Last week, DSS posted an intent to apply for a State Plan Amendment (SPA) to ensure they can still use the ARPA dollars set aside for infrastructure payments/support for home and community-based providers to integrate their systems for Connie data transfers.

The SPA proposal can be found here: SPA 24-AD: Value Based Purchasing Benchmark Payments for HCBS ARPA Funding

Comments are due by 12/11/24. The Association needs your feedback by 12/9/24 to be able to incorporate into our overall comments. Please contact Tracy Wodatch (wodatch@cthealthcareathome.org) with questions or suggestions.

Source: The Alliance, November 22, 2024

The Preliminary October 2024 Interim Performance Reports (IPRs) for the expanded HHVBP Model are now available on the Internet Quality Improvement and Evaluation System (iQIES), and home health providers have until December 6, 2024, to submit a recalculation request, should that be necessary.

The quarterly IPRs provide home health agencies (HHAs) with the cohort assignment, performance year measure data for the 12 most recent months, and the interim Total Performance Score (TPS). Using the IPR, an HHA can assess and track their performance relative to peers in their respective cohort throughout the expanded Model performance year. The October 2024 IPRs also report preliminary Achievement Thresholds (AT) and Benchmarks (BM) by volume-based cohort for the quality measure set applicable to the third performance year, CY 2025, and following performance years, respectively.

Source: The Alliance, November 22, 2024

All indications are that the Centers for Medicare & Medicaid Services (CMS) is moving forward with the Hospice Special Focus Program (SFP) as planned. As part of this rollout, 50 hospices will be selected for the first SFP cohort. We anticipate these hospices will soon be notified. Following that notification, CMS plans to publish a list of hospices identified as eligible SFP candidates based on its current methodology.

We recognize the concerns this program raises, particularly around the reliance on flawed and incomplete data. Despite repeated advocacy efforts from the Alliance, the entire hospice community, and our congressional champions including Representative Jimmy Panetta (D-CA), the author of the HOSPICE Act which created the SFP, CMS has not addressed these issues. The release of this information may lead to unintended harm for patients and providers.

While this is a critical moment, there is still time for CMS to change course. If it does not, Members of Congress can take action to hold them accountable and make necessary reforms.

To help you stay prepared, the Alliance has compiled the latest information and materials for members, which you can access here: Hospice Special Focus Program Resources.

 

Source: The Alliance, November 26, 2024

The Office of Management and Budget (OMB) has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123), and the Detailed Explanation of Non-Coverage (DENC, CMS-10124). The NOMNC and DENC renewed notices contain updates which are applicable only to Medicare Advantage (MA) enrollees. Providers must use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025.

The NOMNC has been modified to reflect regulations providing MA enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date.

Additionally, DENC and instructions have been updated to include a new element for health plans to complete along with special instructions for repeat appeals within the same episode of care.
HHAs, SNFs, hospices, and CORFs are required to provide a NOMNC to beneficiaries when their Medicare covered service(s) are ending. The NOMNC informs beneficiaries on how to request an expedited determination from their BFCC-QIO and gives beneficiaries the opportunity to request an expedited determination from a BFCC-QIO. A DENC is given only if a beneficiary requests an expedited determination. The DENC explains the specific reasons for the end of covered services.

The revised notices can be found on the Beneficiary Notice Initiative website and are the last four links in the download section.

Source: The Alliance, November 21, 2024

In light of a recent data breach that could compromise a beneficiary’s MBI, the Alliance submitted to the Centers for Medicare & Medicaid Services (CMS) the following question. Following the question is CMS’ response.

 

Note: Changes to a beneficiary’s Medicare Beneficiary Identifier (MBI) can affect the match. If an HHA becomes aware of a change to the MBI via the MBI look-up tool and uses the new MBI on their claim when the prior MBI was used on the OASIS, that will cause the claim to be returned. In these cases, HHAs should update item M0063 on the OASIS and then resubmit the claim.

Source: HHS-OIG, November 29, 2024

 

The selected HHAs complied with terms and conditions and federal requirements for expending PRF funds. Accordingly, this report does not contain recommendations.

Calling all leaders! It’s time to inspire, motivate, and lead at the Twenty-Second Annual Northeast Home Health Leadership Summit. Join us for a powerful gathering of industry experts and visionaries. Register now and be part of the conversation shaping the future of home care! 

Source: Ana Handshuh & Julie Kennedy, RubyWell