PDGM In the News: In Case You Missed It
Erin Begin

• Why Home Health Agencies Should Gear up for PDGM Wound Care Opportunity
  
• Home Health Clinicians Face PDGM Knowledge Gap
  
• PDGM’s Co-Morbidity Changes May Trigger Substantial Payment Bump
  
• PDGM Unlikely to Be Delayed; Coders Next Home Health Rockstar
  

F2F Encounter Advisements from NAHC
Erin Begin
Agencies have asked if they are still able to use the forms that were in use when a physician narrative was required as part of the F2F encounter, the following clarification was issued on this practice:

NAHC recommends agencies not use the forms that were in use when a physician narrative was required as part of the F2F encounter. These form have been a source of confusion for both the agencies and the medical review contractors. Some of the forms have certification statements in addition to the statement on the POC. Agencies have also mistakenly used the form as the F2Fencounter, rather than a visit note. Further, I think some of the medical reviewers have a knee jerk reaction to deny claims when they see these forms, leaving agencies to defend their application.

In the final 2019 HHPPS rule, CMS clarified that a POC with sufficient information to support eligibility could be the sole document for the physician to sign and incorporate into his/her medical record. We recommend agencies consider including in the POC clear language the supports the need for skilled services and homebound status.

Home Health Care Planning Improvement Act
Erin Begin
Have you contacted your local representative yet to support S. 296? This legislation, backed by NAHC, would allow non-physician practitioners, such as NP and PAs, to certify home health under Medicare; expanding access to home health services. Under the current model, MDs or DOs who may not have an established relationship with the patient are coordinating services for home health certification. To learn more about how you can support this measure please visit NAHC’s Legislative Action Center.

Home Modifications in Home Care
Erin Begin
Home Modifications are becoming increasingly important for at home care providers. About 76% of those 50 and older want to stay in their homes as long as possible (Home Health Care News). According to a recent study from USC and NASUAD, patients face barriers to access to home modifications to support aging in place. Most notably, there is a lack of consumer awareness and available providers. It is difficult to coordinate services due to needing an interdisciplinary team which includes an OT, RN and handyman, such as the CAPABLE program at Johns Hopkins School of Nursing. Home Health agencies are in important piece of this service, because they can fill two of those 3 requirements. CMS has recently announced that Medicare Advantage plans would have permission to offer expanded services, including home modifications, in 2020. Currently, there are networks being created in Ohio through managed Medicaid programs, such as Caresource, to offer these services, in addition to services coordinated by PASSPORT. Preparing to offer these services now will enable your agency to fill a need when coverage becomes available for more consumers. For more resources an information on Aging in Place and Home Modifications, please visit their website.

Phase 1 EVV Providers Reminded to Complete Bridge Training
Debbie Jenkins
If you are a provider of home health services paid through fee-for-service Medicaid or the Ohio HomeCare Waiver and were part of Phase 1 of EVV, ODM has created a bridge training which focuses on the changes required as a result of the updates made for Phase 2. These updates were implemented on May 6 and if you are using the Sandata system, you should recognize changes. In a stakeholder meeting held Wednesday, May 22, ODM shared that over 1200 Phase 1 EVV providers have not taken the bridge training. If you have not completed bridge training, you can register for it here. In addition, ODM is offering monthly webinars to assist providers in areas of concern. May’s webinars focus on some of the changes in Phase 2. You can register for the remaining webinar below:

• Tuesday, May 30, 2019, at 11:30 a.m.
  

Phase 1 EVV Post Payment Reviews
Debbie Jenkins
OHCA shared earlier this year ODM’s plan to complete post payment reviews for providers who were required to meet EVV requirements in Phase 1 and have had significant non-compliance with those requirements. ODM will begin sending out post payment review letters to 10 providers at the end of June. Those providers will have 30 days to correct EVV claims errors. If errors are not corrected within the 30 day period, ODM will send the provider a second letter with audit findings of over payment. 

Phase 1 EVV users began utilizing the Phase 2 requirements in Sandata on May 6th, but Phase 1 providers using an alternative system have until June 24 for the alternate system to meet the Phase 2 requirements. ODM’s Kristy Wathen confirmed during the EVV Stakeholder meeting this past Friday that ODM will not be auditing any Phase 1 providers using alternate systems for compliance with the Phase 2 updates during the period from May 6 – June 24.

Phase 2 EVV Providers – Complete Training Now!
Debbie Jenkins
If you provide personal care services through the PASSPORT waiver, Medicaid managed care or MyCare Ohio, including the MyCare Ohio waiver (excluding Assisted Living), you will be required to utilize EVV by August 5, 2019. However, training is available now. You will need to use your MEDICAID ID when you register for training (not your AGING or Managed Care IDs). If you need help finding your MEDICAID ID, you can access it in MITS or contact the Provider Hotline at 800-686-1516.

Once at least one person from your agency completes the initial EVV training, your agency will have access to the Sandata system to order devices for staff. Agencies can request a training mobile device by emailing EVV@medicaid.ohio.gov. Once staff have been trained and the administrative components of EVV (entering staff and people served) are completed in Sandata, staff can begin utilizing EVV now. OHCA encourages providers to have staff begin using EVV as soon as possible to allow staff time to get over the learning curve and be able to accurately meet the EVV requirements by August 5.

Hospice

Update: Hospice Room and Board Billing Change
Erin Begin
In an issue of News Bites earlier in May, OHCA reported that effective July 1, 2019, the Department of Medicaid (ODM) is requiring MyCare Ohio managed care plans to switch from direct payment of hospice room and board claims to the SNF to the traditional method of paying the hospice, which in turn forwards the payment to the SNF. Three plans – Molina Healthcare, Aetna Better Health of Ohio, and UHC Community Plan – currently pay SNFs directly for hospice room and board, reducing the administrative burden on hospices and SNFs. Aetna Better Health issued a detailed statement to its providers indicating that they are poised to start accepting claims from the hospice entities, without the need of a contractual agreement, July 1st, 2019.

Since that communication, we have been in contact with UHC Community Plan and Molina Healthcare, who have both stated that they have received the required clarifications from ODM and are currently working on processes and communication to enable acceptance of Hospice Room and Board claims from hospice entities July 1st, 2019, as directed by ODM. OHCA will share any updates on their proposed changes as soon as they are available, accompanied by a summary of billing and authorization requirements for each health plan.

In the interim, if not currently in a network arrangement, hospice entities should start sending W-9 information to these payor plans to ensure that the claims can be accepted out of network and payments can be issued, resulting in no delays to reimbursement. You will also want to work with your billing staff to establish payor set ups in your system to remit claims electronically to each health plan.

If you are unfamiliar with the MyCare plans active in the counties which you serve, please reference the MyCare Region Maps provided below.

• Region map

• Plans by region

CMS Releases Quarterly Hospice Compare Refresh
Erin Begin
The May 2019 quarterly Hospice Compare refresh of quality data is now available. It is based on Hospice Item Set (HIS) quality measure results from data collected Q3 2017-Q2 2018 and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey® results reported Q3 2016 – Q2 2018.

You can view the data by visiting Hospice Compare.