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

Medicare Influenza Vaccine Guide for Providers

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.

	Emergency Preparedness Packet for Home Health Agencies
	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

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

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.

Final 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.

	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

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
	2009 PPS Payment Calculator

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
The Centers for Medicare & Medicaid Services (CMS) requires home health agencies to use a standardized assessment tool for all Medicare and Medicaid patients. CMS makes OASIS related web sites and on-line tools available to home health agencies

	CMS OASIS User's Manual
	OASIS User's Manual Chapter 8
	OASIS related policies and Q&A

OASIS-C (NOTE DRAFT VERSION)
CMS has submitted proposed revisions to OASIS items to the Office of Management and Budget for approval. Additional changes may be required. CMS plans to require home health agencies to implement a final version of OASIS in January 2010. Changes to OASIS-B1 found in OASIS-C include removal of items that are not currently used by CMS for payment or quality, addition of items to address clinical domains not currently covered, and modification of item wording or response categories for selected items.

DRAFT OASIS-C and supporting documentation

Consumer Assessment of Health Providers and Systems (CAHPS) (NOTE: DRAFT VERSION)
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 that will be released later this year.

DRAFT CAHPS survey and supporting documentation

Outside Resources for Sale

Briggs Corporation

Ordering Information: Briggs Corporation, 7300 Westown Parkway, suite 100  West Des Moines, IA 50266. 1.800.247.2343  www.BriggsCorp.com

• Fall Prevention Program – stock no. 8500

• An Evidence-Based Fall Prevention Program provides tools that can result in reduced hospitalizations, improved fall outcomes and increased referrals. 

Marrelli and Associates, Inc.

Ordering Information: Marrelli & Associates, Inc.,P.O. Box 629, (941) 697-2900, Boca Grande, FL 33921-0629, www.marrelli.com

• Hospice and Palliative Care Handbook: Quality, Compliance, and Reimbursement
  Second Edition. The handbook provides concise information about hospice and palliative care conditions for care planning and reimbursement. (528 pages).

• The Handbook of Home Health Orientation
  This handbook was written to serve as an adjunct to home health agency-specific orientation. (435 pages).

• Nursing Documentation Handbook
  Third Edition. This book presents examples and guidelines of nursing documentation easily referenced by a patient’s clinical problems. (472 pages).

• The Nurse Manager’s Survival Guide: Practical Answers to Everyday Problems
  Third Edition. The Nurse Manager’s Survival Guide discusses major areas of successful management, including recruitment and retention, communication, time management, day-to-day operations, and resource management. (395 pages).

• Home Health Aide: Guidelines for Care: A Handbook for Caregiving at Home (Aide Handbook)
  Second Edition. This easy-to-use handbook for home health and hospice aides offers information about the role and qualities of a successful aide, the home health care team, documentation requirements, safety and infection control in home care, and more. (234 pages).

• Home Health Aide: Guidelines for Care: Instructor Manual
  Second Edition. A comprehensive guide to teach home health and hospice aides, this resource is the companion text to accompany Home Health Aide: Guidelines for Care (the handbook for aides). (312 pages).

• The Handbook of Home Health Standards & Documentation Guidelines for Reimbursement
  This handbook is a complete guide to providing quality care and effective documentation through detailed documentation guidelines, including ICD-9-CM, service skills, factors supporting homebound status, discharge plans, and specific tips for reimbursement. (680 pages).