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LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features a Home Health CY 2023 Prospective Payment Rule summary.

Home Health, Hospice & DME Open Door Forum: Wednesday, June 29 at 2:00PM

Please call at least 15 minutes prior to the forum start time.

The next Home Health, Hospice & DME Open Door Forum is scheduled for June 29 from 2:00-3:00PM.

The agenda will include:

• Opening Remarks
  • Chair – Brian Slater, Center for Medicare, CMS
  • Co-Chair- Kelly Vontran, Center for Medicare, CMS
  • Moderator – Jill Darling, Office of Communications, CMS
• Announcements & Updates
• CY 2023 HH PPS Proposed Rule Update
• June 2022 Hospice
  • Public Reporting: May 2022 refresh reminder 
    • Addition of claims-based measures on Care Compare
    • Provider reports – where to find
• Rulemaking: FY23 Proposed Rule public comment period closed 5/31/22 with brief overview
• Reminders: HQRP Updates and available resources
• June 2022 HHA
• Updates on OASIS manual, specs and QA’s
• Public Reporting:  July 2022 refresh reminder
• Rulemaking: CY23 Proposed Rule has published and is now available for public comments
• Expanded Home Health Value-Based Purchasing (HHVBP) Model Update
• Website available by clicking here
• Help Desk email available here
• HHCAHPS Survey
• The website for the HHCAHPS Survey is available here
• Technical inquiries, or other questions may be emailed to HHCAHPS@RTI.ORG.
• Toll-free telephone number for the HHCAHPS Survey is 866-354-0985

  III. Open Q&A

The call will be offered via conference call only. To participate by phone, dial 1-888-455-1397 and no passcode will be needed.

Vaccination expectations for surveyors

The Centers for Medicare & Medicaid Services (CMS) recently updated its vaccination expectations for surveyors. In January of this year CMS issued the following QSO-22-10-ALL memo requiring state agency surveyors and accrediting organization (AO) surveyors performing deemed status surveys to not participate in onsite surveys unless fully vaccinated (unless vaccination is medically contraindicated or the individual is legally entitled to a reasonable accommodation under federal civil rights laws because they have a disability or sincerely held religious beliefs, practices, or observances that conflict with the vaccination requirement).

That memo has been rescinded.

With QSO-22-18-ALL CMS encourages surveyors conducting federal surveys to be vaccinated but does not require it (or an acceptable exemption).  It remains up to the survey entity to implement policies around COVID-19 vaccination (and exemptions).

Previous guidance for surveyors entering nursing homes was provided in QSO-20-39-NH and this guidance remains.  While it is not directly applicable to home health and hospice providers, it may be applicable to some hospice inpatient facilities. Additionally, some state survey agencies and AOs have incorporated this guidance into their policies and procedures. It is expected that home health and hospice providers will not request vaccination status of surveyors or restrict surveyor access based on vaccination status.

ATTENTION hospices! CMS recruiting additional hospices for HOPE beta testing

As hospices should already be aware, the Centers for Medicare & Medicaid Services (CMS) and Abt Associates are currently beta testing a draft standardized hospice patient assessment instrument called Hospice Outcomes & Patient Evaluation (HOPE).  Additional hospice providers are needed to complete the testing.

Hospices must be Medicare-certified and training for this round of hospices is anticipated to occur mid-July 2022 with data collection slated to begin in August 2022 and continue through early fall 2022.

CMS is specifically seeking hospice providers with sufficient registered nurse, social worker, and chaplain staffing to conduct at least 1 – 2 joint visits per week. Hospices currently participating in the beta test may be finding this difficult amidst the workforce shortage causing CMS to recruit more hospices.

It appears that CMS is still aiming for completion of the beta testing in early fall of this year.  Should this occur, there may be time for CMS to analyze the results of the testing and formulate a proposal for use of the HOPE by all hospices in the FY2024 proposed rule.  This proposed rule would be posted in Spring 2023 for public review.

Joint visits are typical in beta testing standardized assessment instruments such as the HOPE for inter-rater reliability, but it is not expected that joint visits will be required when a HOPE tool is implemented in hospice. CMS includes the following additional information about the 1-2 joint visits per week that would occur as part of the HOPE testing:  For joint visits, two registered nurses visit one patient at the same time to complete the HOPE nurse assessment. Two social workers visit the patient at the same time to complete the HOPE social work assessment, and two chaplains visit the patient at the same time to complete the HOPE chaplain assessment. One of the two registered nurses, social workers and chaplains may attend their joint visit via video call, such as Zoom. HOPE assessments are completed at hospice admission, for symptom reassessment and at live discharge.

Recruitment will continue until CMS reaches the desired number of participants (number not specified). Those interested in participating should email HOPETesting@abtassoc.com by June 30.

You’re Invited: Honoring Wishes hosts Coalition to Transform Advanced Care - TOMORROW morning at 8:00AM

C-TAC is the Coalition to Transform Advanced Care, a national advocacy group dedicated to improving the lives of Americans impacted by serious illness. There are 12 million individuals, families and caregivers who struggle in a healthcare system that does not align with their values or needs.

Please join the Honoring Wishes Task Force on its monthly call as Jennifer Blemur, Esq. Director of Policy & Advocacy for C-TAC as she describes the work of C-TAC, as well as the role that state-level advanced illness coalitions can play in improving care in their state. The Honoring Wishes Task Force is Ohio’s coalition of clinicians, health systems, post-acute providers, emergency responders, and other stakeholders focused on improving healthcare decisionmaking and communication.

To register for the call tomorrow at 8:00AM, please click here.

2022 LeadingAge Ohio Annual Conference and Trade Show - REGISTRATION NOW OPEN!

Join us August 30 - September 1, 2022 at the Hilton Columbus at Easton for the LeadingAge Ohio Annual Conference and Trade Show! Our theme this year is MOMENTUM.

LeadingAge Ohio is excited to announce that registration is officially open! Register yourself or sign up your group today to take advantage of 57 excellent breakout sessions, continuing education credits, an inspiring keynote speaker, networking opportunities, and much, much more. Join us at the can’t-miss in-person event of the summer for members and partners!

To register for the LeadingAge Ohio Annual Conference & Trade Show, please click here.

To download the full brochure, please click here.

To make your hotel reservation, please click here.

Final PAC fundraising brewery stop in Columbus/Dublin on June 30

*Non-profit organizations should not forward this email as it deals with political action committee (PAC) business.

Join LeadingAge Ohio staff, legislators, and members in the central Ohio region this Thursday, June 30, from 5:00-7:00PM, at North High Brewing/Dublin Brewpub for the final stop in the LeadingAge Ohio PAC fundraising receptions. Representative Tracy Richardson and others are planning to attend and enjoy some time with our members.

What the Media Said about end of life care this week – June 28, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding telehealth visits
  
• 2022 LeadingAge Ohio Annual Conference and Trade Show - REGISTRATION NOW OPEN!
• ICD-10-CM Diagnosis Codes: Fiscal Year 2023
• Honoring Wishes hosts C-TAC June 29
• The biggest barriers to hospice recruiting by Jim Parker, hospice news
• Free webinar on future CMS pilot to test transmission of hospice election data to Part D plans
• Surveys for compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements
• CMS revises instructions to claim edit for hospice transfers
• Version 3.3 of the HHS Security Risk Assessment Tool now available
• CMS proposed rule risks stability of home health care
• Cleveland PAC event a big success, Cincinnati (June 23) and Columbus (June 30) events coming up
• What the Media Said about end of life care this week – June 21, 2022

2022 LeadingAge Ohio Annual Conference and Trade Show - REGISTRATION NOW OPEN!

Join us August 30 - September 1, 2022 at the Hilton Columbus at Easton for the LeadingAge Ohio Annual Conference and Trade Show! Our theme this year is MOMENTUM.

LeadingAge Ohio is excited to announce that registration is officially open! Register yourself or sign up your group today to take advantage of 57 excellent breakout sessions, continuing education credits, an inspiring keynote speaker, networking opportunities, and much, much more. Join us at the can’t-miss in person event of the summer for members and partners!

To register for the LeadingAge Ohio Annual Conference & Trade Show, please click here. For complete details on this year's conference, please click here to be directed to the LeadingAge Ohio dedicated Annual Conference & Trade Show webpage.

ICD-10-CM Diagnosis Codes: Fiscal Year 2023

Fiscal year 2023 ICD-10-CM diagnosis code files and guidelines are available on the 2023 ICD-10-CM webpage. These codes are effective for discharges and patient encounters on or after October 1, 2022.

Honoring Wishes hosts C-TAC June 29

C-TAC is the Coalition to Transform Advanced Care, a national advocacy group dedicated to improving the lives of Americans impacted by serious illness. There are 12 million individuals, families and caregivers who struggle in a healthcare system that does not align with their values or needs. Please join Honoring Wishes Task Force monthly call as Jennifer Blemur, Esq. Director of Policy & Advocacy for C-TAC as she describes the work of C-TAC, as well as the role that state-level advanced illness coalitions can play in improving care in their state. To register for the call on Wednesday, June 29 at 8:00AM, click here.

The biggest barriers to hospice recruiting by Jim Parker, hospice news

Please see the following story which ran in Hospice News on June 13, 2022.

As hospices sweat over recruitment and retention, many say that competition on wages and benefits is the leading barrier, as well as widespread misperceptions of their services.

Their employees, however, also cite burnout and the lack of flexibility of a career path as reasons they may leave the field.

A majority of hospices who responded to a survey by senior citizen advocacy group LeadingAge and consulting firm BerryDunn indicated that compensation, benefits and misperceptions were their biggest hiring challenges, according to a recent report. The survey was designed to identify best practices related to home health and hospice providers’ most pressing problems.

For several years running, staffing has been at the top of that list.

“Many of the most successful hospice organizations managed to accommodate for these [staffing] deficits without sacrificing quality,” the report indicated. “Strategies revealed in the study include increasing the amount of social workers and re-allocating non-clinical responsibilities, such as scheduling, to other areas of the organization.”

The long-standing hospice and palliative care workforce shortage has worsened substantially during the pandemic, threatening not only profit margins but access to care for patients and families. A number of hospices have shut down or sold their businesses because they could not hire enough workers.

Providers have also had to compete for new hires with better capitalized organizations like health systems or travel nurse companies. Generally speaking, these have been able to offer nurses higher wages and more flexible scheduling as demand for their services increased during COVID.

Nearly every hospice surveyed by LeadingAge and BerryDunn (98%) said that the workforce shortage has had a negative or “extremely negative” impact on their organization, according to the report. Close to 8-10% claimed that at least 20% of their registered nurse positions are currently unfilled.

While most health care organizations have seen a rise in turnover during the pandemic, hospices seem to be having a rougher go, the survey found.

Most reported turnover rates of 16% to 20% during the past 12 months. But more home health agencies than hospice agencies had turnover rates of less than 10%, while more hospice agencies had turnover rates of 30% or higher.

Agencies to some extent have helped mitigate the risk of turnover by bolstering their cadre of social workers, who can take on more of the conversations and other support that in their absence would fall on nurses.

Shifting other nonclinical responsibilities for nurses to other employees also appeared to slow nurse turnover, with scheduling as one of the main tasks identified.

But the biggest determinant was compensation.

Even though hospices have been gradually increasing clinicians’ pay during the pandemic — with some also offering signing or retention bonuses — larger providers such as health systems have been able to offer more.

Hospice worker wage and salary increases ranged from 3% to 6% during the last two years. Admission liaisons, nurses, aides and IT staff saw the largest increase, according to the National Association of Home Care & Hospice (NAHC).

“Right now caregivers that have left the home care space, specifically private duty, have left for more wages,” Aveanna Healthcare Holdings (NASDAQ: AVAH) CEO Tony Strange recently said at the RBC Capital Markets Global Healthcare Conference. “We need to make sure that we continue to press [reimbursement] rates in order to pass those wages down to caregivers to entice them back into the home care space.”

LeadingAge and BerryDunn surveyed more than 1,000 home health and hospice sites to compile these data, which was collected over a 12-week period between September and December 2021. Organizations responded via online survey software, online polling, verbal interviews, and submitted paper survey responses.

The survey was field tested twice and refined using input from hospice agency leaders, according to LeadingAge.

Free webinar on future CMS pilot to test transmission of hospice election data to Part D plans

Numerous industry stakeholder groups have been working with the National Council of Prescription Drug Plans (NCPDP) to improve coordination between hospice providers and Part D plans to ensure appropriate coverage for prescription drugs while patients are on hospice service.

A key issue believed to play a significant role in poor coordination is the length of time it takes for information about a patient’s hospice election to filter through the Centers for Medicare & Medicaid Services’ (CMS’) systems to the Part D prescription drug plans.

CMS is now set to launch a pilot study under which hospice EMR vendors, clearinghouses, and Part D plans will test whether hospice election information can be transmitted more timely from hospice EMR vendors/clearinghouses via an intermediary (called the Part D Transaction Facilitator) directly to the patient’s Part D plan.

In an effort to educate hospice providers, Part D plans, hospice EMR vendors/clearinghouses, and other interested parties, NCPDP is hosting a FREE WEBINAR on June 29 to describe the how the pilot will work. The pilot will utilize the Notice of Election (NOE) 837I Transaction Standard to provide information for the Part D Transaction Facilitator, who will create the NCPDP Telecommunication Standard Nx real-time Hospice enrollment transactions for submission to the Medicare Part D plans. The intent of this new process is to allow for timely Hospice election notification to Medicare Part D Plans.

ABOUT THE WEBINAR

• Background: Join this webinar to learn about a pilot initiative to solve for Hospice enrollment notification delays sent to the Medicare Part D plans that may result in inappropriate payments made by the Medicare Part D plans during a Hospice election period
  
  
• Date/Time:  June 20 at 1:00PM
  
  
• Learning Objectives: 
  After this educational session, attendees will be able to:
  • Understand the journey from delayed information to real-time information.
  • Describe the Hospice Election Status Nx Transactions and all they do.
  • Learn about becoming an NCPDP/CMS Hospice Election Status pilot participant.
    
    
• Registration: To register, please click here. Scroll down to Upcoming Webinars and click on Hospice Election Status NCPDP/CMS Pilot. Please note that while most NCPDP webinars require payment, this webinar is complimentary.

Surveys for compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements

The Centers for Medicare & Medicaid Services (CMS) posted memo QSO-22-17-ALL containing new instructions for surveys for compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements. CMS previously issued guidance and survey procedures to survey entities for assessing and maintaining compliance with the regulatory requirements for vaccination.

Under the previous guidance, federal, state and Accreditation Organization (AO) surveyors were to assess for compliance with the vaccination requirements at surveys for initial certification, standard recertification or reaccreditation, and complaint surveys.

Effective immediately, surveyors will continue to survey for compliance with the vaccination requirements during initial and recertification surveys, but will now only survey for compliance in response to complaints alleging non-compliance with this requirement (not all complaint surveys). Since the vaccination requirements became effective earlier this year, 95% of the nearly 12,000 providers that have been surveyed by states are in compliance with the requirements.

This most recent memo also instructs state survey agencies to reach out to their CMS Location if they are considering citing vaccine requirements at immediate jeopardy, Condition or actual harm levels. CMS is reviewing its previous interpretive guidance describing Immediate Jeopardy, Condition-level and actual harm determinations to ensure that deficiency citations recognize good faith efforts by providers/suppliers and to more fully evaluate harm or potential harm to patients/residents by considering trends in COVID-19 rates in the community.

CMS revises instructions to claim edit for hospice transfers

The Centers for Medicare & Medicaid Services (CMS) recently updated Change Request (CR) 12619 Gap Billing Between Hospice Transfers which provides instructions to the Medicare Administrative Contractors (MACs) to implement the edit and updates Chapter 11 of the Medicare Claims Processing Manual to reflect that there must not be a gap in billing for hospice transfer situations, a hospice transfer will be rejected if the transfer does not occur immediately. The Manual instructions indicate that transfers are not allowed from the same provider.

Hospices must not submit an 8XC if the CMS Certification Number (CCN) is the same. In this scenario the beneficiary is not transferred to another hospice, they are transferred to another location of the same hospice. It is the term “another location” that is new in this revised CR.

Originally, the term “subunit” was used which is a specified term associated with home health agencies. The use of the term could be confusing to hospices as they do not have “subunits” so it was replaced with “another location.”

Version 3.3 of the HHS Security Risk Assessment Tool now available

The Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) have released version 3.3 of the popular HHS Security Risk Assessment (SRA) Tool. This tool is designed to aid small and medium sized health care organizations in their efforts to assess security risks.

The latest version of the SRA Tool contains a variety of feature enhancements based on user feedback and public input. New features include the incorporation of Health Industry Cybersecurity Practices (HICP) references, file association in Windows, improved reports, and other bug fixes and stability improvements.

Also new this year is the SRA Tool Excel Workbook. This alternative version of the SRA Tool takes the same content from the Windows desktop application and presents it in a familiar spreadsheet format. The Excel Workbook contains conditional formatting and formulas to calculate and help identify risk in a similar fashion to the SRA Tool application.

This version of the SRA Tool is intended to replace the legacy “Paper Version” and may be a good option for users who do not have access to Microsoft Windows.

CMS proposed rule risks stability of home health care

The Centers for Medicare and Medicaid Services (CMS) issued its annual proposed rule regarding Medicare home health services payment rates for CY 2023. As usual, the rule also includes a hodgepodge of non-rate related proposals as well. This article provides a summary of the proposed rule.

Overall, the rule presents serious concerns for the home health community as it includes significant proposed rate reductions to account for the change in the payment model in 2020. Medicare law requires CMS to make permanent and temporary adjustments intended to ensure that the transition to the PDGM payment model is budget neutral in comparison to expected Medicare spending on the 2019 payment model. The outcome of the CMS analysis of the impact of the new payment model is a proposed 7.69% permanent rate adjustment based on the conclusion that HHAs were overpaid in 2020 and 2021 due to provider behavior changes in coding.

To read a compete write up by NAHC, please click here.

Cleveland PAC event a big success, Cincinnati (June 23) and Columbus (June 30) events coming up

*Non-profit organizations should not forward this email as it deals with political action committee (PAC) business.

Cleveland event a big success! Last Thursday, members from Northeast Ohio joined LeadingAge Ohio partners and associate firms to raise money for the LeadingAge Ohio PAC at Great Lakes Brewing Company in Cleveland as the first stop on the summer PAC Brew Tour. In addition to some great beer and food, a number of state legislators stopped in to spend some time with our members. 

Cincinnati Brew Tour stop this week. If you missed out in Cleveland, fear not. Join LeadingAge Ohio staff, legislators, and members in the southwest region on Thursday, June 23, from 5:00-7:00PM at Sonder Brewing in Mason. Representative Bill Seitz, Representative Jessica Miranda, Representative Sara Carruthers, Senator Steve Huffman, Senator George Lang, Senator Bill Blessing, and others are planning to attend and enjoy some time with our members. 

The final stop of the tour will be Thursday, June 30 at North High Brewing in downtown Dublin for all of our central Ohio friends. We hope to see you at these next two PAC events! If you have any questions, please contact Patrick Schwartz at pschwartz@leadingageohio.org. 

Check out the LeadingAge Ohio Education Calendar!

LeadingAge Ohio holds valuable education webinars and in-person events all throughout the year. To see the complete schedule of events, please click here!

What the Media Said about end of life care this week – June 21, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding eye protection in hospice inpatient units
  
• LeadingAge home health and hospice recap
• LeadingAge Ohio All-Member Call: Today at 11:30AM
• Hospice care compare May refresh will not include new measures
• CMS sending letters to physicians referring to hospice
• OIG workplan to include OASIS falls reporting and post-acute transfer policy
• CMS transitions administrative functions for HHA enrollments and CHOWs
• ODH Health Alert: Monkeypox virus update
• LeadingAge Ohio Board of Directors: nominations due July 1
• Ohio employers should weigh in on work-based learning
• Life Safety Code: Current Hot Topics and Updates webinar - June 22
• Advanced Principles of Hospice Management - September 21
• Hospice Clinical Bootcamp - October 12
• Have you met Elliott Ness? Support the PAC at Great Lakes Brewing!
• Check out the LeadingAge Ohio Education Calendar!

You asked... We answered regarding eye protection in hospice inpatient units

You Asked:

Our hospice has an inpatient unit. Do we need to wear eye protection in all patient rooms when the community transmission rate is substantial or high, or just in PUI (person under investigation)/COVID positive patient rooms?

We Answered:

LeadingAge Ohio reached out to the Ohio Department of Health (ODH) to see what they recommended for eye protection for staff working in hospice inpatient units when the community transmission rate is substantial or high. The Survey Administrator Bureau of Survey and Certification, ODH gave the following guidance:

Our surveyors are enforcing the most current CDC guidance related to PPE including the bolded and underlined area below as it relates to eye protection.

Implement Universal Use of Personal Protective Equipment for HCP
If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis). Additionally, HCP working in facilities located in counties with substantial or high transmission should also use PPE as described below:

• NIOSH-approved N95 or equivalent or higher-level respirators should be used for:
• All aerosol-generating procedures (refer to Which procedures are considered aerosol generating procedures in healthcare settings?)
• All surgical procedures that might pose higher risk for transmission if the patient has SARS-CoV-2 infection (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract).
• NIOSH-approved N95 or equivalent or higher-level respirators can also be used by HCP working in other situations where additional risk factors for transmission are present such as the patient is not up to date with all recommended COVID-19 vaccine doses, unable to use source control, and the area is poorly ventilated.  They may also be considered if healthcare-associated SARS-CoV-2 transmission is identified and universal respirator use by HCP working in affected areas is not already in place.
• To simplify implementation, facilities in counties with substantial or high transmission may consider implementing universal use of NIOSH-approved N95 or equivalent or higher-level respirators for HCP during all patient care encounters or in specific units or areas of the facility at higher risk for SARS-CoV-2 transmission.
• Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) should be worn during all patient care encounters.

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features information on the CDC issuing no updates to the healthcare recommendations at this time and LeadingAge staff meeting with home health and hospice subject matter experts at CMS.

LeadingAge Ohio All-Member Call: Today at 11:30AM

The next LeadingAge Ohio All-Member Call will take place today at 11:30AM. Please plan to join the LeadingAge Ohio advocacy team to discuss the “new lame duck”, as Ohio policymakers sprint from one deadline to the next. An infusion of ARPA investment, coupled with a chaotic redistricting process has created intense periods of policymaking, and aging services continue to be in focus as providers struggle to emerge from the pandemic. Find out what initiatives the legislature advanced and which it delayed, including when to expect HCBS ARPA funding, the latest on PACE expansion, work to offset workforce expenses of nursing facilities, and a new solution for hospice transportation. Members will also hear the latest on Ohio’s nurse aide training rules and Ohio’s new home care license, as well as how they can use campaign season to connect with legislators.  

The call is free to members but registration in advance is required. To have your question answered on the call, email it to COVID19@leadingageohio.org.

Hospice care compare May refresh will not include new measures

Last week, the Centers for Medicare & Medicaid Services (CMS) had originally planned to publicly display data for two new quality measures (Hospice Visits in the Last Days of Life (HVLDL) and the Hospice Care Index (HCI) claims-based measures), however these measures have been suppressed by CMS for all hospices and CMS is targeting the August 2022 refresh for the inaugural public display of these two new quality measures. The May 2022 quarterly refresh for the Hospice Quality Reporting Program will now only include the Hospice Item Set (HIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, and Claims-based measure scores exclude Quarter 1 and Quarter 2 of calendar year 2020. In addition, state averages will now be displayed for each measure.

CMS sending letters to physicians referring to hospice

The Centers for Medicare & Medicaid Services' (CMS) Center for Program Integrity recently started mailing letters inviting physicians starting in Florida to one-on-one training sessions about the Medicare hospice benefit. These letters are being sent to physicians who are ordering and referring Medicare beneficiaries to hospice services. Purpose of this three-hour, in-person trainings is to help physicians understand Medicare hospice benefit, referral process, and regulations. Husch Blackwell produced a product discussing what these training sessions involve, why CMS is conducting them, and how physicians and hospices can respond.

OIG workplan to include OASIS falls reporting and post-acute transfer policy

The Department of Health & Human Services Office of the Inspector General (OIG) reported the addition of a new study and a new audit that should be of interest to the home health and hospice communities. These alerts to the public via daily updates of new audits and reports is part of the OIG Work Plan. The OIG Descriptions of the new work items are provided below:

Accuracy of Falls Reporting in Home Health OASIS Assessments
In April 2022, the Centers for Medicare & Medicaid Services (CMS) began publicly reporting on the Care Compare website the percentage of patients in home health care who fell and endured major injuries for each home health agency (HHA). HHAs report falls in patient assessments using the standardized Outcome and Assessment Information Set (OASIS), and CMS reports the agency fall rates calculated from these assessments.

In this study, OIG will assess the accuracy of HHAs’ reporting of falls in OASIS. Specifically, OIG will use Medicare claims to identify hospitalizations due to falls with major injuries among Medicare beneficiaries in home health care and will then assess the extent to which those falls were reported in OASIS assessments. OIG plans to describe the characteristics of beneficiaries who did not have their falls reported, as well as the characteristics of HHAs that have particularly low reporting rates. This study will be conducted by the Office of Evaluation and Inspections, and the OIG expects to release findings from this study during FY2023.

Follow-up Review of Inpatient Claims Under the Post-Acute-Care Transfer Policy (PACT)
Medicare makes the full Medicare Severity Diagnosis-Related Group (MS-DRG) payment to a hospital that discharges an inpatient beneficiary “to home.” However, if a patient is on hospital service for a shorter period of time than expected and is subsequently discharged to home with home health care, hospice, or other post-acute care, Medicare pays hospitals a per diem rate.  As a result, the hospital receives less payment than would be the case if it were paid the full amount for the MS-DRG.

OIG has conducted a number of studies to determine whether the post-acute transfer policy is being implemented properly, including one related to post-acute transfers to home health care.

One prior OIG review found that the CMS Common Working File (CWF) edits that detected inpatient claims under the post-acute care transfer policy were working appropriately. However, some Medicare contractors did not receive automatic notifications of improperly billed claims or did not act to adjust those claims. As a result, OIG recommended that CMS recover the identified overpayments in line with its policies and procedures and ensure that the Medicare contractors are receiving the notifications and are acting to recover the overpayments. CMS concurred with all OIG recommendations and detailed how they were addressed.

This follow–up audit, being conducted by the OIG Office of Audit Services, will determine whether CMS’s CWF edits are working properly in detecting inpatient claims under the post-acute-care transfer policy and are automatically recovering overpayments, and whether Medicare contractors are receiving the automatic notifications and acting to recover overpayments. The audit report is scheduled for completion in FY2023.

CMS transitions administrative functions for HHA enrollments and CHOWs

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12749 that describes the transitioning of certain certification enrollment functions performed by the CMS Survey and Operations Group (SOG) Locations (formerly CMS Regional Offices) to CMS’ Center for Program Integrity (CPI) Provider Enrollment Oversight Group (PEOG) and the Medicare Administrative Contractors (MACs).

To date, CMS has transitioned several transactions that include voluntary termination applications and federally qualified health center initial enrollment applications, changes of ownership, and changes of information. Effective May 27, 2022, the following enrollment transactions will “transition”, which includes home health agency (HHA) initial enrollment applications and changes of ownership.

• Ambulatory surgical center (ASC) initial enrollment applications, changes of ownership, and changes of information.
• Community mental health center (CMHC) initial enrollment applications, changes of ownership, and changes of information.
• Comprehensive outpatient rehabilitation facility (CORF) initial enrollment applications, changes of ownership, and changes of information.
• Home health agency (HHA) initial enrollment applications, changes of ownership under 42 CFR § 489.18 (as distinguished from changes in majority ownership under

42 CFR § 424.550(b)), and changes of information

• Outpatient physical therapy/outpatient speech pathology (OPT/OSP) provider initial enrollment applications, changes of ownership, and changes of information.
• Portable x-ray supplier (PXRS) initial enrollment applications, changes of ownership, and changes of information.

CMS has revised the Program Integrity Manual, Chapter 10, section 10.2.1.6 to reflect the changes along with detailed instructions for initial enrollment and CHOWs for HHAs.

ODH Health Alert: Monkeypox virus update

Yesterday afternoon, the Ohio Department of Health (ODH) shared the attached Monkeypox Virus Update outlining resources available through ODH for the diagnosis of monkeypox and other important information. Healthcare providers who suspect monkeypox due to clinical presentation and patient history should report suspected cases to the appropriate local health department based on the patient’s address.

LeadingAge Ohio encourages members to evaluate their emergency preparedness response protocols specific to monkeypox. They should consider monkeypox’s impact on the facility’s hazardous vulnerability risk, training, communication, their nursing staff’s competency in assessment, response, and contact tracing. LeadingAge Ohio encourages members to reach out to local health departments’ to understand their plans for response to a suspicion of monkeypox at a facility and discuss the process for obtaining lab results.

LeadingAge Ohio Board of Directors: nominations due July 1

Last week, LeadingAge Ohio released a call for nominations to serve on the LeadingAge Ohio Board of Directors and individuals in all stages and capacities of leadership positions are encouraged to apply. Individuals with expertise and interests aligned with the 2022+ LeadingAge Ohio Strategic Plan, which centers on advocacy and workforce development, will be strong candidates for  Board positions. The Nominating Committee will meet to evaluate candidates for board service in mid July.

To review the nomination packet, click here. LeadingAge Ohio encourages any who are interested in serving on the board to contact Susan Wallace at swallace@leadingageohio.org to express interest. Nominations are due no later than Friday, July 1.

Ohio employers should weigh in on work-based learning

LeadingAge Ohio is part of the Complete to Compete (C2C) coalition, a statewide network of employers, education and higher education stakeholders working toimprove post-secondary attainment and better align education / training with Ohio’s jobs. C2C launched a survey to gauge understanding in what businesses, organizations, and agencies know about work-based learning programs in Ohio. The information gained from the survey will be utilized to reinforce existing work-based learning resources and identify areas of growth in strengthening the framework to grow the program. 

LeadingAge Ohio members are encouraged to participate in the survey, regardless of how involved your organization has been in work-based learning in the past. Opportunities for students to become involved with aging services and providers can forge pathways into aging careers in light of current workforce needs.

Please use this link to access the survey. The survey should take no more than 20 minutes to complete. Please submit your responses to the survey by June 15, 2022.

Please email Workforce Director, Randi Hamill, at rhamill@leadingageohio.org if you have any questions or need assistance.

Life Safety Code: Current Hot Topics and Updates webinar - June 22

Join LeadingAge Ohio and representatives from the Ohio Department of Health (ODH) on June 22 at 1:00PM for the most up-to-date information on top Life Safety Code deficiencies and remedies, as well as other hot topics related to Life Safety. CMS Blanket waivers that are expiring will be covered along with common Emergency Preparedness plan trends. Updates and changes to the Preventative Maintenance Manual will also be discussed.

Who will benefit from this webinar?

• Nursing and Hospice Facility Maintenance Staff
• Managers
• Administrators
• Compliance Officers

To register for this event, please click here.

Advanced Principles of Hospice Management - September 21

This program will provide an overview of hospice management principles for new hospice clinical and administrative managers or hospice managers who want to get an update on the latest technical and regulatory topics. Topics covered will include best practices in sustaining a successful program that meets the end-of-life needs of patients, families and the wider community. Day-to-day management issues and practical resolutions will also be addressed.

Topics discussed will include:

• Overview of the regulatory bodies that govern hospice operation and a detailed discussion of the CMS survey process
• Details of the Hospice Medicare Benefit and Conditions of Participation that pertain specifically to the management of hospice
• Local Coverage Determinations and adequate non-cancer documentation
• Hospice Quality Reporting Guidelines
• Assessments, Plan of Care and IDG processes
• Operational issues such as staffing ratios, physician orders and visit frequencies, Hospice ABN’s, etc.
• Importance of good nursing facility communication

For additional information and/or to register, please click here.

Hospice Clinical Bootcamp - October 12

Join LeadingAge Ohio's Director of Home Health/Hospice Regulatory Relations Anne Shelley for this day-long offering will include what direct care staff need to know related to the Medicare Hospice Benefit, the Hospice Conditions of Participation, Advance Care Planning, Hospice-Nursing Facility Collaboration, Non-Cancer documentation, symptom management and professional barriers and communication in hospice. This education will greatly benefit all new hospice nurses, social workers, chaplains and volunteer and bereavement coordinators, not to mention being a good refresher for all seasoned front-line staff.

Objectives:

1. Explain the philosophy of hospice care.
2. Define unique hospice characteristics.
3. Explain components of the Hospice Medicare Benefit.
4. Discuss the importance of Advance Care Planning.
5. Discuss components and importance of hospice symptom management.
6. Identify basic components of hospice Conditions of Participation.
7. Discuss major components of Hospice COP’s, Sub-Part C.
8. Discuss the major components of Hospice COP's, Sub-Part D.
9. Describe information needed in non-cancer documentation.
10. Discuss the importance of hospice collaboration with nursing facilities.

For additional information and/or to register, please click here.

Have you met Elliott Ness? Support the PAC at Great Lakes Brewing!

*Non-profit organizations should not forward this email as it deals with political action committee (PAC) business.

Join LeadingAge Ohio staff, legislators, and members in the northeast region on Thursday, June 16, from 5:00-7:00PM, at Great Lakes Brewing Company in downtown Cleveland for the first of three LeadingAge Ohio PAC fundraising receptions. 

LeadingAge Ohio will be hosting two additional gatherings on June 23 in Cincinnati (Sonder Brewing) and on June 30 in Columbus (North High Brewing). Complete details can be viewed by clicking here.

Check out the LeadingAge Ohio Education Calendar!

LeadingAge Ohio holds valuable education webinars and in-person events all throughout the year. To see the complete schedule of events, please click here!

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding Home Health therapy orders
  
• LeadingAge home health and hospice recap
• NAHC request - PCHETA support sign-on opportunity
• Additional free at-home, rapid COVID-⁠19 tests
• OIG looking at home health falls reporting
• Study finds hospice comfort medications have great variation
• Help Your Board Hit the Governance Bullseye, webinar series: Starts June 7
• Life Safety Code: Current Hot Topics and Updates webinar - June 22
  
• LeadingAge Ohio PAC Brew Tour: Thursdays in June
• Goals of care with individuals with cognitive impairment: Wednesday, May 25
• Public Health Emergency likely to continue beyond July 16
• What the Media Said about end of life care this week – May 24, 2022

You asked... We answered regarding Home Health therapy orders

You Asked:

If there is a home health patient who does not have an order for physical therapy (PT) on admission, but three weeks later has an event and needs a therapy evaluation, how long of a time-frame does the therapist have to get out to the home to evaluate the patient if the nurse gets an order for physical therapy to evaluate and treat with no specific date applied to the order?  Is it a 5-day window to evaluate and treat the patient like the admission time-frame?

We Answered:

LeadingAge Ohio reached out to the Ohio Department of Health (ODH) regarding the timeframe for an evaluation and treatment from the therapist after the start of care. This was ODH’s response:

There is no specific time frame in the regulations; however, if the physician writes an order for PT to evaluate and treat, we would expect to see a PT visit to evaluate and treat. Some agencies have policies stipulating time frames and some have “expectations” that the visit would happen as soon as possible. ODH has seen these orders fall thru the cracks and it’s many weeks before therapy ever sees the patient or sometimes not at all. There is often no follow up with the physician to inform him/her of the delay or reason why therapy never provided service. Either of those scenarios would result in a citation. 

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features an article on PHE likely to continue beyond July 16.

NAHC request - PCHETA support sign-on opportunity

Last Thursday, the Palliative Care and Hospice Education and Training Act (PCHETA (S. 4260) was re-introduced in the US Senate by Senators Tammy Baldwin (D-WI) and Shelley Moore-Capito (R-WV). The Bill text is available here and the one pager is available here. PCHETA is a bill that would make major investments to increase and bolster the hospice and palliative care interdisciplinary workforce. LeadingAge Ohio will keep members informed on the bill’s progress.

Additional free at-home, rapid COVID-⁠19 tests

Last week, the Biden Administration announced that COVIDTests.gov is now open for a third round of ordering. People who have difficulty accessing the internet or need additional support placing an order can call 1-800-232-0233 (TTY 1-888-720-7489) to get help in English, Spanish, and more than 150 other languages, 8:00AM - midnight, 7 days a week. For more information, people can visit COVID.gov/tests/faq.

OIG looking at home health falls reporting

In April 2022, a new OASIS-based measure for falls with major injuries for home health agencies was publicly released on Care Compare; Percent of Residents Experiencing One or More Falls with Major Injury. This month OIG added a study to their work plan to assess accuracy of home health agency reporting on falls in OASIS. The report will use Medicare claims to identify hospitalizations due to falls with major injury and the analysis will look the extent to which falls were reported on OASIS. The report will include a description of the beneficiary characteristics who did not have falls reported as well as characteristics of home health agencies that have low falls reporting rates. The report will be issued in 2023.

Study finds hospice comfort medications have great variation

A new study from the University of Michigan looked at two types of medication often used to support individuals with anxiety, agitation, delirium and other symptoms while on hospice. The two categories of drugs reviewed were benzodiazepines and antipsychotics. There has been concerted effort to reduce the use of these drugs in older adult populations, but little research has focused on their use in hospice. The study reviewed 400,000 Medicare beneficiaries who had not been prescribed these types of medications in the prior 6 months. The research found 54% of patients in the 4,300 hospices studied filled a prescription for a benzodiazepine and 31% filled an antipsychotic while on hospice. The greatest predictor of whether a patient was prescribed one of these medications was if they received care from a high prescribing hospice agency, not a patient’s clinical characteristics. The study also revealed differences between non-profit and for-profit hospice prescribing trends and racial and ethnic variations by patients.  

Help Your Board Hit the Governance Bullseye, webinar series: Starts June 7

LeadingAge Ohio and HJ Sims invite you to join this webinar series with your board members, as HJ Sims provides a series of comprehensive virtual content geared directly toward the governance of senior living providers. The series will benefit all leaders within our field, especially board members, leadership teams, and individuals new to these roles. Participants will walk away with a clear understanding of the role and responsibilities of boards, how to think through affiliations, acquisitions and other partnerships, and other challenges in this volatile, post-COVID era. 

Each session will tap the intellectual capital of industry experts from governance, law, finance, development, and strategic planning. Invite your board members and plan to attend the entire series for maximum impact. Webinars will be held every Tuesday in June.

Life Safety Code: Current Hot Topics and Updates webinar - June 22

Join LeadingAge Ohio and Representatives from the Ohio Department of Health (ODH) on June 22 at 1:00PM, for the most up-to-date information on top Life Safety Code deficiencies and remedies, as well as other hot topics related to Life Safety. CMS Blanket waivers that are expiring will be covered along with common Emergency Preparedness plan trends. Updates and changes to the Preventative Maintenance Manual will also be discussed.

Who will benefit from this webinar?

• Nursing and Hospice Facility Maintenance Staff
• Managers
• Administrators
• Compliance Officers

To register for this event, please click here.

LeadingAge Ohio PAC Brew Tour: Thursdays in June

*Non-profit organizations should not forward this email as it deals with political action committee (PAC) business.

The LeadingAge Ohio PAC will host fundraising events at three of Ohio’s premier breweries for its first-ever Summer PAC Brew Tour! These fundraising receptions will take place on Thursdays in June with three options to choose from - Cleveland at Great Lakes Brewing Company (June 16), Cincinnati at Sonder Brewing (June 23), and Columbus at North High Brewing Company (June 30). Legislators will be invited to attend as guests. Enjoy some great beer, great food, and support the PAC while networking with your colleagues! 

Organizations interested in sponsorship should contact Corey Markham at cmarkham@leadingageohio.org.  

Cleveland - Great Lakes Brewing Company
Thursday, June 16, 2022
2516 Market Ave
Cleveland, OH 44113
5:00-7:00PM
Register online here

Cincinnati - Sonder Brewing
Thursday, June 23, 2022
8584 Duke Blvd
Mason, OH
5:00-7:00PM
Register online here

Columbus - North High Brewing Company
Thursday, June 30, 2022
56 N High St
Dublin, OH 43017
5:00-7:00PM
Register online here

Goals of care with individuals with cognitive impairment: Wednesday, May 25

Join the Honoring Wishes Task Force next Wednesday for a conversation with Leigh Ann Kingsbury of InLeadS Consulting, who will offer her insights on goals of care conversations with individuals with cognitive impairment. A nationally-recognized expert in person-centered practices and healthcare decision making, Leigh Ann is a frequent presenter and facilitator on advance care planning, advocacy for individuals with disabilities, and legal aspects like guardianship and alternatives to guardianship. Recently she served as facilitator for Ohio’s Alzheimer’s and Related Dementias Task Force convened by the Department of Aging. 

There is no cost for the webinar, but advance registration is required by clicking here. The presentation is part of a monthly series that LeadingAge Ohio hosts on behalf of the Honoring Wishes Task Force, a statewide coalition of post-acute providers, health systems, hospice & palliative care experts, elder law attorneys and other stakeholders. These webinars are open to all professionals interested in engaging with older adults and individuals with disabilities in healthcare planning discussions.

Public Health Emergency likely to continue beyond July 16

The current extension of the Public Health Emergency (PHE) is due to end on July 16. When it does end there are implications for Medicare, Medicaid and the CHIP program – for states, providers, and beneficiaries. However, the Department of Health and Human Services (HHS) Secretary Xavier Becerra committed to giving states and others 60 days’ notice if the PHE is not going to be renewed. Since May 16 passed with no notice, it is reasonable to expect that it will be renewed once again.

What the Media Said about end of life care this week – May 24, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding Physician Assistants (PA) in hospice
  
• You asked... We answered regarding universal source control, relaxing of restrictions and testing
• LeadingAge home health and hospice recap
• CMS stakeholder call: Wednesday, May 11 at 11:00AM
• Medicare Quality Improvement Organization Appeals Overview for Healthcare Provider Webinar: May 25
• CMS updates home health medicare billing manual
• 2 new HHVBP resources focused on Quality Measures & Improvement
• MLN updates VBID Hospice Benefit Component billing information
• Home health U537F NOA error solved
• Palmetto question report
• Help Your Board Hit the Governance Bullseye, webinar series: Starts June 7
• ODM shares MITS “dark” days
• LeadingAge Ohio PAC Brew Tour: Thursdays in June
• What the Media Said about end of life care this week – May 10, 2022

You asked... We answered regarding Physician Assistants (PA) in hospice

You Asked:

I have three questions about physician assistants (PAs) working in hospice:

1. Can a PA complete Face to Face (F2F) encounter visits to document assessment of eligibility?
2. Can a PA work for a hospice?
3. Can we bill for PA visits when the visit is made for symptom management (or must they also be the attending physician to bill for their visit)?

We Answered:

According to the Hospice Medicare Benefit Policy Manual Chapter 9, a Physician Assistant unfortunately cannot complete a F2F visit to determines a hospice patient’s eligibility.  It is in federal statute that only a physician or nurse practitioner can perform F2F encounters at this time.  A physician assistant can be employed by a hospice, but for a hospice to be able to bill for their services, the PA must be the hospice patient’s attending physician.  Please see the citation below that refers to physician assistants as attending physicians for hospice.

Hospice Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice Services Under Hospital Insurance

40.1.3.3 – Physician Assistants as Attending Physicians (Rev. 246, Issued: 09-14-18, Effective: 12-17- 18, Implementation: 12-17-18)

Effective January 1, 2019, Medicare will pay for medically reasonable and necessary services provided by physician assistants (PAs) to Medicare beneficiaries who have elected the hospice benefit and who have selected a PA as their attending physician. PAs are paid 85 percent of the fee schedule amount for their services as designated attending physicians.

 A physician assistant is defined as a professional who has graduated from an accredited physician assistant educational program who performs such services as he or she is legally authorized to perform (in the State in which the services are performed) in accordance with State law (or State regulatory mechanism provided by State law) and who meets the training, education, and experience requirements as the Secretary may prescribe. The physician assistant qualifications for eligibility for furnishing services under the Medicare program can be found in the regulations at 42 CFR 410.74 (c).

If a beneficiary does not have an attending physician, a nurse practitioner, or physician assistant who has provided primary care prior to or at the time of the terminal illness, the beneficiary may choose to be served by either a physician or a nurse practitioner who is employed by the hospice. The beneficiary must be provided with a choice of a physician or a nurse practitioner.

Medicare pays for attending physician services provided by physician assistants to Medicare beneficiaries who have elected the hospice benefit and who have selected a physician assistant as their attending physician. This applies to physician assistants without regard to whether they are hospice employees.

Effective January 1, 2019, Medicare will pay for medically reasonable and necessary services provided by PAs to Medicare beneficiaries who have elected the hospice benefit and who have selected a PA as their attending physician. PAs are paid 85 percent of the fee schedule amount for their services as designated attending physicians.

Attending physician services provided by PAs may be separately billed to Medicare only if:

• The PA is the beneficiary's designated attending physician; and
• Services are medically reasonable and necessary; and
• Services would normally be performed by a physician in the absence of the PA, whether or not the PA is directly employed by the hospice; and
• Services are not related to the certification of terminal illness.

If the physician assistant is employed by the hospice, the hospice can bill Part A for physician services meeting the above criteria on a hospice claim. If the physician assistant is not employed by the hospice, the physician assistant can bill Part B for physician services meeting the above criteria. PAs are authorized to furnish physician services under their State scope of practice, under the general supervision of a physician; therefore the regulations at 42 CFR 410.150(a)(15) require that payment for PA services may be made to the employer or contractor of a PA.

Payment for physician assistant services is made at 85 percent of the physician fee schedule amount. Services that are duplicative of what the hospice nurse would provide are not separately billable.

Since PAs are not physicians, as defined in 1861(r)(1) of the Act, they may not act as medical directors or physicians of the hospice or certify the beneficiary’s terminal illness and hospices may not contract with a PA for their attending physician services as described in section 1861(dd)(2)(B)(i)(III) of the Act, which outlines the requirements of the interdisciplinary group as including at least one physician, employed by or under contract with the agency or organization. All of these provisions apply to PAs without regard to whether they are hospice employees.

Physician assistants cannot certify or re-certify an individual as terminally ill, meaning that the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course. In the event that a beneficiary’s attending physician is a nurse practitioner or a physician assistant, the hospice medical director or the physician member of the hospice IDG certifies the individual as terminally ill.

The hospice face-to-face encounter must be performed by a hospice physician or hospice nurse practitioner. PAs may not perform the face-to-face encounter.

You asked... We answered regarding universal source control, relaxing of restrictions and testing

You Asked:

The Centers for Disease Control and Prevention (CDC) webpage has information on both the COVID-19 county level and community transmission level. Which one should I be following to determine universal source control, relaxing of restrictions, and testing? 

We Answered:

The CDC recommends use of COVID-19 Community Levels to determine the impact of COVID-19 on communities and take action. Community Transmission levels are provided for healthcare facility use only. Healthcare facilities need to monitor the community transmission levels on the CDC COVID Data Tracker webpage. The webpage begins with the COVID-19 Integrated County View. Healthcare facilities need to scroll further down on the webpage then select Ohio in the drop down. The data-type drop down should be set to community transmission.

Healthcare settings should use the CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic guidance for relaxing of restrictions of distancing and masking when the community transmission levels are moderate to low. When the community transmission level increases to substantial to high, healthcare facilities should implement universal source control of eye protection in addition to masking. Facility policies should define the frequency of how often they will monitor this webpage and adjust source control measures and operational practices accordingly. Nursing homes are to conduct routine staff testing according to the community transmission levels outlined in the CMS QSO-20-38-NH memo.

LeadingAge Ohio encourages members to explain to stakeholders the difference between the community guidance and the guidance for healthcare settings. A best practice is to have a routine update for staff to keep them abreast of the changing community transmission levels and reminders of how universal source control changes as the community level changes to high and substantial levels. We encourage members to continue to submit questions to COVID19@leadingageohio.org.

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features Hospice CAHPS survey data submission deadline.

CMS stakeholder call: Wednesday, May 11 at 11:00AM

On April 7, the Centers for Medicare & Medicaid Services (CMS) released a national policy for coverage of aducanumab (brand name Aduhelm™) and any future monoclonal antibodies directed against amyloid approved by the FDA with an indication for use in treating Alzheimer’s disease. From the onset, CMS ran a transparent, evidence-based process that incorporated more than 10,000 stakeholder comments and more than 250 peer-reviewed documents into the determination.

As a part of CMS’ continued commitment to engage stakeholders on an ongoing basis, CMS will hold a national stakeholder call on May 11 at 11:00AM to review the recent finalized coverage decision on monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s Disease. CMS will review the overall coverage process, the finalized decision, and address questions as time allows.  

To RSVP for this call, please click here. After registering, you will receive a confirmation email containing information about joining the webinar.

Medicare Quality Improvement Organization Appeals Overview for Healthcare Provider Webinar: May 25

Medicare patients and their caregivers have the legal right to challenge a Hospice, home health or skilled nursing facility discharge notice or other notice that Medicare-covered services are being terminated. As a Medicare Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO), Livanta receives thousands of appeals each year from patients or their caregivers when they are faced with a transition to a lower level of care that they believe is not appropriate or when they believe their medical condition is not stable enough to be discharged.

Presenters discuss appeal rights in detail and describe what patients, families and providers can expect when they call Livanta and begin the case review process.

Who will benefit from this webinar:

• Home Health and Hospice providers,
• SNF administrators,
• Directors
• Clinical Managers
• QAPI professionals

For additional information and/or to register, please click here.

CMS updates home health medicare billing manual

Last month, the Centers for Medicare & Medicaid Services (CMS) updated the home health billing manual to reflect changes to eliminate the Request for Anticipated Payment and add the Notice of Admissions process. In the original MLN article noting the changes and transition, concerns were raised regarding the Definition of Allowed Practitioner, particularly paraphrasing regulations for advance practice nurse collaboration with physicians. CMS released an updated MLN and edits to the home health billing manual to clarify the definition of allowed practitioners.

2 new HHVBP resources focused on Quality Measures & Improvement

To support home health agencies (HHAs) participating in the expanded Home Health Value Vased Purchasing (HHVBP) Model, the HHVBP TA Team produced two expanded Model resources focused on quality measures and quality improvement. The on-demand video, Quality Measures Used in the Expanded HHVBP Model, provides measure-specific information on each of the quality measures included in the expanded Model.

The accompanying written resource, How to use Existing Quality Assurance and Performance Improvement (QAPI) Processes to Support Improvement in Expanded Home Health Value-Based Purchasing (HHVBP) Model, provides a practical and visual guide to the quality improvement cycle as it relates to the expanded HHVBP Model and overall quality improvement efforts. This resource also highlights data and reports currently available to HHAs in iQIES and on the Care Compare website.

Both resources are designed to support HHAs as they prepare for the first performance year, calendar year 2023, of the expanded HHVBP Model. These resources, and others, are now available on the Expanded HHVBP Model webpage.

For questions, please email the HHVBP Model Help Desk at HHVBPquestions@lewin.com.

MLN updates VBID Hospice Benefit Component billing information

MLN released an article for hospices and others billing Medicare Administrative Contractors (MACs) for services they provide to Medicare hospice patients enrolled in Medicare Advantage (MA) plans participating in the voluntary Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component. The article links to several updated manuals which clarify billing for the VBID hospice model in preparation for CY 2023. As a reminder, Medicare will deny payment for claims with dates of service during a hospice election (with a hospice election start date on or after January 1, 2021 through December 31, 2024) for services provided to a patient enrolled in an participating VBID Model’s Hospice Benefit Component MA plan. Regardless of plan participation dates, hospices must still submit claims for these services to Medicare through their MAC. If a beneficiary is not enrolled in a participating VBID Hospice MA plan, Medicare fee-for-service will become financially responsible for most services, with the MA plan supporting any supplemental benefits.

Home health U537F NOA error solved

LeadingAge has shared before that Medicare Administrative Contractors (MACs) have identified an issue where U537F is assigning incorrectly on some notices of admission (NOAs), due to the Common Working File (CWF) not correctly recognizing discharges (patient status other than 30 on the last HH period). The CWF maintainer has developed a fix for this issue. Effective April 25, providers can resubmit any home health NOAs (32A) that have returned to provider incorrectly and are advised to bill the KX modifier on the final HH period of care claim(s) affected by the late NOA. The claim(s) should also include Remarks to request an exception to the late-filing penalty. These remarks can be similar to ‘Late NOA due to System Problem 34567.’

Palmetto question report

The Hospice Coalition will be meeting via telecommunications with Palmetto representatives on June 9. Please route this request for questions to the individuals in your hospice agencies who deal with Palmetto routinely to see if they have any questions they would like us to raise during the meeting. Please submit questions by Friday, May 13.  

You may submit questions any time they occur to you by emailing Jeff Lycan at jlycan@nhcooperative.org and they will be added to the list for the next quarterly meeting.

Help Your Board Hit the Governance Bullseye, webinar series: Starts June 7

LeadingAge Ohio and HJ Sims invite you to join this webinar series with your board members as HJ Sims provides a series of comprehensive virtual content geared directly toward the governance of senior living providers. The series will benefit all leaders within our field, especially board members, leadership teams and those new to these roles. Participants will walk away with a clear understanding of the role and responsibilities of boards, how to think through affiliations, acquisitions and other partnerships, and other challenges in this volatile, post-COVID era. 

Each session will tap the intellectual capital of industry experts from governance, law, finance, development, and strategic planning. Invite your board members and plan to attend the entire series for maximum impact.

Webinars will be held every Tuesday in June and can be registered for individually by clicking on the date below, or select the full series option available in the June 7 date:

• June 7- Session 1 - Role of the Board
• June 14 - Session 2 - Legal Responsibilities of Boards
• June 21 - Session 3 - A Board's Role in Mergers and Acquisitions, Strategic Affiliations and Sponsorship Transitions
• June 28 - Session 4 - Governing During Challenging Times

Who Should Attend:

• Board Members
• Leadership
• Leadership Team Members

ODM shares MITS “dark” days

The Ohio Department of Medicaid (ODM) announced that its Medicaid Information Technology Sytem (MITS) will experience "dark days" beginning June 23 through July 1. All claims submitted by a billing/trading partner during this time period will be held and processed after July 1 and will be processed in the new OMES system. Facilities should be aware that if claims are billed during that time period, reimbursement will be delayed. Facilities that also use a trading partner to complete their billing will need to make sure the trading partner is ready for this transition.

At this point, ODM is uncertain whether a facility can manually enter a claim in the MITS system during the time window. ODM continues to work with its partners, but wanted to notify providers well in advance of the dates, so that they can plan for the delays. More information will be forthcoming from ODM as we near the transition window.

LeadingAge Ohio PAC Brew Tour: Thursdays in June

*Non-profit organizations should not forward this email as it deals with political action committee (PAC) business.

The LeadingAge Ohio PAC will host fundraising events at three of Ohio’s premier breweries for its first-ever Summer PAC Brew Tour! These fundraising receptions will take place on Thursdays in June with three options to choose from - Cleveland at Great Lakes Brewing Company (June 16), Cincinnati at Sonder Brewing (June 23), and Columbus at North High Brewing Company (June 30). Legislators will be invited to attend as guests. Enjoy some great beer, great food, and support the PAC while networking with your colleagues! 

Organizations interested in sponsorship should contact Corey Markham at cmarkham@leadingageohio.org.  

Cleveland - Great Lakes Brewing Company
Thursday, June 16, 2022
2516 Market Ave
Cleveland, OH 44113
5:00-7:00PM
Register online here

Cincinnati - Sonder Brewing
Thursday, June 23, 2022
8584 Duke Blvd
Mason, OH
5:00-7:00PM
Register online here

Columbus - North High Brewing Company
Thursday, June 30, 2022
56 N High St
Dublin, OH 43017
5:00-7:00PM
Register online here

What the Media Said about end of life care this week – May 10, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding hospice CAHPS quality scores
  
• LeadingAge Ohio all-member call: Today at 11:30AM
• LeadingAge home health and hospice recap
• National stakeholder call with CMS administrator: Today at 3:30PM
  
• CMS Open Door Forum recap
• Preview reports and star rating preview reports for the July 2022 refresh now available in iQIES
• OTC COVID-19 at-home testing billing guidance
• Medicare Cost Report E-Filing system: Interim rate and settlement documentation webinar
• LeadingAge Ohio PAC events announced
• Ready to connect with your peers at the 2022 Annual Conference?
• Workforce Director begins full-time work this week
  
• What the Media Said about end of life care this week – April 26, 2022

You asked... We answered regarding hospice CAHPS quality scores

You Asked:

Our hospice manager reached out to our Strategic Healthcare Programs (SHP) rep who holds the caregiver satisfaction surveys for our hospice to see if there was anything we could do to help improve our Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. The hospice team suggested leaving a note in the admit packet stating the possibility of a survey coming their way and the why’s behind it. The SHP representative’s reply to this proposed strategy was, “You cannot discuss any of the questions on the survey or encourage them to fill out the survey in any capacity”. Can you provide guidance on navigating this if we want to improve our quality scores?

We Answered:

There are guidelines regarding hospice CAHPS surveys detailing what hospices can and cannot communicate with their patients and those guidelines can be found in the CAHPS Hospice Survey Quality Assurance Guidelines. Letting families know they may be receiving a survey is allowed. Please see an excerpt from the guidelines below.

Communicating with Patients and/or Their Caregivers about the CAHPS Hospice Survey CAHPS Hospice Survey guidelines allow hospices to communicate about the CAHPS Hospice Survey with patients and/or their caregivers prior to administration of the survey. For example, hospices may inform caregivers during the hospice admission process that they may receive the CAHPS Hospice Survey. If a hospice wants to let caregivers know that they may receive a survey and encourage them to complete it, the hospice must inform all caregivers.

Certain types of communications are not permitted because they may introduce bias in the survey results. For instance, hospices/survey vendors are not allowed to:

• Ask any CAHPS Hospice Survey or CAHPS Hospice Survey-like questions of caregivers prior to administration of the survey
• Attempt to influence or encourage caregivers to answer CAHPS Hospice Survey questions in a particular way
• Imply that the hospice, its personnel, or agents will be rewarded or gain benefits for positive feedback from caregivers by asking caregivers to choose certain responses, or indicate that the hospice is hoping for a given response, such as a “10,” “Definitely yes” or an “Always”
• Indicate that the hospice’s goal is for all caregivers to rate them as a “10,” “Definitely yes,” or an “Always”
• Offer incentives of any kind for participation in the survey
• Invite or ask the caregiver if they want to participate in a survey or suggest they can “opt out” of the survey
• Show or provide the CAHPS Hospice Survey or cover letters to caregivers while they are in the hospice or at any time prior to the administration of the survey
• Mail or distribute any pre-notification letters or postcards after patient death to inform caregivers about the CAHPS Hospice Survey Note:
  • Hospices may not contact caregivers directly regarding survey responses.

LeadingAge Ohio all-member call: Today at 11:30AM

Join LeadingAge Ohio staff, along with Dana Ullom-Vucelich and Kristen Collins from Ohio Living, today at 11:30AM for the next all-member call, which will feature a robust discussion of retention strategies. Workforce continues to be the top concern among LeadingAge Ohio members, and has fostered other challenges like lagging census and survey citations across provider types. The Centers for Medicare & Medicaid Services (CMS) have signaled their concern, with turnover measures being added to the Care Compare measures beginning in July.

Dana and Kristen will discuss how Ohio Living has maintained a low turnover rate percentage across their organization, whether on their campuses or in home health and hospice operations, offering strategies that other members may employ in their own practices.  

The call is free to members but registration in advance is required. To have your question answered on the call, email it to COVID19@leadingageohio.org.

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features information on the upcoming CMS HCBS webinar.

National stakeholder call with CMS administrator: Today at 3:30PM

Please join the Administrator of the Centers for Medicare & Medicaid Services (CMS), Chiquita Brooks-LaSure, and her leadership team, who will provide updates on the CMS Strategic Vision and key accomplishments during the first quarter of 2022 today at 3:30PM. The Administrator’s vision is for CMS to serve the public as a trusted partner and steward dedicated to advancing health equity, expanding coverage, and improving health outcomes as we engage the communities we serve throughout the policymaking and implementation process. Members are invite to join for this third national stakeholder call to learn more! 

Speakers:  

• CMS Administrator, Chiquita Brooks-LaSure
• Principal Deputy Administrator and Chief Operating Officer, Jon Blum
• CMS Leadership Team 

To RSVP for today's call, please click here.

After registering, you will receive a confirmation email containing information about joining the call. Please note that when you click the link to join the call later today, you will see a message stating that the host will allow you to join the event momentarily. Please continue to wait at that screen until the CMS team begins the call.

CMS Open Door Forum recap

On the April 20 Centers for Medicare & Medicaid Services (CMS) Home Health, Hospice, and DME (Durable Medicare Equipment) Open Door Forum (ODF), the following information and updates were provided:

HOSPICE

FY2023 Hospice Proposed Rule

CMS provided a brief update of the proposed payment rate update (2.7%), wage index changes, and other aspects of the recently released FY2023 hospice proposed rule. 

Hospice Quality Reporting Program

CMS reminded hospices that the FY2024 annual payment update is based on the CY2022 data submissions.  Hospices must comply with the following HIS and Hospice CAHPS Survey participation requirements to avoid the APU penalty which increases to 4% in FY2024.

• Submit at least 90% of HIS records within the 30 days of the event date (patient’s admission or discharge) for patient admissions/discharges occurring 1/1/22 – 12/31/22
• Ongoing monthly participation in the CAHPS Hospice Survey 1/1/22 – 12/31/22
• Hospice Care Index (HCI), and
• Hospice Visits in Last Days of Life (HVLDL)

Public reporting of the new claims-based measures will occur with the May 2022 refresh of Care Compare. The Provider Preview Reports for this refresh were made available to hospices in their CASPER folders in March. Hospices should note that the Preview Reports drop off their CASPER folder after 60 days; therefore, hospices are encouraged to download and save or print these reports for future reference. CAHPS Hospice Survey Star Rating will be reported in August 2022. It will NOT be reported with the May Care Compare refresh.

HOME HEALTH

OASIS Updates

The quarterly OASIS Q&As are now available here.

The draft OASIS-E guidance manual and OASIS-E data specifications are expected to be posted early summer.

Public Reporting

Preview Reports and Star Rating Preview Reports for the July 2022 Care Compare refresh are available in iQIES. Instructions for accessing the reports can be found under the March 25, 2022 update here, and any questions about access should be directed to the iQIES Help Desk by phone at (800) 339-9313 or by email at iQIES@cms.hhs.gov.

CMS also reminded home health agencies that it had previously identified an issue in the iQIES system that may have affected HHA’s Services Provided values that are displayed on the HHA Provider Preview reports that were distributed in iQIES on 02/23/2022. CMS asked HHAs to review the Services Provided Information on the HHA Provider Preview Reports for the April 2022 refresh and contact their OASIS Education Coordinator (OEC) or OASIS Automation Coordinator, should inaccuracies be identified. The process to collect and maintain the Services Provided information recently migrated into iQIES and CMS is addressing the issues identified. To allow time to complete the identified changes, CMS decided for the April 2022 refresh, to publish the same Services Provided data for each Home Health Agency that was posted on Care Compare for the January 2022 refresh. CMS is still urging HHA providers to carefully review the Services Provided data within the Preview Reports release on 2/23/2022. If the values are incorrect for your agency, please contact your State Automation or State OEC and request an update of your Services Provided data in iQIES. Should you have questions, please contact the iQIES Help Desk by phone at (800) 339-9313 or by email at iQIES@cms.hhs.gov. CMS continues to work to refine and rectify the update process moving forward.

Home Health CAHPS

CMS shared that the recording of the CAHPS Update Training conducted at the end of January 2022 is available. The agenda for the training and the slides are available for download here, and the full recording of the training can be obtained by sending an email requesting it to hhcahps@rti.org.

The CY2024 annual payment update (APU) period began on April 1, 2022. Home health agencies are required to provide data for April 2022 through March 2023 to meet compliance requirements and avoid the APU penalty. Those providers that believe they are exempt from CAHPS because they are a small agency, specifically having had 59 or fewer patients from the period of April 2021 through March 2022, need to complete the Participation Exemption Request Form for the annual payment update for calendar year 2024.

The HHCAHPS Coordination Team Quarterly Review newsletter is now available.

Home Health Value Based Purchasing Expansion Update

The April 2022 Expanded Home Health Value Based Purchasing Model newsletter is now available. Education materials will be located on the expanded model webpage and some items will be located in iQIES. Benchmark and achievement thresholds are expected to be posted in iQIES in mid-May. Providers should expect a Guide to be posted and updated materials for two composite measures and podcasts and videos related to home health in general to be posted. A sample interim performance report and final report will be available in iQIES with a webinar to be held in August to discuss the reports. CMS encouraged providers to sign up for newsletters via the Model’s webpage to know when these materials are available. Questions can be submitted to the Help Desk at  HHVBPquestions@lewin.com.

Preview reports and star rating preview reports for the July 2022 refresh now available in iQIES

For this refresh, Home Health (HH) Outcome and Assessment Information Set (OASIS) will be based on the standard number of quarters. This refresh resumes the reporting of all claims-based measures for the Home Health Quality Reporting Program (QRP). Due to the COVID-19 reporting exceptions, the claims-based measures have been calculated excluding Q1 and Q2 2020 data from measure calculations. For additional information, please see the Home Health QRP COVID-19 Public Reporting Tip Sheet in the downloads section of the Home Health Quality Reporting Training webpage and the Home Health Data Submission Deadlines webpage.

For additional information, please see the HH QRP COVID-19 Public Reporting Tip Sheet in the downloads section of the HH Quality Reporting Training webpage and the Home Health Data Submission Deadlines webpage.

OTC COVID-19 at-home testing billing guidance

Effective January 15, 2022, CareSource, in alignment with Centers for Medicare & Medicaid Services (CMS) guidance, began covering FDA-authorized over-the-counter (OTC) at-home COVID-19 diagnostic tests without a prescription and with no member cost sharing. As a measure to eliminate barriers to COVID-19 testing, the FDA-authorized OTC at-home COVID19 diagnostic tests are now covered without a prescription and no member cost share, with a limit of 8 individual tests per 30 days, in accordance with federal guidance.

Medicare Cost Report E-Filing system: Interim rate and settlement documentation webinar

If you’re a Medicare Part A provider or organization that files cost reports, you can attend this CMS webinar today at 1:00PM to learn about new functionality in the Medicare Cost Report E-Filing (MCReF) system:

• View and download interim rate review, tentative settlement, and final or reopening settlement documentation completed by your Medicare Administrative Contractor
• Submit individual or bulk (chain providers) Medicare Part A cost reports for fiscal years ending on or after December 31, 2017
• Track the status of Medicare Part A cost reports with fiscal years ending after December 31, 2009

Send questions in advance to OFMDPAOQuestions@cms.hhs.gov with “MCReF Webinar” in the subject line. We’ll answer your questions during the webinar or use them to develop educational materials.

More Information is available in this MLN article or you can visit the MCRef webpage by clicking here.

LeadingAge Ohio PAC events announced

The LeadingAge Ohio PAC once again broke its previous year’s fundraising record in 2021 by raising over $32,000 thanks to the generous support of our committed members. This year, the PAC will once again focus on reaching new heights and building momentum with exciting events throughout the year, including its first ever Brew Tour and the return of the Golf Outing. To learn more about the PAC, visit the PAC webpage here. All proceeds for the events below support the LeadingAge Ohio PAC, so make sure to pay via personal, partnership, or LLC funds (no corporate payments).

2022 Summer Brew Tour:

The LeadingAge Ohio PAC will host events at three of Ohio’s premier breweries for its first-ever Summer PAC Brew Tour! These fundraising receptions will take place on Thursdays in June with three options to choose from across the state. Legislators will be invited to attend as guests. 

Cleveland - Great Lakes Brewing Company
Thursday, June 16, 2022
2516 Market Ave
Cleveland, OH 44113
5:00-7:00PM
Register online here

Cincinnati - Sonder Brewing
Thursday, June 23, 2022
8584 Duke Blvd
Mason, OH
5:00-7:00PM
Register online here

Columbus - North High Brewing Company
Thursday, June 30, 2022
56 N High St
Dublin, OH 43017
5:00-7:00PM
Register online here

2022 PAC Golf Outing

The LeadingAge Ohio PAC Golf Outing will also return in 2022. Join LeadingAge Ohio members, partners, and guests at the Golf Club of Dublin on Monday, October 3 to enjoy a day of golf at a beautiful club, support the PAC, and win some prizes! The outing will be a scramble with a shotgun start at 10:00AM. Sponsorships are available. Learn more and register online here.

Ready to connect with your peers at the 2022 Annual Conference?

Join LeadingAge Ohio August 30-September 1, 2022 at the Hilton Columbus at Easton for the LeadingAge Ohio Annual Conference and Trade Show! We are excited to announce this year’s theme: Momentum! Momentum is what propels our field forward. When harnessed, it can spread quickly. Our world has changed. Our field has changed. Now we need to build on what we have accomplished to prepare for what lies ahead.

Hotel registration for this year's conference is now open through the LeadingAge Ohio 2022 Annual Conference and Trade Show website.

Interested in sponsoring this event and supporting Ohio’s voice for aging services, LeadingAge Ohio? Please contact Corey Markham at 614-545-9015 or cmarkham@leadingageohio.org for information on becoming a Sponsor!

Workforce Director begins full-time work this week

As you may have seen in The Source a few weeks ago, LeadingAge Ohio welcomed Randi Hamill as Workforce Director. Randi began full-time work for LeadingAge Ohio yesterday. She comes to LeadingAge Ohio having worked several years in adult protective services in North Carolina, where she supported clients across the continuum including in facility settings. Here in Ohio she’s worked with the Age Friendly Innovation Center at the Ohio State University while earning her Master’s in Social Work, supporting the development and evaluation of their Age Friendly Scholars program. At LeadingAge Ohio, Randi will focus on developing and implementing programs that help LeadingAge Ohio members address the breadth of their workforce needs. You can welcome Randi or reach out to discuss the workforce issues most pressing to your organization by emailing her at rhamill@leadingageohio.org.

What the Media Said about end of life care this week – April 26, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding masking of staff in non-patient care areas
  
• LeadingAge home health and hospice recap
• LeadingAge Ohio Awards nomination deadline extended until Wednesday, April 20
• DNR “Fix” bill signed by the Governor
• ARPA HCBS Provider Relief Payments
• Next Home Health, Hospice & DME Open Door Forum: April 20
• Home health quality update
• Eligible patients can receive free second COVID booster
• Hospice PEPPER available for download
• Ready to connect with your peers at the 2022 Annual Conference?
• Wait, what? Email spoofing and how to protect yourself
• What the Media Said about end of life care this week – April 12, 2022

You asked... We answered regarding masking of staff in non-patient care areas

You Asked:

All our home health and hospice staff are either fully vaccinated or have an exemption. It was our understanding that if the staff were fully vaccinated, they were allowed to not mask in non-patient care areas of our office. It seems that the CDC has come out with some new terminology and guidance related to "up to date" vaccine status, which means not only being fully vaccinated, but also having one booster. The latest CDC guidance for health care professionals who are up to date with all recommended COVID-19 vaccine doses is, they can choose not to wear source control or physically distance when they are in well-defined areas that are restricted from patient access (e.g., staff meeting rooms, kitchens, etc.) What about staff who are fully vaccinated but don’t have any boosters? 

We Answered:

LeadingAge Ohio reached out to the Ohio Department of Health (ODH) to ask when home health and hospice agencies are surveyed, what is the surveyor looking for related to source control/masking for fully vaccinated individuals in non-patient care areas of their office. ODH’s response was:

On survey, we are not looking at related masking of staff in non-patient care areas, we are only looking at source control/masking in patient care areas. 

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features information on Wednesday's LeadingAge Coronavirus call and inpatient hospice 1134 waivers ending.

LeadingAge Ohio Awards nomination deadline extended until Wednesday, April 20

Did you miss the awards nomination deadline? Are you still interested in nominating a colleague for one of the 2022 award categories and honoring them at the LeadingAge Ohio Annual Conference & Trade Show this summer?

Fear not - the deadline has been extended until Wednesday, April 20. 

The LeadingAge Ohio Awards Program celebrates exemplary work of the individuals and organizations within our membership on an annual basis. COVID’s relentless impact makes honoring innovations by staff and volunteers more important than ever. Check out the 2021 award tributes here.

Nominations for this year’s awards are open and include nine different categories. With many opportunities to recognize staff and volunteers, please spread the word about the Awards Program to get the nomination process started. The application period will now close on Wednesday, April 20. 

Visit the Annual Awards webpage on the LeadingAge Ohio website under the About header within the Recognition & Awards section to access the award descriptions/nomination forms by category.

Questions regarding the annual Awards Program can be directed to Patrick Schwartz, Director of Strategic Communications, pschwartz@leadingageohio.org.

DNR “Fix” bill signed by the Governor

Last Wednesday afternoon, Governor DeWine signed HB 138 into law. HB 138 included numerous changes to the laws governing emergency medical technicians (EMTs), including a long-awaited “fix” which would allow EMTs to follow Do Not Resuscitate (DNR) orders signed by nurse practitioners and physician assistants. The legislation will be effective 90 days following signing, or July 5. At this point, LeadingAge Ohio does not anticipate additional rule revisions will be required to further codify the change. 

Questions regarding the change may be sent to Anne Shelley at ashelley@leadingageohio.org or Susan Wallace at swallace@leadingageohio.org.

ARPA HCBS Provider Relief Payments

The Ohio Department of Medicaid (ODM) announced that it has received approval from the Centers for Medicare and Medicaid Services (CMS) for the managed care portion of provider relief payments as appropriated by the Ohio General Assembly in H.B. 169. This latest approval impacts the following categories:

• MyCare
• Hospice
• Home Health
• Community behavioral health
• Non-institutional durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)
  

This portion of payments does not require an Executive Order or an emergency rule. 

For reference: The distribution methodology for these payments is as follows:

• MyCare: Payment is equal to approximately 10% of paid claims, using claim period from November 1, 2020, through October 31, 2021, as the basis, and distributed to providers as a lump sum.
• Hospice: Payment is equal to approximately 10% of paid claims, using claim period from July 1, 2020, through June 30, 2021, as the basis, and distributed to providers as a lump sum.
• Home Health: Payment is equal to approximately 10% of paid claims, using claim period from July 1, 2020, through June 30, 2021, as the basis, and distributed to providers as a lump sum.
• Community Behavioral Health: Payment is equal to approximately 10% of paid claims, using claim period from July 1, 2020, through June 30, 2021, as the basis, and distributed to providers as a lump sum.
• Non-institutional DMEPOS: Payment is equal to approximately 10% of paid claims, using claim period from July 1, 2020, through June 30, 2021, as the basis, and distributed to providers as a lump sum.
  

Unlike previous payments, the Medicaid managed care plans will process these payments directly to providers. ODM is working with them to distribute these funds as quickly as possible. 

Please Note: Providers will almost certainly receive multiple checks from multiple plans.   

ODM also introduced a dashboard tool that allows providers to enter their Medicaid billing ID and view ALL payments that will be dispersed to them from FFS, Managed Care, and MyCare per H.B. 169. The dashboard details all categories of provider relief from H.B. 169 (ARPA HCBS and non-ARPA/GRF funds) EXCEPT for Assisted living (RCFs), PACE, and DODD waiver providers. Providers can access the tableau through the ARPA HCBS page of our website by clicking the LAUNCH button located in this link. 

VERY IMPORTANT - PLEASE NOTE:

• The managed care preprint relief payment is calculated as 10% of claims, however the amount providers will receive with this first payment is 50% of the total.
• This was required by CMS in order to avoid a situation where a provider may be “overpaid”.
• At the end of calendar year (CY) 2022, ODM will reconcile a provider’s total claims to actual CY22 claims experience and a final relief payment will be calculated.
• There is no action required on the part of the provider during this reconciliation process.
• ODM will work with the plans at the end of the year on this final installment of relief.
• ODM will send out an announcement when the final installments are prepared, and post the final amount of payment to the dashboard.
  

ODM recognizes the complexity of the provider relief payment disbursement, and acknowledges that it has been a confusing process for providers. Community provider relief payments are contained in Ohio’s American Rescue Plan Act Home- and Community-Based Services (ARPA HCBS) plan, which can be found here. 

For questions about any of these provider payments, please email ProviderReliefInquiries@medicaid.ohio.gov.

Next Home Health, Hospice & DME Open Door Forum: April 20

The next Home Health, Hospice & DME Open Door Forum is scheduled for April 20 from 2:00-3:00PM.

The agenda will include:

• Announcements & Updates
  • Rulemaking: Updates on the FY 2023 Hospice Proposed Rule
  • New Resources available for the HQRP
  • Public Reporting: (May 2022 refresh updates)
  • OASIS
  • Public Reporting (updates on the Interim QAO Performance Reports and the April and July refresh)
  • http://homehealthcahps.org and email for questions about HHCAHPS to hhcahps@rti.org 
• FY 2023 Hospice Proposed Rule
• Hospice
• Home Health
• Home Health Services information on Care Compare
• Home Health CAHPS Survey Update
• Open Q&A

The call will be offered via conference call only. To participate by phone, dial 1-888-455-1397 and use passcode 5109694.

Home health quality update

Many health agencies have experienced problems in the iQIES system that affected how Services Provided values for their agencies were displayed on the HHA Provider Preview reports distributed in February and on Care Compare. The Center for Medicare & Medicaid Services (CMS) recently released a notice about the systems transition that may affect home health agency demographic data.  Specifically, CMS indicated that while it is transitioning to the Provider Enrollment, Chain and Ownership System (PECOS) system as the source for agency demographic data, a final date when all demographic data will be obtained from PECOS has not been identified.

During this transition, all home health agencies are responsible to ensure their latest demographic data are updated and available in both iQIES and PECOS systems. A referencing document that outlines the steps home health agencies should follow can be accessed in the Downloads section of the How to Update Home Health Demographic Data page. Should you have questions regarding this updated process, please contact the iQIES help desk by email at iQIES@cms.hhs.gov or by phone at (800) 339-9313.

CMS also recently posted an announcement that the Preview Reports and Star Rating Preview Reports for the July 2022 Refresh are available. However, home health agencies are not seeing the reports in their iQIES folders. It appears that the announcement was made in error and the reports are not yet available.  The reports are due out this month and LeadingAge Ohio will let members know when they are available.

Eligible patients can receive free second COVID booster

On April 6, the Center for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine, and there is no applicable copayment, coinsurance, or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.

The CDC recently updated its recommendations regarding COVID-19 vaccinations. Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least 4 months ago are eligible for another booster to increase their protection against severe disease from COVID-19. Additionally, the CDC recommends that adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago can receive a second booster dose of a Pfizer-BioNTech or Moderna COVID-19 vaccine.

The COVID-19 vaccine, including the booster doses, is the best defense against severe illness, hospitalization, and death from the virus. CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations. More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available by clicking here and through the CMS COVID-19 Provider Toolkit.

People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

Hospice PEPPER available for download

The annual Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for download. PEPPER is a data report that contains a single hospice’s claims data statistics (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC)) for areas targeted by CMS as being at risk for improper Medicare payment.

Each hospice receives a PEPPER, which contains statistics for these target areas, regardless of whether the hospice’s data are of concern. The report shows how a hospice’s data compares to national, MAC jurisdiction and state statistics for the three most recent years.

Hospices can use the PEPPER to see how they compare to others in each of these target areas. The PEPPER also includes suggested interventions that hospices could consider when assessing their risk for each of the target areas.

The target areas for this year’s pepper are:

• Live Discharges No Longer Terminally Ill
• Live Discharges – Revocations
• Live Discharges LOS 61 – 179 Days
• Long Length of Stay
• Continuous Home Care Provided in an Assisted Living Facility
• Routine Home Care in Assisted Living Facility
• Routine Home Care in Nursing Facility
• Routine Home Care in Skilled Nursing Facility
• Claims with Single Diagnosis Coded
• No General Inpatient Care or Continuous Home Care
• Long General Inpatient Stay

NEW target areas this year:

• Average Number of Medicare Part D Claims for Beneficiaries Residing at Home
• Average Number of Medicare Part D Claims for Beneficiaries Residing in an Assisted Living Facility
• Average Number of Medicare Part D Claims for Beneficiaries Residing in a Nursing Facility

The PEPPER must be downloaded by each hospice.  It will not be mailed.  It is available electronically at the PEPPER Resources Portal.  An updated PEPPER User’s Manual is available at www.PEPPERResources.org under the Hospices tab.

RELI Group, the PEPPER contractor for the Centers for Medicare & Medicaid Services (CMS), will hold a webinar on Tuesday, May 17 from 3:00-4:00PM that will include the history/background of PEPPER, a high-level review of the target areas, a walk-through of a sample PEPPER, and guidance for accessing the PEPPER. Registration is required.

Ready to connect with your peers at the 2022 Annual Conference?

Join LeadingAge Ohio August 30-September 1, 2022 at the Hilton Columbus at Easton for the LeadingAge Ohio Annual Conference and Trade Show! We are excited to announce this year’s theme: Momentum! Momentum is what propels our field forward. When harnessed, it can spread quickly. Our world has changed. Our field has changed. Now we need to build on what we have accomplished to prepare for what lies ahead.

Hotel registration for this year's conference is now open through the LeadingAge Ohio 2022 Annual Conference and Trade Show website.

Interested in sponsoring this event and supporting Ohio’s voice for aging services, LeadingAge Ohio? Please contact Corey Markham at 614-545-9015 or cmarkham@leadingageohio.org for information on becoming a Sponsor!

Wait, what? Email spoofing and how to protect yourself

With the increase of people becoming more reliant on working from home and using the internet, email spoofing is on the rise. Email spoofing is the act of sending emails with a forged sender address. It tricks the recipient into thinking that someone they know or trust sent them the email. Usually, it’s a tool of a phishing attack, designed to take over your online accounts, send malware, or steal funds.

Spoofed email messages are easy to make, but also easy to detect. Recently our own President and CEO, Susan Wallace had her email account spoofed. Those of us who receive emails from Susan on a regular basis noticed immediately that the writing style was not hers and the request was not one she traditionally makes, which raised a flag. A quick look at the sender information showed her name, but the email address attached to it was not a “LeadingAgeOhio.org” URL, thus easy to detect. 

If you receive a suspicious email from an employee, agency or even a friend, do not respond or open any attachment, contact your IT group or whoever in your organization that handles your email system. More information on email spoofing is available in this October 2021 article from CyberNews.com.

What the Media Said about end of life care this week – April 12, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• Brod passes the baton to Wallace
• You asked... We answered regarding transfer billing
  
• LeadingAge home health and hospice recap
• Preview Reports for the May 2022 refresh
• HB 169 Provider Relief Payments announced, includes funds to nursing homes and hospices
• Congress debates HCBS expansion, Improvement for Veterans
• Home Health CAHPS participation exemption request deadline
• CMS identifies issue with Provider Preview Reports
• MACPAC addresses HCBS workforce challenges
• COVID-19 Vaccine Boosters Communications Toolkit
• HCBS reduces costs for families and states
• CDC stretches vaccine intervals for males 12-39
• Leading Faithfully: Being present to the dying and those who love them
• What the Media Said about end of life care this week – March 29, 2022

Brod passes the baton to Wallace

Earlier this month, Susan Wallace assumed leadership of LeadingAge Ohio, succeeding Kathryn Brod who had served as the organization’s Chief Executive for nearly eight years. At a gathering of members and colleagues last week, each of LeadingAge Ohio’s previous board members shared words of gratitude for Brod, who came to LeadingAge Ohio after a long career serving non-profit aging services in various capacities. 

In written remarks, Rev. Ken Daniel, President/CEO of United Church Homes noted, “Kathryn has been the consummate leader who was the right person at the right moment in LeadingAge Ohio’s history.” Current LeadingAge Ohio Board Chair Allison Salopeck, President/CEO of Jennings, noted Brod was “the most selfless person I know,” and colleagues shared stories and gratitudes for Brod’s service to the organization, which included preparing her successor. 

Wallace now leads the organization, having served in association management for the past fifteen years, following a brief career as a hospice social worker. Wallace began at LeadingAge Ohio following eight years with the Midwest Care Alliance prior to its merger with LeadingAge Ohio in 2014 and has steered advocacy work for LeadingAge Ohio since 2019, serving as spokesperson and subject matter expert for Medicaid reimbursement and other policy issues. “I am so honored to be able to continue Kathryn’s legacy at LeadingAge Ohio,” remarked Wallace. “We have seen LeadingAge Ohio’s reputation and influence grow in recent years. Our members are known as collaborators and thought leaders in their communities. I look forward to helping our organization maintain that trajectory into the future, ensuring that Ohio continues to be a great place to age.”

You asked... We answered regarding transfer billing

You Asked:

Is it possible for a patient to transfer from one hospice to another over the course of two days if the patient is traveling several hours to the new hospice?  For example, the patient is leaving hospice A on a Monday, but does not arrive at the new hospice B until Tuesday. Can hospice A bill for the transfer on Monday and hospice B bill the transfer on Tuesday? I believe this situation has occurred in the past.

We Answered:

Currently, transfers are being allowed to process through the Common Working File (CWF) where the “from date” from the receiving hospice does not make the “to date” from the transferring hospice, resulting in a gap following the date of transfer. In these cases, it is deemed to be a gap in care and therefore would not be considered a continuous hospice election. The Centers for Medicare & Medicaid Services (CMS) issued Change Request 12619 and effective July 1, 2022 a new CWF edit will no longer allow a gap of care to occur during a transfer. The CWF edit will reject the hospice transfer if the transfer does not occur immediately and there is a gap in the number of billing days between one hospice and the next. If the receiving hospice’s claim “from date” is not the same as the transferring hospice’s “through date” with “patient status” indicating a transfer (code 50 or 51), the hospice transfer will be rejected. 

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features provider relief funds (PRF) reporting deadlines.

Preview Reports for the May 2022 refresh

Providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. These reports preview data that will be displayed on the Care Compare website in May 2022. For this refresh, two new Claims-based measures will be added for public reporting:

• Hospice Care Index (HCI)
• Hospice Visits in the Last Days of Life (HVLDL)

Hospice Item Set (HIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, and Claims-based measure scores exclude Quarter 1 and Quarter 2 of calendar year 2020. In addition, state averages will now be displayed for each measure.

Once released in CASPER, providers will have 30 days during which to review their quality measure results. Although the actual “preview period” is 30 days, the reports will continue to be available for another 30 days, or a total of 60 days. CMS encourages providers to download and save their Hospice Provider Preview Reports for future reference, as they will no longer be available in CASPER after this 60-day period.

Learn more about the Provider Preview Report (HIS and Claims-based measures) here and about the CAHPS Preview Report here. Hospice QRP Key Dates for Providers can be found here.

HB 169 Provider Relief Payments announced, includes funds to nursing homes and hospices

Last week, Governor DeWine signed an executive order for the Department of Medicaid (ODM) to issue provider relief funds approved by the Ohio General Assembly in H.B. 169 for home health, community behavioral health, and noninstitutional durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Also authorized were payments to nursing facilities, intermediate care facilities, and hospices. Hospices, along with other Medicaid providers, will receive a calculator 10% of their Medicaid service revenue (not including room & board payments) for the period from November 1, 2020 to October 31, 2021.

Centers for Medicaid & Medicaid Services (CMS) approval has been received and the emergency rules were filed March 23. 

These provider payments were processed Thursday, March 24 through Medicaid Information Technology System (MITS). Providers will receive the EFT payments approximately this Wednesday, with paper checks mailed afterwards. Providers will receive a separate remittance advice that includes the code “HB169COVIDPMT” to help identify the payments. As a reminder, these payments are based on fee-for-service (FFS) payments only. The calculation of these payments is equal to approximately 10% of paid claims, using claim period from July 1, 2020, through June 30, 2021, as the basis, and distributed to providers as a lump sum. 

CMS approvals that are still pending include services and equipment provided to individuals through managed care, including MyCare.   

ODM has developed a tool to assist providers to know how much they are receiving and from which payor:

ODM is pleased to announce a new tool that will be available to providers beginning early next week. It is a tableau dashboard that will allow providers to enter their Medicaid billing ID and view payments that will be dispersed to them from FFS, Managed Care, and MyCare per HB 169. This includes all the categories of provider relief from HB 169, ARPA HCBS and non-ARPA/GRF funds, EXCEPT for Assisted living (RCFs) and DODD waiver providers. Providers can access this tableau through the ARPA HCBS page of our website linked here. 

Ohio Medicaid appreciates the difficulty faced by providers and the individuals each serves. We continue to work closely with CMS and impress upon them the urgency in which to move these payments as quickly and efficiently as possible. 

Community provider relief payments are contained in Ohio’s American Rescue Plan Act Home- and Community-Based Services (ARPA HCBS) plan. Additional information about the Ohio plan can be found here. 

ODM declined to share with the associations the exact amounts each provider will receive, noting that since funds were based on their Medicaid revenue, doing so would reveal confidential information. 

ODM has previously noted that, once emergency rules are filed, payments should be delivered to providers via the MITS system within seven days. LeadingAge Ohio encourages members to reach out to Susan Wallace with any questions related to provider relief at swallace@leadingageohio.org.

Congress debates HCBS expansion, Improvement for Veterans

The Elizabeth Dole HCBS for Veterans and Caregivers Act, H.R. 6823 introduced in the U.S. House of Representatives earlier this month and would work to improve home and community-based services (HCBS) services for patients, their families, and their caregivers.

Specifically, this legislation would:

• Expand access to HCBS services for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.
• Raise the cap on how much the VA can pay for the cost of home care from 65% of the cost of nursing home care to 100%.
• Coordinate expanded VA home care programs with other VA programs.
• Establish a pilot project to address home health aide shortages.
• Providing respite care to caregivers of veterans enrolled in home care programs.
• Establish a “one stop shop” webpage to centralize information for families and veterans on programs available.
• Require the VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the Program of Comprehensive Assistance for Family Caregivers into any other home care program they may be eligible for.

Following the introduction of the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act, the House Committee on Veterans’ Affairs held a hearing on the bill, and several other pieces of legislation designed to improve the Veterans Administration (VA) and health care delivery for veterans.

In written testimony, Dr. Julianne Flynn, Acting Assistant Under Secretary for Health Care within the Veterans Health Administration offered support for numerous provisions included in H.R. 6823, in particular the increase of to 100% of what the VA can pay for home based on the cost of nursing home care. Likewise, the legislation received favorable comments from other members of the panel as well as testifying witnesses from the Elizabeth Dole Foundation and the Paralyzed Veterans of America.

Home Health CAHPS participation exemption request deadline

The deadline for home health agencies to submit a request for an exemption from participating in the Home Health CAHPS (HH CAHPS) Survey for the CY 2023 Annual Payment Update (APU) is March 31.

Medicare-certified home health agencies are eligible for an exemption if they served 59 or fewer survey eligible patients between April 1, 2020, and March 31, 2021. If your agency is exempt, you do not need to participate in the HHCAHPS data collection period, which runs from April 1, 2021 through March 31, 2022.

To be exempted from participating in the HH CAHPS Survey for the CY 2023 APU, HHAs must count the number of home health patients they served between April 1, 2020, and March 31, 2021, who meet HHCAHPS survey eligibility criteria and then report that count on the Participation Exemption Request Form. Please note, exemptions are active for one year only.

CMS identifies issue with Provider Preview Reports

The Centers for Medicare & Medicaid Services (CMS) had previously identified an issue in the iQIES system that may have affected your HHA’s Services Provided values that are displayed on the HHA Provider Preview reports that were distributed in iQIES on 02/23/2022. Moreover, CMS had previously asked HHAs to review the Services Provided Information on the HHA Provider Preview Reports for the April 2022 refresh and contact their OASIS Education Coordinator (OEC) or OASIS Automation Coordinator, should inaccuracies be identified. The process to collect and maintain the Services Provided information recently migrated into iQIES and we are addressing the issues identified.

To allow time to complete the identified changes, CMS has decided for the April 2022 refresh, to publish the same Services Provided data for each Home Health Agency that was posted on Care Compare for the January 2022 refresh. We believe that this will allow us to publish the most accurate Services Provided data at this time.

CMS is still urging HHA providers to carefully review the Services Provided data within the recently issued Preview Reports, however, would like to note that they are not attaching a deadline to this review. These reports were distributed in iQIES on 02/23/2022.  If the values are incorrect for your agency, please contact your State Automation or State OEC and request an update of your Services Provided data in iQIES.  Should you have questions, please contact the iQIES Help Desk by phone at (800) 339-9313 or by email at iQIES@cms.hhs.gov. CMS continues to work to refine and rectify the update process moving forward. 

For those experiencing issues locating your agency’s HHA Provider Preview Report, follow the steps outlined below:

New Users

1. Only active users with login credentials to iQIES as of the distribution date of the HHA Provider Preview reports for the April 2022 refresh will have the report in their HHA Provider Preview Report folder.
   
   a. If you are a new user of iQIES and received your iQIES login credentials after the February 23, 2022 distribution of the HHA Provider Preview reports, please contact the iQIES Help Desk for assistance (see iQIES Help Desk contact information below).
   
   b. Inform the help desk staff that you are a new user of iQIES since the HHA Provider Preview reports for the April 2022 refresh were made available. The iQIES help desk team will gather the necessary information from you including such things as your agency’s CMS Certification Number (CCN) and will then make the report for your agency available to you in the HHA Provider Preview Reports folder in iQIES.
   
   c. Follow the steps below to locate your agency’s report in the HHA Provider Preview Report folder.

Existing Users

1. If you were an active user prior to the February 23, 2022 distribution of the HHA Provider Preview Reports but you cannot locate your report, please follow the steps below:
   
   a. Log into iQIES by clicking here
   
   b. Select the My Reports option from the Reports menu
   
   c. From the My Reports page, locate the HHA Provider Preview Reports folder.
   
               i. NOTE: The folders and reports on the My Reports page are listed in alphabetic order so users may need to utilize the page forward functionality at the bottom of the webpage to advance to the page where the folder is located. Alternatively, users may change the default number of rows that display on the webpage from 10 to a larger number to view the larger list of items.
          
   d. Select the HHA Provider Preview Reports link to open the folder.
   
   e. To locate the latest HHA Provider Preview report, select the down arrow adjacent to the Created Date label at the top of the table. This will order the reports in the folder from newest to oldest.
   
   f. Select the report file with the following label: Preview of Home Health Agency Quality Measure Scores To Be Posted on Care Compare (April 2022)_Updated [provider’s CCN will display after the word Updated].
   
   g. Once the report is open, users will notice the Services Provided information displayed beneath their agency’s demographic information at the top of the report.

Should you have questions, please contact the iQIES Help Desk by phone at (800) 339-9313 or by email at iQIES@cms.hhs.gov.

MACPAC addresses HCBS workforce challenges

Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) released an issue brief, “State Efforts to Address Medicaid Home and Community Based Services Workforce Shortages.” The brief looks at state Medicaid levers to address the HCBS workforce shortage, noting that low wages, high rates of turnover, and lack of advancement opportunities all contribute to the shortage. In turn the shortage of workers limits the ability of state Medicaid programs to provide adequate services to beneficiaries in the community. Among other things, the issue brief provides examples of state actions using funds provided under the American Rescue Plan Act to support the HCBS workforce. Nearly all states who have applied for ARPA funds include some type of HCBS workforce efforts in their plans. 

COVID-19 Vaccine Boosters Communications Toolkit

While COVID-19 cases, hospitalizations and deaths continue to decline in Ohio and nationally, new variants in the future remain likely. It is important that time is taken to encourage all eligible Ohioans in all age groups who haven’t already gotten a COVID-19 vaccine booster shot to get one, especially Ohioans age 50 and over who are at greatest risk of severe illness, hospitalization, and death.

Providers can offer invaluable assistance in increasing COVID-19 vaccinations and saving lives.

People are more likely to get a booster shot if someone they personally know and trust encourages them to do so, answers any questions they may have, and tells them where to get a shot. We are asking you to engage your members/stakeholders in this effort by urging them to use the attached communications toolkit to encourage their patients/clients/stakeholders to get a COVID-19 booster shot.

Attached is a toolkit to promote the importance of booster doses using social media channels with sample text and graphics, or on websites or in publications.

HCBS reduces costs for families and states

A new policy brief from the Brandeis Community Living Policy Center looks at how increased access to and investments in home- and community-based services have positive economic impacts on families, the HCBS workforce, and states. 

CDC stretches vaccine intervals for males 12-39

The Centers for Disease Control & Management (CDC) has updated the interval between dose for the mRNA vaccines to include an 8-week interval for some people ages 12 years and older, especially for males ages 12-39 years due to the small risk of myocarditis. The Interim Clinical Considerations for Use of COVID-19 Vaccines webpage states:

mRNA COVID-19 vaccines are FDA-approved or authorized for a 3-week (Pfizer-BioNTech vaccine) or 4-week (Moderna vaccine) interval between the first and second dose. A 3- or 4-week interval continues to be the recommended interval for people who are moderately to severely immunocompromised, adults ages 65 years and older, and others who need rapid protection due to increased concern about community transmission or risk of severe disease. mRNA COVID-19 vaccines are safe and effective at the FDA-approved or FDA-authorized intervals, but a longer interval may be considered for some populations. While absolute risk remains small, the relative risk for myocarditis is higher for males ages 12-39 years, and this risk might be reduced by extending the interval between the first and second dose. Some studies in adolescents (ages 12-17 years) and adults have shown the small risk of myocarditis associated with mRNA COVID-19 vaccines might be reduced and peak antibody responses and vaccine effectiveness may be increased with an interval longer than 4 weeks. Extending the interval beyond 8 weeks has not been shown to provide additional benefit. There are currently no data available for children ages 11 years and younger. Therefore, an 8-week interval may be optimal for some people ages 12 years and older, especially for males ages 12–39 years.

LeadingAge Ohio encourages providers to keep their policies updated with current CDC guidance and ensure any education material provided to staff, residents, and clients contains the most current recommendations. The facility medical director could also assist a provider in updating their policies accordingly. For providers subject to the vaccine mandate, employers should discuss these recommendations with newly vaccinated individuals, document the interval recommendation for that specific individual, and then ensure they are vaccinated accordingly.

Leading Faithfully: Being present to the dying and those who love them

Join Reverend Becky King, MDiv, BCC and Kim Vesey, RN, CHPN, MS on Wednesday, May 18 for this training, which is specifically designed to better equip participants in the support of end of life care. Clergy, chaplains and care ministry teams for aging services organizations should plan to join this event. Discussion among peers throughout the day will build networking opportunities. Attendees can expect to implement information learned and build resources on a wide range of topics. 

For program information and to register, click here.

What the Media Said about end of life care this week – March 29, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.

Home Health and Hospice Newsletter

In Today's Newsletter

• You asked... We answered regarding hospice aide supervisory visits
  
• LeadingAge home health and hospice recap
• ODH shifts to weekly COVID-19 data reporting
• Honoring Wishes Task Force networking call: March 23
• CMS releases application request for third year of MA-Hospice demonstration
• CMS webinar: Medicare Advantage Value-Based Insurance Design Model – 2023 Hospice Benefit Component Overview: April 5
• Bill to expand HCBS for veterans introduced in congress
• Short time frame to complete application for High School Health Care Preceptor Pilot
• Ohio Assisted Living Association announces new Executive Director
• What the Media Said about end of life care this week – March 15, 2022

You asked... We answered regarding hospice aide supervisory visits

You Asked:

We realize the 14-day RN supervisory visits don't require the hospice aide to be present. How do the annual supervisory visits work?

We Answered:

According to the MLN article of September 2021, the hospice must make sure that the supervisory RN makes an annual on-site visit to the location where a patient is getting care to see and assess each aide while the aide is providing care. This way at least one in-person direct care observation occurs annually for each hospice aide.  The Supervisory RN should document the annual on-site RN visit per the hospice’s own policies and procedures for monitoring and tracking. The annual on-site supervisory RN visit documentation should:

• Show the aide’s performance per the patient’s POC
• Show ability with assigned tasks
• Follow infection control policies and procedures
• Report changes in a patient’s condition
• Create successful relationships with the patient and family

According to the Hospice: CMS flexibilities to fight COVID-19 the annual hospice aide onsite supervisory visit is on hold until 60 days after the expiration of the PHE.  See the flexibility below:

Training and Assessment of Aides: CMS is waiving the requirement at 42 CFR §418.76(h)(2) for Hospice and 42 CFR §484.80(h)(1)(iii) for HHAs, which require a registered nurse, or in the case of an HHA a registered nurse or other appropriate skilled professional (physical therapist/occupational therapist, speech language pathologist) to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. In accordance with section 1135(b)(5) of the Act, we are postponing completion of these visits. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the PHE.

Onsite visits for Hospice Aide Supervision are also waived at this time: CMS is waiving the requirements at 42 CFR 418.76(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time.

LeadingAge home health and hospice recap

Each week, LeadingAge provides a recap regarding home health and hospice. This week's edition features a Home Health Advisory Group recap.

ODH shifts to weekly COVID-19 data reporting

Ohio Department of Health (ODH) Director Bruce Vanderhoff, MD, MBA, announced last Thursday that the state of Ohio will transition from daily to weekly COVID-19 data reporting at www.coronavirus.ohio.gov beginning today, March 17.

A summary of key reporting changes include the following:

• COVID-19 new and cumulative cases, hospitalizations, ICU admissions, and vaccinations that are currently updated daily at coronavirus.ohio.gov will be updated weekly on Thursdays starting Thursday, March 17. Cases will continue to be assigned to the appropriate illness onset date, and vaccinations to their appropriate administration date.
• Newly reported COVID-19 deaths (currently reported twice weekly on Tuesdays and Fridays) will be reported on Thursdays and will continue to be assigned to the appropriate date of death.
• Data about long-term care facilities, as well as the reports from partner agencies (Developmental Disabilities, Veteran’s Homes, Youth Services, Mental Health and Addiction Services and Rehabilitation and Corrections), will be published weekly on Thursdays.
• K-12 schools will no longer be required to report positive COVID-19 cases to their local health departments, unless the school tests a student for COVID-19 and the result is positive. In addition, the COVID-19 School Reporting dashboard will be archived.

For the first time since August 2021, the statewide average case number per 100,000 residents has dropped below 100, with an average of 78.2 cases per 100,000 people as of March 9. Nearly two-thirds of Ohio’s 88 counties are currently below 100 cases per 100,000 people.

This change also brings Ohio’s reporting system more in line with the Centers for Disease Control and Prevention (CDC), which recently introduced new benchmarks for assessing community risk, shifting away from using cases as the sole measure of risk. The new COVID-19 Community Levels assess data related to the proportion of hospital capacity devoted to caring for COVID-19 patients, the number of new patients with COVID-19 admitted to the hospital in the past week, and the number of new COVID-19 cases in a given county in the past week. These data tell us how much the virus is spreading in an area in the context of how many people in the area are getting sick enough to require hospitalization and the strain that’s placing on a community’s acute care safety net. This combination of factors determines the COVID-19 Community Level in a given county expressed in ranges of low, medium, or high. Layered prevention strategies are recommended for communities deemed high risk.

Staying up to date on COVID-19 vaccinations, including getting a booster dose when eligible, is the best form of protection against COVID-19. COVID-19 vaccinations are widely available throughout the state at no cost to Ohioans. Many providers offer walk-in appointments, or appointments can be scheduled using gettheshot.coronavirus.ohio.gov. Ohioans who want to learn more about the safety, efficacy, and side effects of COVID-19 vaccines should talk to their doctor, nurse, or pharmacist, or visit coronavirus.ohio.gov/vaccine.

Honoring Wishes Task Force networking call: March 23

Please mark your calendar for next week's networking call on Wednesday, March 23 at 8:00AM, when the HWTF will host Dr. Susan Hickman of the Indiana University College of Medicine, a nationally-recognized expert on advance care planning research. Dr. Hickman will respond to the recent JAMA article questioning the value of advance care planning. To register, click here. Please share this widely in your newsletters and network-- all are welcome on these monthly calls.

CMS releases application request for third year of MA-Hospice demonstration

On March 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the information for Medicare Advantage Organizations (MAOs) interested in participating in the Hospice Benefit Component of the VBID Model; the scope of the Hospice Benefit Component under the VBID model; specific quality, network, and payment policies being tested as part of the Hospice Component for CY2023; model requirements; an overview of the planned evaluation of the Hospice Component and the application process.  Calendar year 2023 will be the third year of the model, which is expected to be conducted for a total of four years.

While the model has not undergone dramatic changes and the content of the CY2023 RFA closely tracks previous RFAs (i.e., the CY2021 and CY2022 RFAs), CMS has incorporated some notable changes. Of particular interest in the CY2023 RFA to stakeholders are the following:

• In keeping with CMS’ strategic priorities, the CY2023 RFA includes increased emphasis on advancing health equity under the model;
• Discussion of Medicare program waiver considerations to support the model;
• Additional clarity around the model’s goals related to the provision of palliative care outside of hospice care;
• A new Network Adequacy standard applicable to MAO Plan Benefit Packages (PBPs) with one year or more of experience under the model (mature-year PBPs); and
• A brief explanation of the “Learning System Strategy” (Section 5) under which CMS provides support for contracted hospices and participating MAOs under the model.

As has been the case in previous years, CMS has set a deadline of mid-April for MAOs to submit their applications to participate in the model.  For the CY2023 model year, mature-year PBPs will be required to submit their provider networks for CMS review during the summer. Given the expectation that established MAOs will be required to establish networks by mid-year, an inquiry was sent to the CMS VBID staff to check as to when hospices should anticipate that mature-year PBPs and PBPs newly entering the program will likely be entering into contracts with hospices for the CY2023 model year.

To read the complete Medicare Advantage Organizations (MAO) release, please click here.

CMS webinar: Medicare Advantage Value-Based Insurance Design Model – 2023 Hospice Benefit Component Overview: April 5

The CMS Innovation Center will host an office hours session to discuss the Medicare Advantage Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component on April 5 from 3:00 - 4:00PM. Attendees will receive an overview of the Model and the CY 2023 application process and have an opportunity for questions and answers with the Model team.

Registration for this event is available here. The Office Hours Number for this call will be 2456 392 6777 and the password is Apphours405.

Bill to expand HCBS for veterans introduced in congress

Bipartisan legislation to ensure that veterans can receive care in their home for as long as possible has been introduced in the U.S. House of Representatives. The Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act of 2022 (H.R. 6823) would expand and improve expand the home and community-based services (HCBS) programs within the Department of Veterans Affairs (VA), and align public policy with improved outcomes and patient choice, which is to stay in their own home.

This bill will make much needed improvements to the delivery of HCBS for veterans, enabling options in how and where they receive care, while also working to address workforce shortages and support family caregivers.

Specifically, this legislation would:

• Expand access to HCBS services for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.
• Raise the cap on how much the VA can pay for the cost of home care from 65% of the cost of nursing home care to 100%.
• Coordinate expanded VA home care programs with other VA programs.
• Establish a pilot project to address home health aide shortages.
• Providing respite care to caregivers of veterans enrolled in home care programs.
• Establish a “one stop shop” webpage to centralize information for families and veterans on programs available.
• Require the VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the Program of Comprehensive Assistance for Family Caregivers into any other home care program they may be eligible for.

The legislation is led by Representatives Julia Brownley (D-CA) and Jack Bergman (R-MI). At introduction, Rep. Brownley stated, “Over half of all veterans that use VA are over the age of 65, age, combined with their unique health needs, makes many elderly veterans especially vulnerable to going into nursing homes and institutional care. Our nation’s veterans deserve the right to age comfortably and with dignity in their homes.

Short time frame to complete application for High School Health Care Preceptor Pilot

As shared in The Source last week, the Ohio Department of Education, in collaboration with the Ohio Department of Health, announced it will offer paid internships in health care fields to high school students via the High School Health Care Preceptor Pilot.  These internships will provide mentors in the health care industry and create a career pathway for students to obtain CPR certification and industry-recognized credentials, such as STNA and the elder care certificate, as well as prepare students for health care education at the postsecondary level. The grant application will be available from March 7 to 21, 2022. 

LeadingAge Ohio is aware that the application for this funding opportunity is not a simple one, and that this represents an extremely narrow window (March 7-21) to apply for this funding to support paid interns. If your organization has reviewed the application and is interested in participating but feels it may be a challenge to complete by next Monday, reach out to Patrick Schwartz at pschwartz@leadingageohio.org to discuss how LeadingAge Ohio might be able to assist in the process. LeadingAge Ohio aims to encourage partnerships between members and their local school systems, and to that end, lend administrative support to members wishing to pursue this grant, including research, writing and other tasks for preparing the grant.

The importance of aging services providers connecting to local schools, and to Business Advisory Councils (BACs) which support career education, cannot be overstated as we take on this historic workforce crisis together. 

Details on the application process are provided here:

The application portal is now open available on the Ohio Department of Education's webpage. Targeted school districts include the following:

• Whitehall Local School District – IRN 045070;
• Groveport Madison School District – IRN 046979; 
• Reynoldsburg City School District – IRN 047001; 
• Ironton City School District – IRN 044149; 
• Dayton City School District – IRN 043844; 
• Toledo City School District – IRN 044909; 
• Springfield Local School District – IRN 044818; 
• Canton City School District – IRN 043711; 
• Perry Local Schools – IRN 045781;  
• Chillicothe City Schools – IRN 043745; 
• Adena Local School District – IRN 049494; 
• Federal Hocking Local School District – IRN 045914; 
• Washington Court House City School District – IRN 045013; 
• Cleveland Metropolitan School District – IRN 043786; 
• Zanesville City School District – IRN 045179; 
• Columbus City Schools District – IRN 043802.

The $380,760 in grant funding will be awarded to multiple entities to fund in-demand internship opportunities for high-risk, underserved ethnic minority and rural high school students in identified targeted districts. Each entity may be awarded between $10,000 and $80,000 maximum. Please be advised that providers do not need an IRN number to submit the completed application, letter of support, budget documents and appendices. 

Eligible applicants include nonprofit health care organizations, health care providers (including community health centers - for example, federally qualified health centers), health care industry sector partnerships and career-technical planning districts.  Applicants must identify and be willing to match students from a targeted school district with a preceptor.

Please follow instructions on the webpage to obtain a Unique Entity Identifier and to register as a supplier for the State of Ohio. This will be needed for reimbursement.

Interested applicants must be prepared to:

• Register for a Dun and Bradstreet number (DUNS) (Effective April 4, 2022 the US Government will transition from DUNS numbers to Unique Entity Idenditfiers (UEI)); and
• Register as a supplier for the State of Ohio.

Applicants may need to be prepared to:

• Obtain information retrieval numbers (IRN) from the Ohio Department of Education;

Register for an OH|ID account and a Department of Education Profile.

Ohio Assisted Living Association announces new Executive Director

Last Monday, the Ohio Assisted Living Association (OALA) announced Megan Kelley as the association’s new Executive Director. Megan will assume the role effective March 21.

Megan succeeds Jean Thompson, OALA’s first Executive Director, who provided excellent leadership and oversaw incredible membership growth until her recent retirement at the end of 2021. Jean will continue providing support and consultation to the Association.

Prior to her role as Executive Director, Megan spent nine years with National Church Residences, most recently serving as Vice President of Public Policy, Government Relations & Corporate Communications. In addition, Megan just completed a six-year term on the Ohio Ethics Commission. Prior to her work in senior living, she worked in private legal practice and in the Ohio legislature.

What the Media Said about end of life care this week – March 15, 2022

Throughout the pandemic, hospice and end-of-life care has been discussed across the country. LeadingAge Ohio reviews articles and media each week to share with our members.