicians Fee Schedule and has provided for a zero percent update for the months of January and February, 2010. In addition, there have been revisions to the Physician's Fee Schedule Conversion Factor and Practice Expense Relative Value Units (RVUs). The fees posted below reflect those revisions and the zero percent update.

On March 2, 2010, President Obama signed into law the "Temporary Extension Act of 2010." Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010.

The "Continuing Extension Act of 2010" signed into law April 15 extends through May 31, 2010 the zero percent update to the Medicare physician fee schedule that was in effect for claims with dates of service from Jan. 1 through March 31, 2010.

	Table B1 2010
	Table B2 2010

Emergency Preparedness Resources

The packet was developed by the NAHC Emergency Preparedness Workgroup and provides tools to assist agencies, patients and their families, and agency staff develop emergency preparedness plans. The guide has been updated to include the OASIS-C.

Emergency Preparedness Packet for Home Health Agencies-2010

The four page disaster planning guide was developed by the Department of Homeland Security to assist home health providers and their patients.

Preparedness Planning for Home Health Care Providers

Pandemic Influenza Preparedness Resources

Home Health Care During an Influenza Pandemic: Issues and Resources

OSHA - Occupational Safety and Health Administration

	Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers
	Guidance on Preparing Workplaces for an Influenza Pandemic

Regulatory Blueprint for Action

	2009 Regulatory Blueprint for Action
	Hospice Association of America: 2009 Regulatory Blueprint for Action

Proposed Regulations
Proposed regulations are preliminary federal rules that are established by the various government agencies and published in the Federal Register.

42 CFR Parts 409, 418, 424, et al. Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices; Proposed Rule

Comments on Proposed Regulations
Proposed regulations have a thirty to ninety day comment period where by all interested persons may submit written comments on the proposed rules prior to a final action.

Home Health Statute and Regulations
After comments to a proposed rule are analyzed by the respective government agency, a final regulation is published in the Federal Register. These final regulations are what govern the implementation of Federal programs.

Home Health Regulations

	Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2010; Final Rule
	Medicare Program: Home Health Prospective Payment System Refinement and rate Update for Calendar Year 2008
	Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2009
	Home Health Basis, purpose, and scope
	Requirements for Payment
	Plan of Care Requirements
	Skilled Services Requirement
	Dependent Services
	Allowable Administrative Costs, Place of Service Requirements, and Visits
	Excluded Services
	Criteria for Skilled Service and the Need for Skilled Service
	Examples of Skilled Nursing and Rehabilitation Services
	Particular Services Excluded from Coverage

Medicare Statute

	Definition of Home Health
	Conditions and Limitations of Payment for Services (Provides skilled nursing, therapies, plan of care, and homebound requirements interspersed with other provider requirements)
	Limitation on Liability When Claims are Denied
	Waiver of Recovery of Payment
	Exclusions from Coverage

Local Coverage Determinations

Decisions by a fiscal intermediary or carrier whether to cover a particular service:

Beneficiary Notices
Home health agencies are required to provide notice of Medicare non-coverage of services to beneficiaries. The following web sites and resources provide guidance needed to meet beneficiary notice requirements

	CMS Beneficiary Notice Initiative web site
	HHABN Questions and Answers September 2006
	Home Health HHABN Decision Tree for the HHABN "Final Word" Tele-conference.
	HHABN Option Box Decision Tree for Non-Coverage, Reductions, and Terminations of Medical Services.

Medicare Home Health Prospective Payment System (PPS)
Home health agencies are paid prospectively, based on a case-mix system, for their services. The Centers for Medicare & Medicaid Services (CMS) offers detailed information about the PPS methodology and payment calculations on its web site.

	CMS Home Health Center
	CMS Home Health Prospective Payment Question & Answers
	Home Health PPS Pricer
	Home Health Consolidated Billing List 2009
	2010 PPS Payment Calculator-Urban
	2010 PPS Payment Calculator-Rural

Medicare Home Health Conditions of Participation and Guidance to Surveyors
In order to be certified as a provider of Medicare services home health agencies are required to comply with certain regulations. The regulations and instructions to State surveyors are available on-line.

Medicare Home Health Conditions of Participation and Guidance to Surveyors

OASIS-C
The Centers for Medicare & Medicaid Services (CMS) requires home health agencies to use a standardized assessment tool for all Medicare and Medicaid patients. OASIS-B1 is being replaced wiith OASIS-C effective for all assessments completed on or after January 1, 2010. The following documents have been provided by CMS to assist home health agencies transition to and train their staff in OASIS-C.

	OASIS-C August 2009 Version
	OASIS-C Guidance Manual [ZIpped PDF 4.6MB]
	OASIS-C: Changes from OASIS-B1
	CMS OASIS-C Q&As 12/2009
	OASIS-C Q&A Addendum- Subsequent to CMS 12/2009 Official Update

OASIS-C Training Video
“OASIS-C: What You Must Know”  NAHC has arranged for a free video link to the 4 hour preconference from the NAHC Annual Meeting for all home health agencies. The presenters were the CMS contractors who were responsible for the development and testing OASIS-C. This video, with synchronized session handouts, provides: an overview of the design of OASIS-C; in-depth information on the new and revised OASIS items; conventions for accurate OASIS coding; and guidance for implementation. The content and materials presented during the conference were approved by CMS. This free four-part video can be accessed at: www.dcprovidersonline.com. The power point presentation and additional materials (including the OASIS-C data set, Conventions, and Item Usage chart) can be found by scrolling down to Program 900 at: 2009 Annual Meeting Handouts.

Consumer Assessment of Health Providers and Systems (CAHPS)
The term CAHPS refers to a comprehensive and evolving family of surveys that ask consumers and patients to evaluate the interpersonal aspects of health care. CMS and AHRQ have developed a Home Health CAHPS tool for surveying home health patients. Results of these surveys will be publicly reported on Home Health Compare in late 2010 or early 2011. Participation is voluntary, but Medicare payments may be reduced for agencies that do not participate.

Detailed information about the HH CAHPS