In The News

Private Duty Nursing (PDN) Emergency Rule

The Medical Services Board (MSB) met this late last week to consider an emergency rule for Medicaid members who utilize Private Duty Nursing (PDN) who have extraordinary medical needs that require more than the current 16 hour/day to exceed that limit with approval. Under the emergency rule, adult members may now receive up to 23 hours if deemed medically necessary.

During the meeting, HHAC's Advocacy Team member Eliza Schultz, testified, along with others, that this is a good first step to increasing access for patients, but that HHAC is anxious about implementation. We suggested that the rule remove reference to the 16-hour cap all together and simply state that members are allowed up to 23 hours if necessary. We also brought up our serious concerns with Kepro. Adult PDN services must still receive prior authorization through Kepro and are starting to see denials and shortened hours like we saw in the pediatric space. It seems disjointed that on one hand HCPF is looking to increase access, while their UM provider is denying these same services.

Some Board members seems interested in exploring these concerns and has asked HCPF to return at the next MSB meeting to discuss implementation of this rule in more depth.

The MSB approved the emergency rule with one dissenting vote (because of the implementation concerns). We will continue to engage with HCPF on issues with Kepro and will plan to engage at the next MSB meeting.

Full Approved Rule Attached.

 

The Home Health (HH) OASIS-E Guidance Training Program

The Centers for Medicare & Medicaid Services (CMS) is offering a virtual training program that provides instruction on the guidance for the Outcome and Assessment Information Set (OASIS)-E. This training is part of a comprehensive strategy to ensure home health providers have access to the educational materials necessary to promote understanding and compliance with changes in reporting requirements associated with the Home Health Quality Reporting Program (QRP). These changes go into effect on January 1, 2023. A major focus of this training will be on the cross-setting implementation of the standardized patient assessment data elements being introduced in 2023 to ensure more consistent reporting and evaluation across post-acute care settings.

The training program consists of two parts:

Part 1  LEARN: Watch the pre-recorded training webinars that deliver foundational knowledge to assist in learning the new items and guidance. These videos are intended to be viewed in advance of the live event and are available now on CMS YouTube .

Part 2 – PRACTICE: Attend the live, virtual workshop sessions that provide practice coding scenarios on the items covered in the Part 1 training webinars. These live sessions will take place on September 13th and September 14th between 1 p.m. and 5 p.m. ET.

Training Materials: Additional training resources are located within a ZIP file in the Downloads section of the HH QRP Training page (2022_September_HH Virtual Training Program – Part 1 (ZIP)). These resources include an Acronym List, Action Plan Worksheet, Resource Guide, Case Study documents, and PDF versions of the Training Webinars.

Registration for the Part 2 live, virtual workshop sessions can be completed online through Zoom Events.

If you have questions about accessing resources or feedback regarding the trainings, please email the PAC Training Mailbox. Content-related questions should be submitted to the HH QRP Help Desk.

 

Why Home Health Insiders Expect Uptick In Audits, Inquiries From Federal Watchdogs

Home Health Care News

Audits from the U.S. Department of Health & Human Services’ Office of Inspector General (HHS-OIG) can often catch home health agencies by surprise.

And after a slower audit period during the COVID-19 pandemic, experts told Home Health Care News that providers should expect a ramp-up in audits over the next year.

Battling that element of surprise will be key to getting through a successful audit process.

“Having a very healthy, robust compliance program that really challenges the health of a home health agency internally is a good way to be ready for when an outside entity, like the government, does the same,” Bryan Nowicki, a partner at Husch Blackwell, told HHCN.

Home health agencies should be at a place where they aren’t just prepared for audits, but also expect them.

“Don’t be surprised if and when you get an audit,” Husch Blackwell Associate Erin Burns told HHCN. “It’s likely going to happen, and knowing that should help you be more prepared in the long run.”

“The audit process itself is — as we tell our clients — a marathon, not a sprint,” Burns said.

Knowing that audits are coming is part of the battle, Burns said. But knowing what OIG or other federal agencies are looking for is another piece to the puzzle.

Historically, audits done by OIG include the office taking 100 claims at random, evaluating those claims and then coming to an error rate. OIG will then extrapolate that error rate and assess it over the industry.

Other audits — like the ones done by unified program integrity contractors (UPICs) hired by the U.S. Centers for Medicare & Medicaid Services (CMS) — are used to investigate home health agencies for potential fraud.

“We have seen an uptick in UPIC activity across the board for home health this year and I think that relates, in part, to the government relaxing some of the COVID restrictions,” Nowicki said. “I think the audits will focus on the time periods when COVID was an issue and I think that’s something home health agencies will have to address.”

Many in the industry have expected OIG audits to proliferate in home health, like they have in hospice over the last few years. The home health industry could also see an uptick in audits from OIG on provider relief funds as well, Burns said.

Generally, both audit processes will look at financial data for home health agencies, homebound statuses, OASIS compliance and other factors that impact payment.

OIG is likely going to refine what exactly they are looking for on the other side of the pandemic, Nowicki said. However, what that looks like won’t be known for another year or so.

Read Full Article

 

What Does Teaching End of Life Care Look Like?

By Barbara Karnes

“Dying is not a medical event” and “The medical model views death as a failure, something to be fixed, to address” are two quotes you will hear from me repeatedly. The second quote is actually part of the foundation of healthcare so when working with end of life caretakers (nurses, social workers, home health aides, even chaplains) we are pulling from that “job pool.” 

With the staffing shortage affecting all areas of healthcare those of us working in end of life must recognize the ideology regarding end of life most workers have—-to fix it. The teaching is that death is bad. Death is a failure.

Yet, in end of life work the patient’s death is the goal, not to be fought or avoided but to be accepted and supported. The before and after the death is where the education and guidance, the “work,” is done.

When hiring, my first question has always been “What are your thoughts about dying and death? What do you think happens?" The response often tells me if the potential hire is a “good fit” for end of life work. When I say “good fit” I mean not only will they be able to provide direction and guidance for the patient and family but will they be able to internally process and adjust to all of their patients dying?

I’ve always said I can teach anyone how to take care of someone who is dying, the physical, communication, supportive skills. It is the interpersonal, empathy, and heart skills that I can’t teach. They are part of the personality fabric of a person, their core, and that I can’t teach or instill.

Working outside the medical model is challenging. You have to learn an entirely different set of skills. Again, dying is not a medical event. It is a social, communal event so our medical skills have less of a role to play than our personal, interactive, teaching skills.

What does teaching how to take care of someone who is dying look like? 

*First, explore your own personal beliefs and experiences of and with dying and death. We carry our personal experiences that in turn make us who we are and how we react to situations. 

*Start teaching about the physical aspects of dying: The process of dying, the months, weeks, days and hours of how death approaches. What are staff to look for to guide families as to time frames and what are instructions for the family? 

*Teach what to do about what you are seeing, not just the physical but the emotional, mental and even spiritual aspects of end of life care. 

*Communication skills are an internal part of end of life care. How do you support? What do you say? What do you not say?

Read Full Article

 

Getting Help for Your Mental Health

Taking good care of your mental health is an important health priority, especially during stressful times such as the COVID-19 pandemic. We have resources on our website that may help, including our fact sheets on stressdepression, and anxiety. You can also find helpful brochures and fact sheets on the National Institute of Mental Health website

If you (or someone you know or care about) are in immediate distress you can call, text, or chat the 988 Suicide & Crisis Lifeline, which is now active across the United States. 988 is a new, shorter phone number that will make it easier for people to get mental health crisis services. The old number, 1-800-273-TALK (8255), still works, and it will continue to function indefinitely.  

Get More Information

 
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