Home Health
CMS Open Door Forum: Key Updates for Home Health & Hospice
December 4, 2023The Centers for Medicare and Medicaid Services (CMS) held a Home Health, Hospice, and DME Open Door Forum on November 29, 2023. The summary of the Forum applicable to home…
Plan Ahead! CMS Shares New HHVBP Resources for CY 2024 & 2025
November 20, 2023resources to help providers plan and succeed in Expanded HHVBP model for the Calendar Year (CY) 2024 and CY 2025. See below for the new at-a-glance resources.
CMS Issues New Resources in Advance of CY 2024 Home Health Final Rule Implementation
November 20, 2023Last week, CMS shared the following MLN Matter Articles to provide an overview of key provisions of the CY 2024 Home Health Final Rule, including payment and provider enrollment changes….
2024 OASIS-E Manual Now Available
November 13, 2023The 2024 Update to the OASIS-E Manual and the associated Change Table are now available in the Downloads section on the OASIS Users Manuals page. There are no changes to the OASIS-E…
On November 1, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which…
On Thursday, October 18, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS), issued two resource documents to help explain to patients the…
On October 11, CMS issued Change Request 13417, which provides instruction to Medicare Administrative Contractors (MACs) on updated interest rates under the Medicare program. Effective October 17, 2023, CMS has instructed…
Many Redetermination requests submitted through myCGS are dismissed because the form is not completed correctly. Digits of the Internal Control Number (ICN) are transposed, codes and modifiers added to the form are…
ICYMI: HHAeXchange Issues Provider Notice on Visit Start Date
October 16, 2023HHAeXchange recently shared the following notification to providers: DHS has issued guidance pertaining to shifts where the actual start date is different than the scheduled start date. According to Systems…
Quality Reporting Program: Non-Compliance Letters for CY 2024 APU for Home Health Agencies
October 16, 2023CMS is providing notifications to home health agencies that were determined to be out of compliance with the Home Health Quality Reporting Program (HHQRP) requirements for calendar year (CY) 2022,…
Quarterly Medicare Credit Balance Reports Due October 30
October 16, 2023As a reminder, the Medicare Credit Balance Report for the quarter ending September 30 is due by October 30, 2023. CGS will suspend all claim payments at 100% if a completed…
CMS Releases BIMS Resource
October 9, 2023The Centers for Medicare & Medicaid Services (CMS) is offering a 3-minute, animated explainer video, BIMS and BIMS Summary Score: Stopping and Coding an Incomplete Interview for Home Health providers….
Update to EVV Requirements for Pediatric Home Health Aide Services in the FFS and Managed Care Delivery Systems
September 25, 2023The Department of Human Services (DHS) has issued a new bulletin on the update for EVV requirements for pediatric home health aide services in the fee-for-service (FFS) and managed care…
CMS has released an updated version of the 2021 Medicare Post-Acute Care and Hospice Provider Utilization and Payment Public Use File (PAC-PUF). As a reminder, the PAC PUF presents summarized information on services…
HHAs Inaccurately Report Falls with Major Injury
September 18, 2023On September 5, 2023, the Office of the Inspector General (OIG) issued a report showing that home health agencies (HHAs) failed to report over half of falls with major injury and hospitalization…
CMS Open Door Forum: Key Updates for Home Health & Hospice
September 11, 2023The Centers for Medicare and Medicaid Services (CMS) held a Home Health, Hospice, and DME Open Door Forum on August 30, 2023. The summary of the Forum applicable to home…
Secretary of State Al Schmidt announced last Tuesday that Pennsylvania is taking the first step to implement the Nurse Licensure Compact by allowing nurses with multistate licenses issued by 40…
DHS: Updates to Pediatric Shift Care Services for Beneficiaries Under 21 Years of Age
September 11, 2023DHS has announced it will cover personal care services provided to Medical Assistance (MA) beneficiaries under 21 years of age under the home health services benefit effective with dates of service on…
CGS: NEW Process for 56900 Reopening Requests
September 11, 2023To ensure your 56900 reopening requests are routed and handled efficiently, please use one of these options to submit the appropriate request form and documentation: What is a 56900 denial?…
Reserve your seat today and join PHA and OASIS Answers on August 28 – 29 in Harrisburg for a Blueprint for OASIS Accuracy Workshop. Following the workshop, attendees will have the opportunity…
Last week, the National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services…
Expanded HHVBP Resource Index Now Available
June 19, 2023Last week, the Centers for Medicare and Medicaid Services (CMS) released a Resource Index for the Expanded Home Health Value-Based Purchasing Model. This new tool compiles all the resources on…
HHAeXchange Shares EVV Updates
June 5, 2023As follow up from questions received during the Annual Conference, HHAeXchange is sharing the following updates to PHA members. Home Health MCO Implementations HHAeXchange and the MCOs are continuing to…
Last week, PHA submitted comments to CMS on the FY 2024 Hospice proposed rule. The comments included input and recommendations on: PHA also responded to the request for information related to health equity….
On May 15, 2023, the Office of Medical Assistance Programs (OMAP) issued a Managed Care Operations Memo (MCOPS Memo) to the Physical HealthChoices Managed Care Organizations (PH-MCOs) to restate and update…
The Office of Management and Budget (OMB) has renewed the Advance Beneficiary Notice of Noncoverage (ABN) form (Form CMS-R-131). The use of the renewed form with the expiration date of 01/31/2026 will be…
CMS Releases Findings from Technical Expert Panel, Listening Sessions on Hospice Special Focus Program Development
May 8, 2023As part of the Consolidated Appropriations Act of 2021 (CAA), Congress enacted significant changes to the hospice survey process, including a Special Focus Program (SFP) for poor performing hospice providers….
Recently, PHA has heard from members regarding discrepancies in EVV-related compliance reports available to providers and the MCOs. PHA reached out to HHAeXchange and the managed care organizations, and on…
DHS Provides Updates on Paid Family Pediatric Caregivers; Welcome, Juliet Marsala, OLTL Deputy Secretary!
May 1, 2023As previously reported, parents and other legally responsible individuals may continue serving as paid home health aides for medically fragile children, provided they meet all other state, federal, and provider agency requirements,…
Effective May 1, 2023, claim and eligibility-specific calls received in the Provider Contact Center (PCC) will need to be properly authenticated by the Computer Telephony Integration (CTI) system prior to speaking to a…
State Board of Nursing Issues Policy Clarifying CRNPs Ordering/Supervising Use of Conscious Sedation Medication
April 3, 2023On April 1, 2023, the Pennsylvania State Board of Nursing issued a Statement of Policy to clarify circumstances under which CRNPs can order and supervise the administration of conscious sedation.
Last week, the Centers for Medicare and Medicaid Services (CMS) added two new training resources to the Home Health Quality Reporting Program (QRP) Training webpage:
On March 15, 2023, the Medicare Payment Advisory Commission (MedPAC) issued its March 2023 Report to the Congress: Medicare Payment Policy. As part of its annual report, MedPAC included the following home health and hospice recommendations:
The Centers for Medicare and Medicaid Services (CMS) has shared additional guidance on submitting claims with the new G-codes for telehealth encounters, including:
On February 24, the Drug Enforcement Administration (DEA) released a proposed rule intended to govern the prescribing of controlled substances via telemedicine at the end of the COVID-19 Public Health Emergency (PHE)….
CMS Releases Report on Home Infusion Therapy Services
February 27, 2023CMS has released the Home Infusion Therapy (HIT) Monitoring Report for February 2023, which includes benefit use data from the first quarter of 2020 through the second quarter of 2022. The report…
CGS Provider Alert: Provider Responsibility When Using Billing Companies and Outsourced Agencies
February 27, 2023Please see below for a recent provider alert issued by CGS regarding the use of billing companies or outsourced agencies. The Centers for Medicare & Medicaid Services (CMS) requires providers,…
DHS Issues Bulletin on Shadow Nursing for Pediatric Patients
February 20, 2023On Friday, February 17, the PA Department of Human Services (DHS) issued Bulletin 05-23-02, 16-23-01, Coverage of Case Specific Training/Shadow Nursing for Private Duty/Shift Nursing Services for MA Beneficiaries Under 21…
DHS Says Parents Can Continue as Paid Home Health Aides for Medically Fragile Children
February 13, 2023Last week, PHA received notice that parents may continue serving as paid home health aides for medically fragile children, after the Department of Human Services (DHS), PHA, and other stakeholders…
Members Ask; PHA Answers: Nurse Shadowing for Pediatric Services
February 13, 2023In December, the Office of Medical Assistance Programs (OMAP) issued a Bulletin adding a rate for nurse shadowing for pediatric services. The nurse shadow rate is effective for claims with dates of…
Updated HHQRP User Manual Now Available
February 13, 2023The Home Health Quality Reporting Program (HHQRP) Measure Calculations and Reporting User’s Manual has been updated to reflect quality measure changes implemented since the Manual Addendum Update in October 2020. These changes…
Home Health Notice: Revised Editing of Telehealth Claims
February 6, 2023From January 1 – February 6, 2023, CMS incorrectly returned claims with telehealth services if they did not include an in-person visit with the same revenue code (reason code 31869).
Beginning on May 1, 2023, claim and eligibility-specific calls received in the Provider Contact Center (PCC) will need to be properly authenticated by the Computer Telephony Integration (CTI) system prior to speaking…
The Latest on Pediatric Paid Family Caregivers
February 6, 2023PHA continues to advocate for policy changes to allow parents to continue as paid family (home health aide) caregivers after the PHE and partner with other advocates on this critical…
MedPAC, MACPAC Release Updated Data on Dual-Eligibles
February 6, 2023The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) have released an updated data book: Beneficiaries Dually Eligible for Medicare and Medicaid.
CMS Releases OASIS Quarterly Q&As
January 30, 2023The January 2023 Quarterly OASIS Q&As are now available. In this update, CMS addresses the transition from OASIS-D to OASIS-E and provides clarification on several items on the new OASIS-E instrument, including:
CMS Publishes Monthly HHVBP Newsletter + January 2023 PIPR Reports Now Available in iQIES
January 30, 2023Home health providers can now access the January 2023 Home Health Value-Based Purchasing (HHVBP) Newsletter. This month’s edition focuses on the expanded HHVBP Model performance feedback reports and includes an overview…
CMS Adds Home Equity Page to Home Health, Hospice Quality Reporting Program Websites
January 30, 2023CMS has added a Health Equity page to both the HQRP and HHQRP websites as a means of further advancing health equity for individuals served by CMS programs. These pages include links to additional…
Updated Late Notice of Admission – The Exception Process
January 23, 2023Last week, CGS updated the Late Notice of Admission (NOA) Exception Process to add the following claims errors that would require the NOA to be cancelled and resubmitted:
CMS Open Door Forum Includes Updates for Home Health & Hospice
January 16, 2023On Wednesday, January 11, CMS held a Home Health, Hospice, and DME Open Door Forum, with updates on the following: