Don’t Waste HCBS 2.0
McKnight’s Home Care | Liza Berger
The best things come to those who wait. That old Heinz ketchup slogan may be an apt description for the recent re-introductions of legislation and funding for home- and community-based services (HCBS).
Two major developments occurred Thursday in Washington, DC, for proponents of HCBS. Sen. Bob Casey (D-PA) in the morning disclosed he was introducing legislation to help fund the Better Care Better Jobs Act, which would support the expansion of Medicaid HCBS. Called the HCBS Access Act, it would establish “a permanent funding stream to keep the infrastructure strong and to make sure we’re able to continue to pay direct care professionals at a rate that ensures qualified, reliable services in a qualified reliable workforce into the future.”
Then an even bigger piece of related news broke: President Biden designated $150 billion for home- and community-based services in his newly released fiscal year budget proposal. For those who don’t follow the play-by-play in the nation’s capital, $150 billion was precisely the amount of the previous Better Care Better Jobs Act, which failed to make it into any legislative package.
To those who doubted such legislation would ever make a comeback, I ask, who would’ve thunk it?
Even more surprising than the reintroduction of key bills is the president’s new outspokenness on this issue. Through his actions on the budget and his words in recent speeches, there is no question where the president stands at this point. He believes that aging in place is the model for growing older.
While passage of any new legislation is up to Congress (and a divided one at that). aging services providers have a golden opportunity to steer its fate. I am not one to tell people what to do, but it seems to me that if you want a bill containing Better Care Better Jobs or Biden’s funding to pass, the time is now to talk to your senators and representatives. Tell them why HCBS is so important, what the workforce requires to deliver HCBS and how the healthcare system as a whole can benefit.
You, providers, have what most people do not — a second chance. Carpe diem, folks. |
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You Need to Register for this CMS Webinar on PDGM
Wednesday, March 29, 2023 (11:30 PM – 1:00 PM MDT)
Free to all!
Medicare Home Health Prospective Payment System (HH PPS) Calendar Year (CY) 2023 Behavior Change Recap, 60-Day Episode Construction Overview, and Payment Rate Development Webinar.
NAHC has indicated that it is critical that you, and, if possible, multiple people in your organization, register for the CMS PDGM webinar for stakeholders on March 29. You need to sign on to send an overwhelming message to CMS that we aren’t backing down. If only 20-30 people show up, it will be devastating for us as an industry because it would send a message to CMS that our concerns are not important. Can we count on you to register for this FREE webinar and sit in to make sure your voice is heard? Please join all of us in attending and making sure CMS knows we are here to stay, we are here to fight for our industry, and we aren’t backing down.
During this webinar, CMS will provide an overview of several provisions from the CY 2023 HH PPS final rule on behavior changes, the construction of 60-day episodes, and payment rate development.
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Guidance for the Use of Telehealth in Hospice and Palliative
SUMMARY:
The following is a synopsis of direction given by NHPCO after consulting with CMS and the HHS Office of Civil Rights, to provide clarity about telehealth in hospice and palliative care. Information includes what stays and what goes at the end of the COVID-19 PHE.
Hospice Face-to-Face Encounters through Telehealth
1. How long can the hospice face-to-face telehealth flexibility be used?
- The statutory provision extends the hospice face-to-face telehealth flexibility through 12/31/24, regardless of the status of the PHE.
2. What methods can be used for the hospice face-to-face encounter?
- The statutory requirement for the hospice face-to-face encounter specifies that when an encounter is conducted via telehealth it MUST be performed via audio-visual communications technology.
Use of Telehealth for Hospice Routine Home Care
When can telehealth be used for hospice routine home care?
- Hospice providers can provide services to a Medicare patient receiving routine home care through telecommunications technology (e.g., remote patient monitoring; telephone calls [audio only and TTY]; and two-way audio-video technology), if it is feasible and appropriate to do so.
- Only in-person visits are to be recorded on the hospice claim.
- This waiver will expire at the end of the PHE on May 11, 2023.
Telehealth Services Payable under the Physician Fee Schedule when Furnished via Telehealth
It is likely that some services offered by palliative care providers will be covered as telehealth services. Providers should check the list of codes in the 2023 Physician Fee Schedule to determine how and how long services will be paid. We are grateful to Acevedo Consulting for preparing this list of services to determine their post public health emergency status as the PHE concludes on May 11, 2023.
- In the CY 2023 Final Rule, CMS finalized alignment of availability of services on the telehealth list with the extension timeframe enacted by the CAA, 2022. The CAA, 2023 further extended those flexibilities through CY 2024. Check the Medicare Telehealth Post-Pandemic Resource List (PDF) for deadlines for use.
- There are two codes allowed through audio-only interaction that are often used by hospice and palliative care providers – the two advance care planning codes:
- 99497 – Advance care planning, first 30 minutes
- 99498 – Advance care planning, additional 30 minutes
- The hospice face-to-face encounter may NOT be conducted through audio-only telehealth.
Use of Non-Compliant Devices for Telehealth
On April 21, 2020, the Department of Health and Human Services (HHS) issued a Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID–19 Nationwide Public Health Emergency
Under this Notification, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth without risk that the Office of Civil Rights (OCR) might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID–19 nationwide public health emergency.
Under this notification, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.
The allowance to use non-HIPAA compliant devices is set to end at the end of the PHE on May 11, 2023. OCR’s FAQs on the topic indicate it will end with the PHE. See question #6.
The specific provisions that apply to hospice and palliative care providers are still evolving. NHPCO expects that there will be additional clarification issued for some components of hospice flexibilities, so watch for additional updates. |
Cyber Attacks Hurt Home Health Operations – But Patient Outcomes Are Next
Home Health Care News | By Patrick Filbin
For home-based care providers, cyber attacks are less likely to be an “if,” and more likely to be a “when.”
And, as cyber attackers get more creative and persistent, it’s important for providers to understand the implications of attacks.
“Over the last 18 months, we’re seeing massive impacts to patient care,” Fortified Health Security CEO Dan Dodson told Home Health Care News. “In the health system space, we’re seeing organizations go down for weeks and months, literally diverting care. It’s one thing for a patient record to be exposed, and nobody wants that. But it’s an entirely different set of circumstances when you can’t deliver care.”
Fortified Health is a Tennessee-based cybersecurity firm.
In order to be as prepared as possible, provider leaders need to know what to look for and what their staff needs to look for. They also need to be equipped with the proper resources when an attack does come to fruition.
Over the past decade, cyber security experts have seen a gradual uptick in cases where attackers are pursuing private information.
“It hasn’t been just this year, although we have seen a number of them already, but it’s gradually been increasing probably over the last 10 years, especially at the start of 2020,” Barbara Citarella, the president of RBC Limited, told HHCN. “The problem for most home-based care agencies is they don’t know what to do when a cyber event happens: what the protocol is, who they should be calling, how detailed it is — to make sure that you’re covering yourself in regard to HIPAA violations and things like that.”
RBC Limited assists agencies with strategic planning for leadership, health care reform and business continuity. Citarella also serves as a subject matter expert to the United States Assistant Secretary of Preparedness and Response.
Cyber attacks on health care organizations are perfect for attackers, Citarella said, because of the wide dearth of information held by health care organizations.
Home-based care providers’ systems are generally vulnerable to attacks, Citarella said. Thus, they should be doing regular risk assessments and should be backing up their own data on a separate server.
“We had a big home care event that took place in 2019, and the agencies that backed up their own data were up and running very quickly, and the agencies that used a third-party biller couldn’t access their information for a long time,” Citarella said. “Agencies have to back up their own information on a separate system, and they should be testing that separate system to see how quickly they can get up and running.”
Consolidation of home health and home care agencies have added to the urgency for protection to be put in place, Citarella said. The attackers are also evolving as the industry grows.
“They’re much more sophisticated,” she said. “They’re coming from a number of countries and interestingly enough, drug cartels are now doing it. It’s a lot easier to take information and steal somebody’s identity if you don’t have to have a force out on the ground. You just need a bunch of people in an office.”
Jason Vander Velde, a senior manager on the IT management team at Wipfli, also has seen an uptick in sophisticated attacks.
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How Data Can Help Home-Based Care Providers Zero In On Growth Opportunities
Home Health Care News | By Patrick Filbin
Home-based care providers, and others in the post-acute care space, need to start collecting the right kind of data in order to get quality outcomes and reach growth targets.
Being on top of Minimum Data Set (MDS) collection and having accurate and detailed coding can be two of the most important aspects of improving outcomes.
“If your coding is done accurately and correctly — and if you’re able to leverage your MDS — you can start to figure out ways to use that data in meaningful ways,” Pathway Health COO Lisa Thomson, said during a panel at the LeadingAge Illinois conference this week. “That all could help drive some opportunities for competency training, clinical training, programmatic development, strategic positioning and aligning with specific partners to really grow your business and retain staff.”
Collecting and using data can be an overwhelming process for home-based care providers. That’s especially true when it seems like the rules and regulations change on a yearly basis.
“The demographics are shifting, and continue to shift, for the type of care and services that we provide,” Thompson said. “It’s important for providers to know how we take some key data points and help us use those data points to drive decisions.”
Thompson used the example of providers across the post-acute spectrum understanding what lane they want to operate in.
Improving quality measures for clinical and chronic diseases is a huge opportunity for providers, Thompson said, and finding a niche within that can be helpful.
Using public data that is now available — due to CMS requiring certain measures to be collected — is one way to find those niches.
“Those chronic diseases are ones that our physician partners, our clinician partners and our acute care partners are being monitored for,” Thompson said. “Who’s the best at chronic disease management in the whole health care sector? We are, as leaders in post-acute care. Chronic diseases are where we have that opportunity.”
By narrowing in on service needs, and using MDS and ICD-10 coding, providers have the ability to build towards a certain focus area.
“Using this data, you can look at trends in your organization and [leverage that against] your marketplace to see what’s the growth potential for Medicare and Medicaid individuals with those disease states that align with the likeness and the demographics of your organization,” Thompson said. “Or you could make changes in your organization to build towards a certain focus.”
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