08/24/2020

Today's COVID-19 Report: Monday, August 24, 2020

Monday, August 24, 2020

Here are the latest need-to-know updates for Monday, August 24 regarding the COVID-19 pandemic.

CMS bulletin reminds states they have the flexibility to increase reimbursement for NHs 

Today, the Centers for Medicare & Medicaid Services (CMS) released a Medicaid Informational Bulletin (CIB) that provides guidance to states on flexibilities that are available to increase reimbursement for nursing facilities that implement specific infection control practices, such as designating a quarantine or isolation wing for coronavirus disease 2019 (COVID-19) patients. The CIB also highlights specific actions that certain states have already taken to better support the nursing facilities’ ability to safely care for all residents, including COVID-19 positive residents, during this public health emergency, and how enhanced nursing facility payment supported those efforts. With this CIB, the Centers for Medicare & Medicaid Services (CMS) is encouraging
states to utilize these flexibilities to improve care for Medicaid beneficiaries residing in nursing
facilities.

More information is available on the CMS press release sent to highlight the bulletin.

Project ECHO: Training to be made available to all nursing homes in the country

The U.S. Department of Health & Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) is coordinating a fast-moving training program that involves learning collaboratives run through the University of New Mexico’s Project ECHO. Project ECHO pulls together groups that meet virtually to participate in didactic learning and share immediate concerns.  It appears that nursing homes – and possibly medical directors - will receive small stipends from the Provider Relief Fund (PRF) to participate in learning “hubs.”  The 50-100 hubs that are part of this nursing home infection control learning network will be run out of large health systems, with help from QIOs and other experts, as well as the the Institute for Healthcare Improvement (IHI).

Every nursing home in the country will be assigned to a hub, based mostly on geography, though nursing homes that serve children will be linked with each other.  Participation is not mandatory. The network is being rolled out in mid-September and nursing homes will be contacted beforehand.  Every nursing home in the country will be assigned to a hub, though they can decline to participate.

The approximately 30 participants in each group will learn together using the 16-week curriculum on COVID safety, quality, leadership, and other topics.  Each participating nursing home will also be provided a contact line for issues and challenges they are struggling with for help in real time.

LeadingAge will participate in an AHRQ advisory panel to help shape the program and review implementation.  LeadingAge can also bring your concerns back to AHRQ for discussion and resolution.  Reach out to Janine Finck-Boyle (JFinck-Boyle@leadingage.org ), Jodi Eyigor (JEyigor@leadingage.org), or Ruth Katz (RKatz@leadingage.org) with questions.

CMS phasing in participation in Review Choice for HHAs

The Centers for Medcare & Medicaid Services (CMS) is phasing in participation in the Review Choice Demonstration for Home Health Agencies (HHAs) in several states, for a limited period of time, to help ease the transition during the current public health emergency. 

Specifically, for HHAs in Ohio, Cycle 2 will begin on August 31, 2020.  Claims submitted under Choice 1 without going through the pre-claim review process will not be subject to a 25% payment reduction until further notice, but will be subject to prepayment review. 

LeadingAge submits home health rule comments

LeadingAge submitted comments responding to the CY 2021 home health proposed rule. LeadingAge did this in conjunction with partners ElevatingHOME and the Visiting Nurse Associations of America (VNAA). While the Centers for Medicare & Medicaid Services (CMS) did not offer many changes beyond the statutory requirement to update the payment rate, which is 2.7% for CY 2020, LeadingAge did offer feedback on a number of items.

LeadingAge recommended:

• CMS not use data from CY 2019 to base changes to the Patient-Driven Groupings Model (PDGM) as COVID-19 has caused such profound changes to utilization patterns and spending.
• CMS consider ways to determine reimbursement for telehealth services by home health agencies despite the statutory obstacles that LeadingAge continues to advocate with Congress to fix.
• CMS limit the potential penalty related to the deadline of RAP submissions from every 30-day episode to only the start for care in 2021 to mimic the policy in 2022 and forward when the RAP is replaced by a Notice of Admission.
• CMS adopt administrative policy changes that reduce the burden for home health agencies to utilize disposable negative pressure wound therapy treatment.

Medical review resumes this month for home health and hospice

Medical review resumes this month for home health and hospice providers. 

Below is a summary, with more detailed information to follow. Providers should expect to see resumption of additional development requests (ADRs) next week, if they have not seen them already.  Providers can look in the claims processing system for claims with status S B6001 which indicates that an ADR has been issued for the claim.  

Home Health

• CGS: Medical Necessity         
  Reason code: 5L000
• This review selects any home health claim with 2 to 6 visits and a diagnosis code of I11.0, Z46.6, J44.1, I10, J44.9, G20, I25.10, N39.0, J18.9, or I87.2 submitted with dates of service prior to March 1, 2020.
• NGS:  Not yet posted due to NGS website technical difficulty. 
• Palmetto: Home Health Services for Eligibility and Medical Necessity.
• Review of inpatient claims submitted for Home Health Services for Eligibility and Medical Necessity

Hospice

• CGS: Not posted. CGS is starting with home health medical reviews and does not know when the hospice reviews will begin. 
• NGS: Not yet posted due to NGS website technical difficulty.
• Palmetto: General Inpatient Care (GIP).
• Review of inpatient claims for Inpatient Hospice Care greater than or equal to 7 days for Revenue Code 656 and place of service codes Q5004–Q5009

LeadingAge Need to Know: COVID-19 – August 24, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured an overview of keynote sessions for the virtual LeadingAge annual meeting and information about, today's LeadingAge update call which features infectious disease expert Dr. Monica Gandhi from the University of California. Check out the full report here.

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.