Bulletin November 5th, 2019

November 5th, 2019



HOME HEALTH: PDGM Final Rule Reduces Behavioral Adjustment Cut to 4.36% - On Thursday, October 31, 2019 the Centers for Medicare & Medicaid Services (CMS) finalized the Patient-Driven Groupings Model (PDGM) for 2020, in addition to its plan to phase out home health pre-payments and introduce a new home infusion therapy benefit.

But perhaps the biggest news for U.S. home health providers is a major update to PDGM’s widely opposed and controversial behavioral adjustment. In its proposed payment rule dropped in July, the PDGM behavioral adjustment stood at 8.01%. In Thursday’s final rule for calendar year 2020 that adjustment decreased to 4.36% a figure that’s likely still higher than the industry would like — but a significant drop nonetheless.

HOME HEALTH: Final OASIS D-1 Data Submission Specifications Now Available, CMS – Final OASIS D-1 data submission specifications are available in the Downloads section of the OASIS Data Specifications webpage at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/DataSpecifications.html. The new version, V2.31.0, is effective for OASIS assessments with an M0090 Date Assessment Completed of January 1, 2020 or later. Changes in this version of the specifications are required to support the transition to the Patient-Driven Groupings Model (PDGM) and consist of the addition of two existing items to the Follow-Up assessment instrument (with corresponding revisions to the All Items instrument) and changes from required to optional data collection at certain time points for 23 items.

HOSPICE: Physician Assistants as Hospice Attending Physician, Forum of States List Serve, November 1, 2019 – The CY2020 Physician Fee Schedule final rule was posted November 1, 2019 and contains a welcome change for hospices.  CMS will revise § 418.106(b)(1) to permit a hospice to accept drug orders from a physician, NP, or PA. The PA must be an individual acting within his or her state scope of practice requirements and hospice policy, and the PA must be the patient’s attending physician, and he or she may not have an employment or contractual arrangement with the hospice.

As many of you are aware, while the BBA 2018 permits physician assistants to serve as attending physicians for hospice patients, the existing hospice conditions of participation only permit hospices to accept prescription orders from physicians and nurse practitioners.  The finalized changes to the hospice conditions of participation at § 418.106(b)(1) are effective January 1, 2020. 

PALLIATIVE CARE and HOSPICE: CMS Outlines Patient On-boarding in New Serious Illness Payment Model, Hospice News, November 4, 2019 The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled its process for identifying and on-boarding patients who are eligible for coverage under the Seriously Ill Population (SIP) payment model, part of the Primary Care First initiative. However, hospice organizations continue to seek additional answers about the workings of the model.

HOME HEALTH and HOSPICE: ODH Has Not Received CMS Survey Guidance on Changes to the CoPs – At the October 30, 2019 Ohio Department of Health (ODH) Non-Long-Term Care (NLTC) Provider meeting OCHCH’s Executive Director Joe Russell and Regulatory Affairs Director Beth Foster asked ODH if the surveyors have received training regarding the changes to the Home Health and Hospice CoPs. ODH representatives stated that they have not received any guidance from CMS.

Foster recommends that you follow the new conditions of participations requirements that go into effect on November 29, 2019. Keep in mind that the surveyors have no CMS guidance at this time.

·         For the details of the revised HH Aide competency requirements, and limiting the requirements for verbal notification of patient’s rights click here.

·         For the new HHA Discharge Planning Condition of Participation click here.

·         For the details of the Hospice agencies deferring to State licensure to qualify their Hospice aides, drug management, and hospices working facility partners to educate facility staff about the hospice philosophy of care and specific hospice practices click here.

RCD UPDATES –                                                                                                                      

ANNOUNCEMENT: OCHCH Weekly RCD Conference Calls

OCHCH recently launched an awareness campaign to provide your agency with the assistance, information, resources, and training you need to tackle the challenges of RCD and PDGM. This campaign is called OPERATION: tackle.

As part of OPERATION: tackle we are hosting weekly conference calls on RCD that started on October 25th and will continue for the foreseeable future. These conference calls will provide an opportunity for us to share the latest developments of RCD, for you to share your challenges, and for our members to share best practices in a real time environment. On the November 1st call you heard from two national leaders. Bill Dombi, President of NAHC gave us the big picture look at the possibility of having a prior authorization for all Medicare providers, and forecasted that RCD in some form will expand to other high risk areas across the nation. You also heard from Sara Ratcliffe, Executive Director of the Illinois HomeCare & Hospice Council, share tips and answered Pre-Claim review questions.

You can listen to the November 1st RCD Call Recording

*The RCD Call Recordings are available on Friday afternoons.

DON’T MISS THIS OPPORTUNITY!! Please mark your calendars for EVERY FRIDAY @ 10am. THE NEXT CALL WILL BE ON FRIDAY, NOVEMBER 8 AT 10AM. The calls will last no more than an hour.

Call-in info through December 2019 will remain the same as the Nov. 1st call:

Login - https://web.telspan.com/go/ochch/ochchpdgm


Dial: 888-392-4564

Passcode: 7896828#

If you have trouble getting on the Call – PLEASE CALL OCHCH 1-614-885-0434 Ext.206, or e-mail ryan@ochch.org

Talk to you soon!

The RCD Demonstration started on September 30, 2019. All episodes of care, both initial and recertifications starting on or after this date are subject to the requirements of the choice selected.



Dial 855-696-0705

Press “0” at the main menu

Press “0” again

Press “3” for HHH

Press “1” for an RCD agent

All RCD provider questions must go through the Palmetto GBA Provider Contact Center (PCC) at 855-696-0705. However, if your questions are not being answered, you are not receiving a call back in a timely manner, or you need assistance to contact Palmetto GBA, PLEASE contact OCHCH by using helpdesk@ochch.org OR call 614-885-0434 Ext 209.

Find RCD Answers through the updated October 16, 2019 Review Choice Demonstration (RCD) for Home Health Services Frequently Asked Questions (FAQs)

Monthly Review Choice Demonstration (RCD) Provider Teleconference Schedule

(11/06/2019 and 12/04/2019)



The following webcasts are hosted by the MACs:

Home Health Patient-Driven Groupings Model (PDGM) Webcast Part One: November 21, 2019

This is the first of two collaborative webcasts about the Home Health Patient-Driven Groupings Model (PDGM), hosted by your Home Health Medicare Administrative Contractors (MACs), CGS, National Government Services and Palmetto GBA. This presentation will begin on Thursday, November 21, 2019 at 02:00 PM Eastern Standard Time. During this webcast, you will receive information to help your agency prepare to implement billing changes for the PDGM on January 1, 2020. PDGM is the Medicare payment model used to reimburse home health agencies. Please plan to attend.

Home Health Patient-Driven Groupings Model (PDGM) Webcast Part Two: December 5, 2019

This is second part of two collaborative webcasts about the Home Health Patient-Driven Groupings Model (PDGM), hosted by your Home Health Medicare Administrative Contractors (MACs), CGS, National Government Services and Palmetto GBA. This presentation will begin on Thursday, December 05, 2019 at 02:00 PM Eastern Standard Time. During this webcast, you will receive information to help your agency prepare to implement clinical changes for the PDGM on January 1, 2020. PDGM is the Medicare payment model used to reimburse home health agencies. Please plan to attend.




HelpDesk Question of the Week


Helpdesk Question of the Week –

HOME HEALTH: Register for an iQIES Account - Action Required

Question: Why is it so important to register for an iQIES account now?

Answer: Action Required NOWThe failure to obtain access to iQIES prior to December 23, 2019 will impact your ability to submit assessment data needed for payment purposes, as the system will have a scheduled downtime so that the data migration can occur in preparation for the January 1, 2020 release. Claims that cannot be matched to assessments will be returned to the HHA, preventing Medicare payment.


Regulatory & Policy Digest


HOSPICE and PALLIATIVE CARE: House Approves Hospice Education Act, Hospice News, October 30, 2019 – The U.S. House of Representatives has passed the Palliative Care and Hospice Education and Training Act (PCHETA), according to the office of Rep. Eliot Engels (D-N.Y.). The bill, which Engels introduced in January, had 294 bipartisan cosponsors.

HOSPICE: Bill Would Allow Hospice Recertification Via Telehealth, Hospice News, November 4, 2019 – A bipartisan group of congressional legislators have introduced corresponding bills in the House and the Senate that would allow hospice physicians to re-certify patients via telehealth systems, among other provisions.

HOME HEALTH and HOSPICE: REMINDER – OAHP & MyCare Ohio Plans Long-Term Care Provider Survey, OAHP – The MyCare Ohio Plans, which include Aetna, Buckeye, CareSource, Molina, and United Healthcare, are collaborating on an initiative to identify opportunities to reduce administrative burden for Long Term Care (LTC) providers. This is your chance to request changes to: the Prior Authorization process; plans not following payer of first resort; plans not following the Medicare regulations and Medicaid rules; providers not able to contract with plans; require all plans to standardize process; delayed reimbursement; receiving less than the Medicaid rate; etc. The survey will be open until November 14, 2019. Click here for more info and the link to the survey.

HOME HEALTH and HOSPICE: REMINDERCMS Pushes Effort to Curb Medicare Fraud, NAHC Report, October 25, 2019 CMS has also released two requests for information (RFI) to obtain input on how to advance their anti-fraud Medicare program. The first RFI, CMS asks for comments on using technology to improve anti-fraud activity and ease provider burdens. In the second RFI, CMS asks for feedback on their program integrity efforts.  Please submit your comments to Beth Foster at beth@ochch.org or to Kathy Royer at kathy@ochch.org by November 15, 2019.

HOME HEALTH and HOSPICE: Home Health and Hospice Agencies – In partnership with Health Services Advisory Group (HSAG), we are reaching out to let you know that HSAG is beginning to recruit for CMS’ new initiative, Healthy Communities, and would like you consider joining in.

The HSAG Healthy Communities initiative is focused on providing no-cost technical assistance to your facility on opioids, readmissions, chronic disease and infections. To assure you continue to receive your Readmission Reports from HSAG, please sign up using the www.hsag.com/healthycommunities link. The reports will be greatly enhanced and will now include Medicare Advantage member data that will provide a better picture of your Medicare population overall. HSAG also provides toolkits, specialized data reports, educational events (many with continuing education credits), and the ability to collaborate with other Home Health/Hospice Agencies and hospitals across the healthcare continuum.

Please consider participation!

Bonnie Hollopeter, LPN, CPHQ, CPHIMS

Quality Improvement Task Lead

Health Services Advisory Group


HOSPICE and HOME HEALTH: Hospice and Home Health Claims Processing Issues Log, Palmetto GBA


Upcoming Education & Events


For Upcoming webinars, conferences, workshops and events click HERE

QIRT 5- Part Webinar Series - https://members.ochch.org/ev_calendar_day.asp?date=10/29/2019&eventid=124

(Individual Parts available for purchase)

PDGM Impact on OASIS - https://members.ochch.org/ev_calendar_day.asp?date=11/19/2019&eventid=139

PDGM Clinical Episode Management - https://members.ochch.org/ev_calendar_day.asp?date=11/21/2019&eventid=140


News Clips & Links


PALLIATIVE CARE and HOSPICE: Lack of Palliative Care Definition Impacts Patients, Hospice Business, Hospice News, November 4, 2019

HOSPICE: Hospices Leverage Social Media Marketing, Hospice News, October 30, 2019

HOSPICE: More Patients with Cardiovascular Disease Dying at Home, Hospice News, October 30, 2019


Ohio Council for Home Care & Hospice  1105 Schrock Rd., Suite 120, Columbus, OH 43229
(614) 885-0434   www.ochch.org