McBee has compiled the regulatory updates from March 2020 to help healthcare providers stay up to date on the many changes the post-acute landscape has seen due to COVID-19. Please take note of the assigned dates to ensure you are receiving the most updated guidance.
[Blog Last Updated 3/31]
(Monday, March 30) Home Health Agencies: CMS Flexibilities to Fight COVID-19
Summary: Documentation is key
- Home health organizations can use Telehealth as long as it is part of the patient’s POC and does not replace a needed in-person visit. The physician must order telehealth services on the POC and once the LUPA Threshold is met then the telehealth services may be utilized.
- Homebound definition update: A patient is considered homebound when the physician advises them not to leave the home because of confirmed or suspected COVID-19 or if the patient has a condition that makes them more susceptible to contract COVID-19
- NP, CNS & PA can certify and recertify eligibility, establish and review Plan of Care, order home health services and order/sign orders for HH services and DME as permitted under state laws/state scope of practicing and the state licensure regulations
- Timeframes related to OASIS: extension of the 5-day completion requirement for the comprehensive assessment to 30 days and waiving the 30-day OASIS submission. Please remember the OASIS will still need to be submitted prior to the final claim.
- Initial Assessments: Home Health agencies can perform initial assessment and determine homebound status/patient eligibility remotely or by record review. The Comprehensive assessment including OASIS is still required to be an in-person visit. Determining the patient’s eligibility via telehealth or medical review will assist in satisfying the 48-hour rule.
- MAC have extended the auto cancellation date of RAPs
- Review Choice Demonstration for Home health Services: CMS is offering HHA the option to pause RCD. HHA do not have to do anything for the pause to go into effect. Claims are subject to post payment review when the Public Health Emergency has ended
- Medical review activities: CMS has suspended all medical reviews activity except in the case of potential fraud. This includes Target Probe & Educate (TPE), Additional Document Request (ADR), Supplemental Medical Review Contractor (SMRC) and Recovery Audit Contractor (RAC)
- Waived onsite visit for HHA Supervision: Onsite supervision is not required but virtual supervision is encouraged. Be sure to check with state regulations if in a licensure state.
- Cost reporting: CMS has delayed the filing deadlines. FYE 10/31/2019 & 11/30/2019 due 6/30/2020. FYE 12/31/2019 due 7/31/2020
- Home health clinicians can obtain samples: If the patient is already on home health services, the nurse can obtain a sample for COVID-19 diagnostic testing, during an otherwise covered visit.
- Medicare Appeals: Extensions to file an appeal
(Friday, March 27) CMS Releases Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kits
- This document released by CMS contains electronic links to reliable sources of information regarding telehealth and telemedicine. Most of the information is directed towards providers who may want to establish a permanent telemedicine program. There are specific documents identified that will be useful in choosing telemedicine vendors, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. However, there is also information that will be useful for providers who wish to care for patients through the virtual services that may be temporarily used during the COVID-19 situation.
- The HIPPS code on Home Health Patient-Driven Groupings Model (PDGM) claims are being recoded incorrectly. The claims are approving/paying with the incorrect recode but are being paid at an incorrect rate due to the recode. This is causing overpayments and underpayments. This issue has been reported to the system maintainer and a fix to resolve this issue is anticipated in May 2020. No provider action is required at this time. Please review this issue and share it with your staff.
- CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19).
CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report.
CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.
CMS will continue monitoring the developing COVID-19 situation and assess options to additional relief to clinicians, facilities, and their staff so they can focus on caring for patients.
(Monday, March 23) Palmetto Issues Notice that CMS has Delayed Filing Deadlines for Cost Reports
Question: Will CMS delay the filing deadline of Fiscal Year End (FYE) December 31, 2019 cost reports due at the end of May due to the Covid-19 outbreak?
Answer: Yes, 42 CFR § 413.24 (f) (2) (ii) allows this flexibility. CMS is currently authorizing delay for the following FYE dates.
The filing deadline for the following cost reports are now June 30, 2020:
- The filing deadline for FYE October 31, 2019 is now June 30, 2020
- The filing deadline for FYE November 30, 2019 is now June 30, 2020
- The filing deadline for FYE December 31, 2019 is now July 31, 2020.
- CMS is prioritizing and suspending certain federal and state survey agency (SSA) surveys, and delaying revisit surveys beginning March 20, 2020, for all certified provider and supplier types. Standard surveys for home health agencies and hospices will not be authorized during this period. Revisit survey not associated with Immediate Jeopardy (IJ) situations will also not be authorized during this period. For home health agencies this also means the imposition of suspension of payments for new admissions (SPNA) following the last day of the survey when termination is imposed will be lifted to allow for new admissions during this time and suspension of per day civil money penalty (CMP) accumulation, and imposition of termination for facilities that are not in substantial compliance at 6 months. Additionally, CMS’ survey prioritization applies to surveys for compliance with federal regulations, not state surveys pursuant to state licensure.
During this three-week timeframe, only the following types of surveys will be prioritized and conducted:
- Complaint/facility-reported incident surveys: State survey agencies (SSAs) will conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level. A streamlined Infection Control review tool will also be utilized during these surveys, regardless of the Immediate Jeopardy
- Targeted Infection Control Surveys: Federal CMS and State surveyors will conduct targeted Infection Control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). They will use a streamlined review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.
- Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that 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. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.
- CMS delayed the October 1, 2020 implementation for the Minimum Data Set (MDS) 3.0 v1.18.1 Release. CMS staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update software and IT systems.
(Wednesday, March 18) Draft OASIS-E Instrument is Released
- The draft OASIS-E All Items Instrument is now available in the Downloads section of the OASIS Data Sets. OASIS-E will be effective January 01, 2021. Please note the instrument is not yet final. Office of Management and Budget (OMB) approval is required and expected later this year.
- The Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.
- The Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay Medicare will temporarily pay practitioners to provide telehealth services for beneficiaries residing across the entire country. Home health agencies, while not being able to bill for telehealth services, may find relief in that the physicians can utilize telehealth technology for a home health F2F encounter.
- Read the Fact Sheet on this announcement
- Read the Frequently Asked Questions on this announcement
(Saturday, March 14) CMS Issues Waivers of 3-Day Stay and Spell of Illness
- On March 14, the Centers for Medicare and Medicaid Services (CMS) issued two waivers to aid skilled nursing facilities in addressing the national COVID-19 outbreak. CMS is waiving both the 3-Day Stay and Spell of Illness requirements – nationally. These waivers mean that skilled nursing facility (SNF) care without a 3-day inpatient hospital stay will be covered for beneficiaries who experience dislocations or are affected by the COVID-19 outbreak.
(Tuesday, March 10) CMS Sends More Detailed Guidance to Providers about COVID-19
- CMS issued guidance to home health agencies and dialysis facilities with actionable information for healthcare workers on screening, treatment and transfer procedures to follow when interacting with patients in response to the 2019 Novel Coronavirus (COVID-19) outbreak.
- CMS issued a frequently asked questions to ensure State Survey Agencies and accrediting organizations charged with inspecting nursing homes and other health care facilities, understand that non-emergency survey inspections are suspended. This shift in survey prioritization enables State Inspectors to address the spread of the 2019 Novel Coronavirus Disease (COVID-19).
