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Welcome to the Florida Home Bound Blog. This section of our website is specially designed to keep Home Care professionals updated on changes that are occurring in this industry. Click here if you want to submit any updates you find. Your contribution to our blog and/or suggestion is greatly appreciated.

 


Home Health Coalition

Updated: 6/27/11

Click here to read more.


The TransforMED Patient-Centered Model

Updated: 04/12/11

Click Here to read more.


Workshop Regarding Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty Laws

Updated: 04/12/11

Vicki Robinson: Good afternoon everybody and welcome to those of you here in the auditorium as well as those joining us by phone. I am Vicki Robinson, senior advisor for healthcare reform for the Office of Inspector General for the Department Health and Human Services. I'm actually until recently I served in a different position where I spent many years working on this exclusively on Stark's kickback and civil money penalty matters. Joining me as co-moderator for today's panel is Troy Barsky, director of CMS' Division of Technical Payment Policy where he leads the CMS team that addresses Stark law issues.

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Accounting Care Organization Frequently Asked Questions

Updated: 04/12/11

The Patient Protection and Affordable Care Act (PPACA) attempts to improve the health care delivery system through incentives to enhance quality improve beneficiary outcomes and increase value of care. One of these key delivery systems reforms is the encouragement of Accounting Care Organizations (ACO's).

ACO's facilitate coordination and cooperation among providers to improve the quality of care for Medicare beneficiaries and reduce unnecessary costs.

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Federal Register: Department of Health and Human Services

Updated: 04/12/11

Summary: This proposed rule would implement section 3022 of the Affordable Care Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs). Under these provisions, providers of services and suppliers can continue to receive traditional Medicare fee-for-service payments under Parts A and B, and be eligible for additional payments based on meeting specified quality and savings requirements.

Dates: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on June 6, 2011.

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Home Health, Hospice & Durable Medical Equipment Open Door Forum

Source: www.cms.gov

Updated: 03/29/11

Special Open Door Forum: Study and Report on the Development of Home Health Payment Revisions to Ensure Access to Care, and Payment for Severity of Illness - Thursday, March 31, 2011 from 1:00pm - 2:300pm ET. The purpose of this Special ODF CMS needs your help identifying beneficiaries who may have difficulty accessing Medicare home health services. We would like to hear about your experiences serving hard to reach populations. Also, we would like you to describe challenges certain beneficiaries may experience in accessing Medicare home health services. This Special Open Door Forum will be dedicated to this very important issue and sharing your first hand experiences.

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Proposed Decision Memo for Erythropoiesis Stimulating Agents (ESAs) for Treatment of Anemia in Adults with CKD Including Patients on Dialysis and Patients not on Dialysis (CAG-00413N)

Source: www.cms.gov

Updated: 03/29/11

Given the totality of the currently available evidence, we propose that CMS not issue a national coverage determination at this time for Erythropoiesis Stimulating Agents (ESAs) for Treatment of Anemia in Adults with CKD Including Patients on Dialysis and Patients not on Dialysis (CAG-00413N).  

In order to maintain an open and transparent process, we are seeking comments on our proposal that no national coverage determination is appropriate at this time.  We will respond to public comments in a final decision memorandum, consistent with the spirit of §1862(l)(3).

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Use Medicare’s Fraud Enforcement to Encourage Compliance in Your Community

Source: hcaf.wordpress.com

Updated: 02/14/11

Since May 2009, the Department of Justice (DoJ) has been working with the Department of Health & Human Services (HHS) on a joint fraud and abuse task force called “HEAT,” which is short for “Health Care Fraud Prevention and Enforcement Action Team.” Strike force teams are operating in seven cities in the United States: Miami, FL; Los Angeles, CA; Detroit, MI; Houston, TX; New York, NY; Tampa, FL; and Baton Rouge, LA. The HEAT team takes great pride in its accomplishments, which it publishes online.

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Tampa Tribune Publishes HCAF’s Opinion on Medicaid Reform

Source: hcaf.wordpress.com

Updated: 02/14/11

As the state’s legislative session nears, Medicaid reform is one of the biggest issues that legislators will have to address to balance the budget. Florida Medicaid as we know it is unsustainable.

This year, 2.9 million Floridians will receive Medicaid, the health program for individuals and families with low incomes and poor resources, which is jointly funded by the state and federal government. By 2019, that number is expected to swell to 4.8 million because of federal health care reform. Of last year’s $70.4 billion state budget, $20.2 billion, or 28 percent, was spent on Medicaid alone.

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Palmetto GBA Releases First Issue of Monthly Medicare Advisory

Source: hcaf.wordpress.com

Updated: 02/08/11

Palmetto GBA has released the first issue of the Medicare Advisory, which is is published monthly and applies to Jurisdiction 11 Home Health and Hospice (J11 HHH).  Medicare home health and hospice providers are encouraged to review each issue of the Medicare Advisory to keep current about Medicare coverage and policy updates. The Medicare Advisory will also include information about upcoming education events and articles from various Palmetto GBA departments to assist providers when filing Medicare claims, updating their enrollment status or answering Medicare reimbursement or payment questions.

Click here to access the February 2011 Medicare Advisory on HCAF’s Resources page (HCAF > Resources > Medicare-Certified Providers > 2011 Medicare Advisory)


Want to register to Florida Accountable Care Services?

Updated: 02/02/11

Click here to sign up for free


Compilation of the Social Security Laws - Shared Savings Program

Source: www.ssa.gov

Updated: 02/02/11

(1) In general.—Not later than January 1, 2012, the Secretary shall establish a shared savings program (in this section referred to as the “program”) that promotes accountability for a patient population and coordinates items and services under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.

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CMS Issues Amended Medicare Physician Fee Schedule for Home Health

Source: hcaf.wordpress.com

Updated: 02/02/11

The Centers for Medicare & Medicaid Services has issued amended Medicare Physician Fee Schedule (MPFS) payment files to contractors for calendar year (CY) 2011. Those payment files include MPFS policy and payment indicator revisions described in the CY 2011 MPFS Final Rule Correction Notice, as well as relevant statutory changes applicable Jan. 1, 2011.
On Dec. 15, 2010, President Barack Obama signed the Medicare and Medicaid Extenders Act of 2010 (MMEA). As enacted, this law contains a number of Medicare provisions that change or extend current Medicare fee-for-service program policies.

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CMS Announces Delay of Implementation for Face-to-Face Requirement

Source: hcaf.wordpress.com

Updated: 12/27/10

Due to concerns that some providers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for purposes of certification of a patient’s eligibility for Medicare home health services and of recertification for Medicare hospice services, the Centers for Medicare & Medicaid Services (CMS) will expect full compliance with the requirements, beginning with the second quarter of CY2011.

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Extended Retention of OASIS Validation Reports Recommended Due to Improper Denials

Source: hcaf.wordpress.com

Updated: 12/27/10

With the beginning use of the Outcome and Assessment Information Set (OASIS)-C in January 2010, submission of the OASIS became a condition of payment. CMS requires medical reviewers to ensure the OASIS has been submitted and accepted to the state repository according to guidelines. If the OASIS is not present in the repository, the claim must be denied.

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CMS delays physician signature requirement for lab requisitions

Source: hcaf.wordpress.com

Updated: 12/27/10

The Centers for Medicare & Medicaid Services will not enforce before April a requirement that a physician or qualified non-physician practitioner sign requisitions for clinical diagnostic laboratory tests paid under the calendar year 2011 clinical laboratory fee schedule.

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DMEPOS Competitive Bidding Program

Source: www.cms.gov

Updated: 12/21/10

Starting on January 1, 2011, Medicare will begin the first phase of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The program's goal is to save billions of dollars for people with Medicare and other taxpayers – while preserving access to quality items and services from qualified suppliers.

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Palmetto GBA Update

Source: hcaf.wordpress.com

Updated: 12/21/10

Check out the announcements below from Palmetto GBA…

Is the administration for the flu and PPV vaccines reimbursed the same way?
This is the revised response to a home health and hospice question regarding the administration of influenza and pneumococcal vaccines.

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NAHC: MedPAC Drafts 2011 Recommendations for Congress

Source: hcaf.wordpress.com

Updated: 12/21/10

The Medicare Payment Advisory Commission (MedPAC) met on Dec. 3, 2010 to unveil and discuss its potential recommendations to Congress for 2011. As part of its agenda, the MedPAC commissioners focused on home health services with more time devoted to that subject area than any other in its two-day meeting.

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Have You Heard of or Tried SNAP Packets?

Source: hcaf.wordpress.com

Updated: 12/21/10

SNAP stands for Superior Nurse Aide Performance! SNAP Learning Packets are comprehensive aide training packages.  You can choose from among 24 different topics. Each packet contains an audio CD (each one is about 1-hour in length); the accompanying handouts; post-test, post-test answer key and a template for certificates of completion.

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CMS Releases Information Regarding Face-to-Face Requirements for Medicaid Providers

Source: hcaf.wordpress.com

Updated: 12/21/10

CMS has released information regarding Face-to-Face Requirements for Medicaid providers. According to CMS representative, Melissa Harris, CMS will publish a notice of proposed rulemaking in Spring 2011, followed by a comment period and a final rule. An “information bulletin” was issued several months ago by CMS to give States a heads-up about the face to face statutory language.

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Hastings Signs Letter to CMS Urging Postponement of Face-to-Face Requirements

Updated: 12/15/10

Great news!  U.S. Congressman Alcee Hastings (D-Miramar) has thrown his support behind an effort to postpone CMS’ implementation of the physician face-to-face encounter requirement for home health, slated to go into effect January 1, 2011.  Rep. Hastings has proven to be a fervent support of home care.  In 2007 he cosponsored the Home Health Care Access Protection Act, which would have amended title XVIII of the Social Security Act to protect Medicare beneficiaries’ access to home health services under the Medicare Program.

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Independence at Home Demonstration

Updated: 12/15/10

The Centers for Medicare and Medicaid Services (CMS) is holding a Special Open Door Forum (ODF) in order to solicit stakeholder input for the design and development of the Independence at Home Demonstration.  This Special ODF will be a “listening session” in which CMS hopes to gather information from stakeholders about issues that will affect demonstration design and implementation. This demonstration was mandated by Section 3024 of the Affordable Care Act to test a payment incentive and service delivery model that utilizes physician and nurse practitioner directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services to applicable beneficiaries.

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Medicare Fraud and Abuse | Significant Changes In Health Care Reform Law

The Health Care Reform Bill made several significant changes in the Fraud and Abuse area.  Some of these changes have already been the subject of posts on this blog. 

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CMS Criteria for Submitted Requests

Requests for adding services to the list of Medicare telehealth services are assigned by CMS to one of the following categories:

Category 1 services are reviewed to ensure that the services proposed for addition to the list of Medicare telehealth services are similar to the services listed above. For example, in reviewing these requests for addition, we look for similarities between the proposed and existing telehealth services in terms of the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. We also look for similarities in the telecommunications system used to deliver the proposed service, for example, the use of interactive audio and video equipment. If a proposed service meets the criteria set forth above, we would add it to the list of Medicare telehealth services.

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Understanding Payment Policies under the Physician Fee Schedule and Other Revisions to Medicare Part B for CY 2011

Before January 1999, Medicare only covered medical services delivered via telecommunication1 that did not inherently require contact with a physician, for example, x-rays.2 On October 1, 2001, Medicare coverage for health care services delivered via telemedicine was expanded3 to include consultations, office visits, office psychiatry services and other additional services.
Today, a Medicare beneficiary enrolled under Part B is eligible for telehealth service so long as the service itself is codified by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services (CMS) under the telehealth statute and the telehealth service is furnished at an "originating site". An originating site is a specified medical facility located in a rural area identified as having a shortage of health professionals, in a county that is not in a metropolitan statistical area or is an entity that is enrolled in a Federal telemedicine demonstration project.

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Important Information on the Timely Claims Filing Requirement

The Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after Jan 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service – or Medicare will deny those claims. 
If you have Medicare Fee-For-Service claims with service dates from Oct 1, 2009, through Dec 31, 2009, those claims MUST be filed by Dec 31, 2010, or Medicare will deny those claims. Claims with service dates from Jan 1, 2009, to Oct 1, 2009, keep their original Dec 31, 2010 deadline for filing.Claims for services that require reporting a line item date of service, the line item date will be used to determine the date of service.  For other claims, the claim statement’s “From” date is used to determine the date of service.


New CMS/Medicare rules:

The patient’s function must be initially assessed and periodically reassessed by a qualified therapist of the corresponding discipline for the type of therapy being provided (that is, PT, OT, and/or SLP). When more than one therapy discipline is being provided, the

corresponding qualified therapist would perform the reassessment during the  regularly scheduled visit associated with that discipline which was scheduled to occur as near as possible to the 13th and 19th visit, but no later than the 13th and 19th visit. We also note that a small percentage of patients which receive 13 and 19 therapy visits receive more than 1 therapy discipline. In addition, HHAs must coordinate their patients’ care per long-standing conditions of participation at § 484.14(g). As such, we would expect such coordination to already be occurring. Given the low volume of such patients and the added flexibility as described above, we do not believe that the coordination associated with multi-therapy discipline patients will be overly burdensome.


FMAP Funding for Medical Extended

Members of the House of Representatives were called back from their August recess to Washington by Speaker Nancy Pelosi (D-CA) to vote on a federal funding bill that will provide approximately $1.3 billion in federal funding to the state of Florida. The bill passed the House yesterday on a vote of 247-161, after approval last week by the Senate. For those of you who participated in the Call to Action, thank you. Your advocacy makes a difference.

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CMS Competitive Bidding of DME Will Affect Home Care in 2011

The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM7014 to alert Home Health Agencies (HHAs) that edits will be in place, effective for services provided on or after January 1, 2011, that will prevent HHAs from billing competitively-bid DME items in competitive bidding areas and consequently, preventing the inappropriate payment of competitively-bid DME items to HHAs.

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Medicare/Medicaid Home Health Agency (HHA) Certification Process

The Centers for Medicare & Medicaid Services (CMS) has a Home Health Providers' website which provides basic information about becoming certified as a Medicare and/or Medicaid home health provider and includes links to the Conditions of Participation (CoPs), applicable laws, regulations, and compliance information.

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CMS: Timely Filing Deadline Changed to "Not More Than 12 Months"

JUST RELEASED: MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months. The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at

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The Home Health Industry and Insufficient Documentation for Medical Necessity and ICD-9 Coding

Source: www.selectdata.com

Updated: 10/20/10

» The therapy treatment plan must:

» Relate to the exact diagnosis that has required therapy intervention

» Identify visit frequency and duration

» Identify the present and prior functional level

» State specifically the procedures, treatments, and/or exercises to be performed

» Clearly list the reasonable goals to be achieved

» Specify the rehab potential

» Specify the discharge plan in clear, easy to understand goals and plan.

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More Information (click the links below)

Medicare Home Health Agency Survey and Certification Deficiencies

How Are Florida's Different Home Care Providers Regulated?

Florida Medicaid - Home Health Services Handbook

Approval Process for Medicare Branch HHA Offices

Hurricane Update

CMS Time Codes

CMS Payments

ACO Workshop