CMS Revises Manual Instructions for the NOA and Allowed Practitioners

From NAHC

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12615 that incorporates policies for the implementation of the  Notice of Admission (NOA) and the subsequent elimination of the Request for Anticipated Payment (RAP). The NOA became effective January 1, 2022.

The CR also provides corrections and clarifications regarding who may sign the certification and plan of care  for home health beneficiaries at section 30.2.1 of the Medicare Benefit Policy Manual.

CMS has not altered any of the policies around the contents, criteria for submission, and untimely submission policy of the NOA.

The revisions in the CR to section  30.2.1 – Definition of an Allowed Practitioner, incorporates the requirements for physician assistant, nurse practitioner, and certified nurse specialist at §410.74, §410.75 and §410.76 respectively. These same requirements are incorporated into the home health Conditions of Participation  at §484.2- Definitions.  CMS has not changed their policy around defining these non-physician practitioners but providing consistency in their policies on the requirements for PAs, NPs and CNSs.

CMS permits these NPPs to practice with in their scope of practice in accord with state laws. Several states do not require a collaborative agreement or other documentation of collaboration with a physician, while other states have specific collaborative arrangement requirements for which NPPs must   comply with when caring for home health patients.  However, where the state is silent on collaboration for an NP and CNS,  CMS, in accord with§ 410.75(c)(3)(ii) and §410 .76(c)(3)(ii),  requires  that the practitioner have  documentation  on her/his scope of practice and some information on how she/he deals with patients whose needs are outside the scope of practice for an NP or CNS as evidence of collaboration, but CMS does not require a collaborative agreement with a physician. 

• 410.75 (c)(3)(ii). In the absence of State law governing collaboration, collaboration is a process in which a nurse practitioner has a relationship with one or more physicians to deliver health care services. Such collaboration is to be evidenced by nurse practitioners documenting the nurse practitioners’ scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice. Nurse practitioners must document this collaborative process with physicians.

• 410.76(c)(3)(ii). In the absence of State law governing collaboration, collaboration is a process in which a clinical nurse specialist has a relationship with one or more physicians to deliver health care services. Such collaboration is to be evidenced by clinical nurse specialists documenting the clinical nurse specialists’ scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice. Clinical nurse specialists must document this collaborative process with physicians.

The National Association for Home Care & Hospice (NAHC) is somewhat puzzled why CMS chose the phrase  “….however, a CNS and NP must work in collaboration with a physician in accordance with §§ 410.76(c) and 410.75(c) even if state laws governing collaboration do not exist.”  to describe the requirements for collaboration where the state is silent.

NAHC will be requesting information from CMS on compliance expectations for the revised manual changes at section 30.2.1 , particularly what the Medicare contractors will be looking for during medical review.

Home Health Agencies Should Brace for PDGM Battle Later This Year

Home Health Care News / By Patrick Filbin
 
Home health providers should brace themselves for a potential Patient-Driven Groupings Model (PDGM) battle with the U.S. Centers for Medicare & Medicaid Services (CMS) later this year.
 
Implemented on Jan. 1, 2020, PDGM is the largest overhaul to how Medicare-certified home health agencies are paid in two decades. And normally when CMS implements something of this magnitude, there are ongoing tweaks and changes to make sure reimbursement is fair to both the government and providers.
 
That balancing act is even more important with PDGM, which must be budget neutral, as mandated by Congress.
 
Yet because of the COVID-19 pandemic, any major recalibrations or corrections to PDGM’s foundation have, so far, been delayed, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi. That could begin to change later in 2022, when CMS is gearing up to release its proposed payment rule for 2023.
 
“We’ve been having those conversations for three years,” Dombi told Home Health Care News during an interview at the Capital+Strategy conference. “We had those conversations before PDGM was put into the law because we knew, going down the pike, you’re going to be seeing what we’re facing from a Medicare home health priority perspective.”
 
Typically, CMS releases its proposed payment rule in late June or early July. With two years of PDGM observations and the public health emergency starting to wane, the agency may float big adjustments at that time.
 
“The concept [of budget neutrality] is a lot easier to state than it is to apply,” Dombi said. “The application of it, right now, has been … kicked down the road for a couple of years with the explanation being, ‘The data is not yet sufficient for us to make the judgment on it.’ The data will be sufficient for 2023.”
 
Now, Dombi said, CMS will be determining what the methodology is for determining whether the budget has been neutral or not.

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FAQs for Providers About the No Surprises Rules

CMS has posted updated Frequently asked Questions for providers about the No Surprises rules.  Information for providers and facilities regarding No Surprises rules, independent dispute resolution, and exceptions to the new rules and requirements can be found at: Frequently asked questions for providers about the No Surprises rules. (PDF)

Over 4 Million MA Beneficiaries Have At-Home Care Access Through Supplemental Benefits

Home Health Care News / By Andrew Donlan
 
New data relating to Special Supplemental Benefits for the Chronically Ill (SSBCI) has been released. And while there are plenty of kinks to work through before these benefits become a significant revenue driver for home-based care agencies, their increasing popularity is undoubtedly encouraging.
 
The Centers for Medicare & Medicaid Services (CMS) unveiled a pathway for primarily health-related supplemental benefits to be offered through Medicare Advantage (MA) plans in 2018, then a year later, created the SSBCI pathway.
 
Uptick in usage for each pathway’s benefits has been slow and steady. Providers can’t reach a consensus on whether the benefits are something everyone in the home-based care space should be following, or if the opportunity that lies within these benefits is meager.
 
Regardless, certain benefits’ success – namely the in-home support services (IHSS) one – should be welcomed news to agencies across the country. That’s according to Elexa Rallos, a senior analyst at the research and advisory firm ATI Advisory.
 
“I think the key takeaway, in particular for [home-based care providers], is that in-home support services is really one of the most popular of these newer, non-medical supplemental benefits,” Rallos told Home Health Care News. “They were popular in 2020, but into the third or fourth year that these benefits have been available, they continue to grow fairly rapidly. They’re among the most popular benefits, and the most popular in the primarily health-related grouping.”

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