Bulletin: May 19th, 2020

May 19th, 2020


COVID-19 Resource Center

HOME HEALTH and HOSPICE: Paramount Advantage will cease to provide coverage effective June 1, 2020 to Medicaid recipients who reside in the Central\Southeast region.  Healthcare providers may have questions about how healthcare coverage for these former Paramount members will transition to other Medicaid managed care plans (MCPs) and what providers should expect from these other MCPs as they assume coverage responsibilities for those members.  

HOME HEALTH and HOSPICE: Medicare Clarifies Recognition of Interstate License Compacts, CMS MLN Connects, May 14, 2020 – A new MLN Matters Special Edition Article SE20008 on Medicare Clarifies Recognition of Interstate License Compacts (PDF) is available. Learn about recognition of interstate license compacts as valid and full licenses.

HOME HEALTH and HOSPICE: Latest FAQs from the Small Business Administration (SBA) on the Payroll Protection Program, NHPCO COVID-19 Policy Updates, May 14, 2020 –  On May 13, 2020, the Small Business Administration (SBA) issued FAQ No. 47 which extended the safe harbor repayment date provided to certain recipients of Paycheck Protection Program (PPP) loans. This repayment date, which was previously extended from May 7, 2020 to May 14, 2020, has again been extended to May 18, 2020. Pursuant to the SBA’s FAQ 47 issued late in the day on May 13, any borrower that applied for a PPP loan and repays the loan in full by May 18, 2020, will be deemed by the SBA to have made the required certification concerning the necessity of the loan request in good faith. Borrowers do not need to apply for this extension.
HOME HEALTH and HOSPICE: Factors to Consider When Planning to Purchase Respirators from Another Country, NHPCO COVID-19 Policy Updates, May 15, 2020
PALLIATIVE CARE: NAHC to NIH: Include our Palliative Care Recommendations in COVID-19 Treatment Guidelines, NAHC Report, May 15, 2020 The National Association for Home Care & Hospice (NAHC) has joined like-minded organizations in the National Coalition for Hospice and Palliative Care in writing a letter to the National Instituets of Health, urging that our expert palliative care content be included in COVID-19 treatment guidelines.
HOSPICE: CMS Issues FAQs for Nursing Home Reopening, NHPCO COVID-19 Policy Updates, May 18, 2020 On May 18, 2020, CMS issued FAQs for nursing homes, with recommendations for reopening. There is no mention of hospice workers in the FAQs, but there is guidance on testing that may be of interest.
HOME HEALTH and HOSPICE: Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration), Palmetto GBA – Providers are reminded that Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the 2% payment adjustment currently applied to all Medicare Fee-For-Service (FFS) claims due to sequestration. The suspension is effective for claims with dates of service from May 1 through December 31, 2020. Action items: Share this information with appropriate staff. Providers should review their patient accounting systems and adjust accordingly due to this change. Secondary insurance plans are responsible for adjusting their systems due to this change.

>>>RCD/PDGM UPDATES –                                                                                                                  

If you have PDGM or RCD QUESTIONS PLEASE SEND THEM TO helpdesk@ochch.org
Use PDGM or RCD as the subject title.
If you need OCHCH to contact Palmetto GBA regarding a PCR NON-AFFIRMATION,
Please e-mail a short description and the UTN and your provider number.
DO NOT e-mail any info that could be non-compliant with the HIPAA regulations
Please check out the toolkits for PDGM and also RCD

>>>RCD UPDATES –                                                                                                                  

RCD Update –

NEW: Option to Stay in PCR, Palmetto GBA – For Home Health providers participating in the Review Choice Demonstration (RCD), you will now have the option to keep Pre-Claim Review (PCR) as your review choice for future cycles. This will avoid having to reselect PCR for each selection cycle. Providers can withdraw from this option and still change to another review choice in a future cycle.

New: RCD Tip: PCR Task Signed Documentation, Palmetto GBA – The Medical Review (MR) team has noticed an increased number of providers in Pre-Claim Review (PCR) who are submitting documentation (plan of care, therapy orders, etc.) that are not signed. As a reminder, for tasks 1 through 4, a signature is required. Documents submitted without a proper physician signature will result in a non-affirmation. Oral orders must be countersigned and dated by the physician before the home health agency submits the final bill.

We Are Going Green with RCD Cycle Results eLetters, Palmetto GBA – Palmetto GBA is going green with RCD Cycle Results eLetters. We will send home health agencies their RCD Cycle Results via eLetter in eServices. Please review and share with your staff.

RCD Tip: Using the Correct Provider Transaction Access Number (PTAN), Palmetto GBA – If you are a part of a Home Health Agency (HHA) with more than one location and multiple PTANs, please make sure you are using the correct PTAN when submitting Pre-claim Review (PCR) requests

RCD for Ohio’s Home Health Services Has Been PAUSED

Ohio Providers Transition to Review Choice Demonstration (RCD) Cycle Two, Palmetto GBABeginning May 1, 2020, you will be able to choose the next round’s review option. Typically, the selection period is open for a two-week period. Due to the current Public Health Emergency (PHE) related to COVID-19, the last day to make a selection has not yet been determined. Palmetto GBA will announce the last day to make a selection as soon as possible on their website and via email update. If you are not signed up for the Palmetto GBA email updates, please visit https://tinyurl.com/GetListserv to sign up.

Our Take

NHPCO’s We Honor Veterans Program and Department of Veterans Affairs Expand Partnership to Provide Grant Funding for Trauma-Informed Care for Veterans  
By Kathy Royer, RN, BA, MBA, DMin, CHPN, CHPCA, CEHCH
In March 2020, NHPCO requested proposals for a grant which would provide training for Trauma Informed Care for Veterans. OCHCH submitted a Request for Proposal (RFP) for the grant to provide education to Hospice and Palliative Care staff and to partner with VA Medical Centers and local VA support groups. OCHCH was one of 13 associations across the nation who were awarded a grant to do this important work.

For several years OCHCH has been interested in doing more to serve Veterans in local communities and the Trauma Informed Care for Vets grant will serve that purpose. We believe there are big gaps in Trauma Informed Care training when it comes to Veteran’s care, but also there is a big gap in the available education that provides such training. As such, OCHCH will be expanding Veteran focused Trauma Informed Care education. We believe that Veteran population in Ohio will greatly benefit from being cared for by Hospice and Palliative Care staff who have been trained in Trauma Informed Care that is specific to our Veteran patients.
OCHCH will offer Trauma Informed Care for Vets education in June 2020 to Hospice and Palliative Care staff. More details about the education will be coming. We are excited to participate in the Trauma Informed Care initiative and look forward to the ways in which Trauma Informed Care for Vets will bring insight, understanding and healing to our Veterans who have courageously served our country.

Click here for the Trauma Informed Care press release from NHPCO.


By Kathy Royer, RN, BA, MBA, DMin, CHPN, CHPCA, CEHCH

HelpDesk Question of the Week

HOSPICE: Admissions
Question: If I remember correctly Hospice admissions are supposed to take place at the primary address where care is to be received.  I cannot find the corresponding reg. please advise is this correct or am I mistaken.  I have been getting a lot of requests to admit at the hospital the day before the patient is sent home.  I have not been doing so and want to make sure that I am correct in what I am doing. 
Answer: Yes a Hospice admission is to be done wear the patient resides.  The following is from the Hospice Medicare Benefit Policy Manual Chapter 9:
40.1.9 - Other Items and Services (Rev. 188, Issued: 05-01-14; Effective: 08-04-14; Implementation: 08-04-14)
 Any other item or service which is included in the plan of care and for which payment may otherwise be made under Medicare, in accordance with title XVIII of the Social Security Act, is a covered service under the Medicare hospice benefit.  The hospice is responsible for providing any and all services indicated in the plan of care as reasonable and necessary for the palliation and management of the terminal illness and related conditions.

The hospice Interpretive Guidelines for 42 CFR 418.54(a), published via a Survey and Certification letter (S & C 09-19, Advance Copy-Hospice Program Interpretive Guidance Version 1.1), require that the initial assessment be conducted in the location where hospice services will be provided.  The plan of care is developed from that initial assessment and from the comprehensive assessment.  Ambulance transports to a patient’s home which occur on the effective date of the hospice election (i.e., the date of admission), would occur prior to the initial assessment and therefore prior to the plan of care’s development.  As such, these transports are not the responsibility of the hospice.  Medicare will pay for ambulance transports of hospice patients to their home, which occur on the effective date of hospice election, through the ambulance benefit rather than through the hospice benefit.  Ambulance transports of a hospice patient, which are related to the terminal illness and which occur after the effective date of election, are the responsibility of the hospice.


Regulatory & Policy Digest


HOME HEALTH: Internet Quality Improvement and Evaluation System (iQIES) Known Issues, Palmetto GBA – There are online resources available for iQIES known issues.

HOME HEALTH and HOSPICE: International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – October 2020 Update, CMS MLN Connects, May 14, 2020 – A new MLN Matters Article MM11749 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--October 2020 Update (PDF) is available. Learn about updated ICD-10 conversions and codes.

HOSPICE: HQRP Quarterly Update for 1st Quarter of 2020 is Available, CMS List Serve, May 15, 2020--The Hospice Quarterly Update for the first quarter of 2020 is now available. This update includes Hospice Quality Reporting Program highlights from this past quarter (January – March 2020), events and engagement opportunities planned for this coming quarter (April –June 2020), and selected questions and answers from the Hospice Quality Help Desk. Please navigate to the HQRP Requirements and Best Practices page to download this document.

HOSPICE: Congress Members Call on CMS to Delay Hospice Carve-In, Hospice News, May 14, 2020 – Members of the Ways and Means Committee in the U.S. House of Representatives have called for a one-year delay for the value-based insurance design model hospice demonstration, commonly called the Medicare Advantage carve-in.

HOME HEALTH: Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify, Palmetto GBA – Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections 1814(a) and 1835(a) of the Social Security Act to allow Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan of care. This is a permanent change that will continue after the Public Health Emergency. Effective for claims with dates of service on or after March 1, 2020, these non-physician practitioners (NPPs) may bill the codes listed in this article. Please share with the NPPs.

HOME HEALTH and HOSPICE: Congress Must Establish Supports for Frontline Caregivers in Home Care, NAHC Report, May 14, 2020 – The novel coronavirus COVID-19 has had a massive impact on the 12 million Americans who receive home care every year and the frontline health care workers who care for them. Home care is enormously popular (roughly 90 percent of Americans want to age in place) and far less expensive than institutionalized setting alternatives. But during the pandemic, we know that caring for people in their homes helps slow the spread of the virus and keeps space open in hospitals to deal with more urgent cases. And, of course, providing a safe alternative to nursing homes has never been more critical.
TAKE ACTION NOW to protect and support frontline home care workers!

HOME HEALTH: CR 11721 makes various clarifying changes to the Medicare Claims Processing Manual, Chapter 10, in order to better reflect the policies of the Patient-Driven Groupings Model. The revised Chapter 10 is a part of CR11721. CMS clarifies claims processing and claim edits relate to determining “early/late” and institutional designations for 30 day periods under the PDGM.

Education & Events

News Clips & Links

HOSPICE: LHC Group Stays Bullish on Hospice Expansion, Hospice News, May 13, 2020

HOSPICE: Hospices Use Heat Map Technology to Track COVID-19, Allocate PPE, Hospice News, May 15, 2020

HOSPICE: Social Workers Adapt to Hospice Care In a Pandemic, Hospice News, May 18, 202

HOSPICE: New $3 Trillion COVID-19 Stimulus Could Impact Hospice, Hospice News, May 18, 2020

HOSPICE: Pennant Group Sees Hospice Surge, Announces Acquisitions, Hospice News, May 18, 2020

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