All Medicare-certified HHAs that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will be required to compete in this model. Transfer OASIS acts as the endpoint OASIS. For purposes of HHCAHPS Survey data submission, the following additional requirements apply: (A) Survey requirements. (2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. An HHA that has less than 60 eligible unique HHCAHPS survey patients must annually submit to CMS its total HHCAHPS survey patient count to be exempt from the HHCAHPS survey reporting requirements for a calendar year. The PEP is calculated by determining the actual days served as a proportion of 60 multiplied by the initial 60-day payment amount. The results will display showing the NPI, Name, NPI Type, Primary Practice Address, Phone, and Primary Taxonomy (see below example). The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. OASIS-C1/ICD-10 Q & A's. OASIS-C2 Q & A's. OASIS-D Q & A's. In-service training may occur while an aide is furnishing care to a patient. End users do not act for or on behalf of the CMS. (4) Any other pertinent instruction related to the patient's care and treatments that the HHA will provide, specific to the patient's care needs. (4) For CY 2012, the adjustment is 3.79 percent. BUSINESS REQUIREMENTS TABLE Use "Shall" to denote a mandatory requirement III. (vi) Evidence of the impact of extraordinary circumstances, including, but not limited to, photographs, newspaper, and other media articles. Applicable measure means a measure (OASIS- and claims-based measures) or a measure component (HHCAHPS survey measure) for which a competing HHA has provided a minimum of one of the following: (1) Twenty home health episodes of care per year for each of the OASIS-based measures. (1) For HHCAHPS, a survey of individuals is defined as the collection of data from at least 600 individuals selected by statistical sampling methods and the data collected are used for statistical purposes. (2) Transmit data using electronic communications software that complies with the Federal Information Processing Standard (FIPS 1402, issued May 25, 2001) from the HHA or the HHA contractor to the CMS collection site. (4) By adding to the amount derived in paragraph (d)(3) of this section, amounts for nonroutine medical supplies, an OASIS adjustment for estimated ongoing reporting costs, an OASIS adjustment for the one time implementation costs associated with assessment scheduling form changes and amounts for Part B therapies that could have been unbundled to Part B prior to October 1, 2000. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The comprehensive assessment must be updated and revised (including the administration of the OASIS) as frequently as the patient's condition warrants due to a major decline or improvement in the patient's health status, but not less frequently than, (1) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a. (ii) The basis for requesting reconsideration to include the specific data that the HHA believes is inaccurate or the calculation the HHA believes is incorrect. A person who meets the qualifications and conditions specified in section 1861(r) of the Act and implemented at 410.20(b) of this chapter. (1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. The HHA must develop, implement, evaluate, and maintain an effective, ongoing, HHA-wide, data-driven QAPI program. Home Health Agencies | CMS - Centers for Medicare & Medicaid Services (ii) Passed an examination for physical therapists approved by the state in which physical therapy services are provided. (D) Other situations determined by CMS to be beyond the control of the home health agency. The HHA must maintain documentary evidence of its QAPI program and be able to demonstrate its operation to CMS. 484.110 Condition of participation: Clinical records. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID19. The physician or allowed practitioner's orders for services in the plan of care must specify the medical treatments to be furnished as well as the type of home health discipline that will furnish the ordered services and at what frequency the services will be furnished. Payment adjustment means the amount by which a competing HHA's final claim payment amount under the HH PPS is changed in accordance with the methodology described in 484.370. A home health aide must receive at least 12 hours of in-service training during each 12-month period. These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright 2002, 2004 American Dental Association (ADA). Home Health Agency (HHA) Providers. A person who is licensed, if applicable, by the state in which practicing, unless licensure does not apply and meets one of the following requirements: (i) Graduated after successful completion of a physical therapist education program approved by one of the following: (A) The Commission on Accreditation in Physical Therapy Education (CAPTE). Payment adjustments made under the expanded HHVBP Model are calculated as a percentage of otherwise-applicable payments for home health services provided under section 1895 of the Act (42 U.S.C. Before the individual may furnish personal care services, the individual must meet all qualification standards established by the state. 484.105 Condition of participation: Organization and administration of services. developer resources. HHAs must electronically report all OASIS data collected in accordance with 484.55. The encoded OASIS data must accurately reflect the patient's status at the time of assessment. Condition of participation: Quality assessment and performance improvement (QAPI). (viii) The physical, emotional, and developmental needs of and ways to work with the populations served by the HHA, including the need for respect for the patient, his or her privacy, and his or her property. [80 FR 68717, Nov. 5, 2015, as amended at 83 FR 56629, Nov. 13, 2018; 84 FR 60645, Nov. 8, 2019]. (g) Standard: Outpatient physical therapy or speech-language pathology services. (i) Medicare does not pay for those days of home health services from the start date to the date of filing of the notice of admission; (ii) The wage and case-mix adjusted 30-day period payment amount is reduced by 1/30th for each day from the home health start of care date until the date of filing of the NOA; (iii) No LUPA payments are made that fall within the late NOA period; (4) Exception to the consequences for filing the NOA late. Applicability of the Home Health Value-Based Purchasing (HHVBP) Model. [Q&A ADDED 04/15; Previously CMS Qtrly 10/14 Q&A #1] A9.1. (vii) Collection or public reporting of a measure leads to negative unintended consequences other than patient harm. [83 FR 56629, Nov. 13, 2018, as amended at 85 FR 27628, May 8, 2020]. (3) All patient care orders, including verbal orders, must be recorded in the plan of care. (4) CMS may grant exceptions or extensions to HHAs without a request if it determines that one or more of the following has occurred: (i) An extraordinary circumstance, such as an act of nature, affects an entire region or locale. The HHA must provide infection control education to staff, patients, and caregiver(s). HHCAHPS stands for Home Health Care Consumer Assessment of Healthcare Providers and Systems. Discharge OASIS is not needed. DME provided as a home health service as defined in section 1861(m) of the Act is paid the fee schedule amount. 484.325 Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model. (b) Standard: Content and duration of home health aide classroom and supervised practical training. The plan includes and identifies in detail the anticipated sources of financing for, and the objectives of, each anticipated expenditure of more than $600,000 for items that would under generally accepted accounting principles, be considered capital items. (a) Method of payment. [80 FR 68718, Nov. 5, 2015, as amended at 81 FR 76796, Nov. 3, 2016; 83 FR 56630, Nov. 13, 2018]. (b) Standard: Accuracy of encoded OASIS data. (2) If a state court has not adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient's representative may exercise the patient's rights. Note: Section 3708 of the CARES Act allows a nurse practitioner, clinical nurse specialist, or physician assistant who is working in accordance with State law to order or refer home health services. Transactions that are separated in time, but are components of an overall plan or patient care objective, are viewed in their entirety without regard to their timing. (h) Standard: Supervision of home health aides. site when drafting amendatory language for Federal regulations: Home Health Services - Ohio (b) Standard: Completion of the comprehensive assessment. Medicare pays for care in a beneficiary's home, when qualifying criteria are met, and documented. (ii) CMS determines if a circumstance encountered by a home health agency is exceptional and qualifies for waiver of the consequence specified in paragraph (i)(3) of this section. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. Classroom and supervised practical training must total at least 75 hours. (iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section. Market-basket update CMS finalizes an update of 3.1%, which is reduced by the required productivity adjustment of 0.5% resulting in a final update of 2.6% for calendar year (CY) 2022. (a) Basis. This subpart is established under sections 1102, 1115A, and 1871 of the Act (42 U.S.C. (d) Standard: Protection of records. (1) For individuals that began employment with the HHA prior to January 13, 2018, a person who: (iii) Has training and experience in health service administration and at least 1 year of supervisory administrative experience in home health care or a related health care program. (iii) If an area of concern in aide services is noted by the supervising registered nurse or other appropriate skilled professional, then the supervising individual must make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while he or she is performing care. (b) Calculation of the value-based payment adjustment amount. (4) Payments for periods beginning on or after January 1, 2022. (C) Hair shampooing in sink, tub, and bed; (x) Safe transfer techniques and ambulation; (xi) Normal range of motion and positioning; (xii) Adequate nutrition and fluid intake; (xiii) Recognizing and reporting changes in skin condition; and. (2) Be developed and maintained in a manner that takes into account each separately certified facility's unique circumstances, patient populations, and services offered. Allowed practitioner means a physician assistant, nurse practitioner, or clinical nurse specialist as defined at this part. (xiv) Any other task that the HHA may choose to have an aide perform as permitted under state law. 484.370 Process for determining and applying the value-based payment adjustment under the Expanded Home Health Value-Based Purchasing (HHVBP) Model. The HHA must provide the patient and caregiver with a copy of written instructions outlining: (1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. (ii) Graduated after successful completion of an occupational therapy assistant education program accredited by the Accreditation Council for Occupational Therapy Education, (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA) or its successor organizations. The eCFR is displayed with paragraphs split and indented to follow (2) Time for filing a request for reconsideration. The HHA must conduct exercises to test the emergency plan at least annually. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. (1) The HHA must send all necessary medical information pertaining to the patient's current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility or health care practitioner to ensure the safe and effective transition of care. (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. (3) When physical therapy, speech-language pathology, or occupational therapy is the only service ordered by the physician or allowed practitioner, a physical therapist, speech-language pathologist, or occupational therapist may complete the comprehensive assessment, and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. (3) A home health aide training program must address each of the following subject areas: (i) Communication skills, including the ability to read, write, and verbally report clinical information to patients, representatives, and caregivers, as well as to other HHA staff. (1) Have his or her property and person treated with respect; (2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; (3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; (4) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to. Request for Information (RFI) for Access to Home Health Aide Services Medicare covers intermittent/part-time personal care services and assistance with activities of daily living (ADL) provided by home health aides if a Medicare beneficiary is certified as needing a skilled service 6( 409.45). Annual update of the unadjusted national, standardized prospective payment rates. No organization, firm, or business that owns, operates, or provides staffing for an HHA is permitted to administer its own HHCAHPS Survey or administer the survey on behalf of any other HHA in the capacity as an HHCAHPS survey vendor. Where two measure categories are not included in the calculation of the Total Performance Score for an individual HHA, due to insufficient volume for all measures in those measure categories, the remaining measure category is weighted at 100 percent of the Total Performance Score. Specific requirements for submission of a request for an exception are available on the CMS website. Approved HHCAHPS survey vendors must fully comply with all HHCAHPS survey oversight activities, including allowing CMS and its HHCAHPS survey team to perform site visits at the vendors' company locations. If there has been a 24-month lapse in furnishing services for compensation, the individual must complete another program, as specified in paragraph (a)(1) of this section, before providing services. (a) Partial episode payments (PEPs) for episodes beginning on or before December 31, 2019. CPT is a trademark of the AMA. The patient has the right to. (d) Standard: Update of the comprehensive assessment. (ii) The basis for requesting reconsideration to include the specific quality measure data that the HHA believes is inaccurate or the calculation the HHA believes is incorrect. Condition of participation: Reporting OASIS information. The HHA must inform State and local officials of any on-duty staff or patients that they are unable to contact. Calculation of the Total Performance Score. 484.75 Condition of participation: Skilled professional services. An HHA must. The home health agency caring for you must be Medicare-certified. (i) The name of the HHA, address associated with the services delivered, and CMS Certification Number (CCN). (d) Standard: Coordination of care. (iv) Consistent with the home health aide training. Condition of participation: Release of patient identifiable OASIS information. (iii) For purposes of HHCAHPS survey data submission, the following additional requirements apply: (A) Patient count. In-home care via Medicaid not only helps elderly persons to maintain their independence and age at home, but is also a more cost-efficient option for the state than is paying for institutionalization. (c) Calculation of the payment adjustment percentage. PDF CMS Guidance Document - Centers for Medicare & Medicaid Services (d) CMS may grant an exception with respect to quality data reporting requirements in the event of extraordinary circumstances beyond the control of the HHA. Any reduction of the percentage change will apply only to the calendar year involved and will not be taken into account in computing the prospective payment amount for a subsequent calendar year. To determine if the physician's specialty is a valid home health ordering/referring specialty, review the information under the "Primary Taxonomy" field. (ii) The initial visit must have been made and the individual admitted to home health care. (11) Be free from any discrimination or reprisal for exercising his or her rights or for voicing grievances to the HHA or an outside entity. citations and headings (2) On or before December 31, 2009, meets one of the following: (i) Is licensed, or otherwise regulated in the state in which practicing. HHA baseline year means the calendar year used to determine the improvement threshold for each measure for each individual competing HHA. (iv) Basic infection prevention and control procedures. Complete the Medicare HHH Reopenings Adjustment Request Form along with a hardcopy UB-04 claim form the Type of Bill (XX7), appropriate condition code, Document control Number (DCN) and an explanation in the REMARKS field. PDF Home Infusion Therapy Supplier Fact Sheet - NAHC The HHA may only transfer or discharge the patient from the HHA if: (1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. A HHA must submit to CMS the OASIS data described at 484.55(b) and (d) in order for CMS to administer the payment rate methodologies described in 484.215, 484.220, 484. PDF CMS OASIS Q&As: CATEGORY 1 - Centers for Medicare & Medicaid Services (4) A system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains the availability of records. The clinical record, its contents, and the information contained therein must be safeguarded against loss or unauthorized use. 484.50 Condition of participation: Patient rights. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. (c) Use of the market basket index. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. (7) Was found under any federal or state law to have: (i) Had its participation in the Medicare program terminated; or, (ii) Been assessed a penalty of $5,000 or more for deficiencies in federal or state standards for HHAs; or, (iii) Been subjected to a suspension of Medicare payments to which it otherwise would have been entitled; or, (iv) Operated under temporary management that was appointed to oversee the operation of the HHA and to ensure the health and safety of the HHA's patients; or, (v) Been closed, or had its patients transferred by the state; or. (i) CMS may waive the consequences of failure to submit a timely-filed RAP specified in paragraph (i)(3) of this section. Condition of participation: Personnel qualifications. An HHA is not entitled to the review regarding the establishment of the transition period, definition and application of the unit of payments, the computation of initial standard prospective payment amounts, the establishment of the adjustment for outliers, and the establishment of case-mix and area wage adjustment factors. Physician assistant means an individual as defined at 410.74(a) and (c) of this chapter. (g) Split percentage payments. Proprietary agency means a private, for-profit agency. Larger-volume cohort means the group of competing HHAs that are participating in the HHCAHPS survey in accordance with 484.245. Skilled professionals must assume responsibility for, but not be restricted to, the following: (1) Ongoing interdisciplinary assessment of the patient; (2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s); (3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; (4) Patient, caregiver, and family counseling; (7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; (8) Participation in the HHA's QAPI program; and. (3) After December 31, 1977 and on or before December 31, 2007, (i) Completed certification requirements to practice as an occupational therapy assistant established by a credentialing organization approved by the American Occupational Therapy Association; or. No fee schedules, basic unit, relative values or related listings are included in CDT-4. (iii) Discharge and return to the same HHA during the 60-day episode. Access to or release of patient information and clinical records is permitted in accordance with 45 CFR parts 160 and 164. (2) Time for filing a request for recalculation. (1) HHAs that are certified for participation in Medicare effective by December 31, 2018 submit requests for anticipated payment (RAPs) to request the initial split percentage payment as specified in paragraph (g) of this section. 484.340 Basis and scope of this subpart. Please go to: /Outreach-and-Education/Outreach/OpenDoorForums/ODF_HHHDME Important Links Billing/Payment Home Health PPS Home Health Patient-Driven Groupings Model Home Infusion Therapy Services Coding and Billing Information CMS may also review any other evidence it believes to be relevant to the recalculation. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or. 484.55 Condition of participation: Comprehensive assessment of patients. (i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services, (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and. (5) If educated outside the United States, on or after January 1, 2008, (i) Graduated after successful completion of an occupational therapy assistant education program that is accredited as substantially equivalent to occupational therapist assistant entry level education in the United States by, (D) By a credentialing body approved by the American Occupational Therapy Association; and. [86 FR 62422, Nov. 9, 2021, as amended at 87 FR 66887, Nov. 4, 2022]. The OASIS data items determined by the Secretary must include: clinical record items, demographics and patient history, living arrangements, supportive assistance, sensory status, integumentary status, respiratory status, elimination status, neuro/emotional/behavioral status, activities of daily living, medications, equipment management, emergent care, and data items collected at inpatient facility admission or discharge only. The specialty code is not a valid eligible code (see below for a list of valid home health ordering/referring specialty codes). (a) General rule. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. Since the period was entered after the first initial, the claim was denied because it did not match the Order and Referring dataset file. (6) For CY 2016, CY 2017, and CY 2018, the adjustment is 0.97 percent in each year. Choosing an item from A recalculation request must be submitted in writing within 15 calendar days after CMS posts the HHA-specific information on the HHVBP Secure Portal, in a time and manner specified by CMS. (3) Forty completed surveys for each component included in the HHCAHPS survey measure. (3) The duties of a home health aide include: (i) The provision of hands-on personal care; (ii) The performance of simple procedures as an extension of therapy or nursing services; (iii) Assistance in ambulation or exercises; and. Condition of participation: Clinical records. This rule . (1) An HHA may request and CMS may grant exceptions or extensions to the reporting requirements under paragraph (b) of this section for one or more quarters, when there are certain extraordinary circumstances beyond the control of the HHA. (1) A qualified home health aide is a person who has successfully completed: (i) A training and competency evaluation program as specified in paragraphs (b) and (c) respectively of this section; or, (ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or, (iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of 483.151 through 483.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or.