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CMS Holds Open Door Forum

Wednesday, March 7, 2018   (0 Comments)
Posted by: Mandy Rubenstein
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CMS held an Home Health, Hospice & DME Open Door Forum on February 28, 2018. A summary of the call follows.

  1. Home Health Agenda Items
  1. Claims Adjustments for 2018 Home Health Rural Add-on Payments
    • MAC software will begin adjusting for the rural add-on from the Bipartisan Budget Act of 2018 beginning with claims received on April 2, 2018. Shortly after that date, MACs will begin reprocessing previous claims from this year which are also eligible for the rural add-on. Providers do not need to take any action.
  1. Posting of Materials from Abt Associates’ Home Health Technical Expert Panel Meeting held on February 1, 2018
    • CMS previously made materials from the TEP available here.
    • CMS was asked about the next steps of the TEP by a Partnership member. CMS provided that a summary of the TEP is being developed and will be released at a date to be determined.
    • CMS is still considering next steps for the TEP.
    • Any questions or comments about this Technical Report should be sent to:
  1. Clarification in calculation of the cross-setting measure Percent of Residents or Patients with Pressure Ulcers that are New or Worsened
    • An updated quality measure specifications document for the cross-setting measure Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened is now available in the Downloads section of the Quality Measures webpage. The measure specification logic has not changed but language has been added to clarify how valid skips are accounted for in the measure denominator.
  1. Changes to the on-demand CASPER reports
    • Changes are being made to reflect the removal of measures that were removed per the PPS rule.
  1. Changes to the calculation algorithm for “Timely Initiation of Care” to align with the new CoP
    • The Medicare Conditions of Participation (CoPs) for home health agencies that became effective January 13, 2018 included a change regarding resumption of care (ROC) dates for patients returning to home health following an inpatient stay.  Specifically, the revised guidance allows for a physician ROC date as an alternative to the fixed 48-hour timeframe for the post-hospital reassessment. 
    • To align with this CoP change, updated logic for the Timely Initiation of Care process measure has been posted in the “Downloads” section here. With this update, an episode will also be included in the numerator (achieve success in the measure) when the physician-ordered ROC date is later than two days after inpatient stay and the agency completes the ROC assessment on the physician-ordered ROC date.  Use of this new calculation logic will be effective for quality episodes that begin on or after January 13, 2018.
    • This change will be reflected in the Quality of Patient Care Star Rating and Home Health Compare Preview Reports available in September 2018 for the January 2019 Home Health Compare update. Also, in September CMS will retroactively apply these specifications to the confidential feedback and Review and Correct reports available through CASPER.


  1. Update for HHCAHPS
    • All Medicare-certified home health agencies (HHAs) seeking an exemption from participating in the HHCAHPS Survey for the CY2019 APU to submit a Participation Exemption Request (PER) form on the HHCAHPS website.  
    • The deadline for submitting the CY 2019 APU exemption request is 11:59 PM Eastern Time Monday, April 2, 2018. This deadline has been extended because March 31, 2018 falls on a Saturday.
    • As announced in the Home Health Prospective Payment System (HH PPS) Rate Update Final Rule for Calendar Year 2018 that was published in the Federal Register on November 7, 2017, Medicare-certified HHAs that served 59 or fewer unduplicated patients between April 1, 2016 and March 31, 2017 who met survey eligibility criteria can request a PER for the CY 2019 APU.
  1. Low Volume Appeals Opportunity Announcement
    • On February 5, 2018, CMS started accepting Expressions of Interest for the Low Volume Appeals (LVA) settlement process. The LVA settlement option is for providers, physicians, and suppliers (appellants) with:
      • Fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals and the Medicare Appeals Council at the Departmental Appeals Board, combined, as of November 3, 2017
      • A total billed amount of $9,000 or less per appeal
    • For more information on participating in LVA to address pending appeals:


  1. Hospice Agenda Items
  1. Update on electronic submission of hospice Notices of Election
    • The previous error with submission of hospice Notices of Election via EDI was successfully resolved on February 5, 2018. Hospices may submit NOEs electronically or though DDE.
  2. HIS Modifications After Preview Reports
    • CMS has noticed an increase in HIS modification after preview reports. Providers are encouraged to review their reports early and often.
  1. Open Q&A


  • Face-to-Face in Bipartisan Budget Act- CMS will provide additional information in the proposed rule
  • TEP- CMS was asked about the future of the TEP. CMS provided that a summary of the TEP is being developed and will be released at a date to be determined. CMS is still considering next steps for the TEP.
  • DMEPOS Competitive Bidding- CMS had no update but will provide updates through its regular channels.

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