MHPCA Monthly Quality & Compliance Update
Jane Moore
MHPCA Quality & Compliance News
Your
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Hospice
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Regulatory
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Keeping you up-to-date on the ever-changing world of hospice and palliative care. Please share this summary with your staff to ensure they are aware of items pertinent to their areas of responsibility.
NATIONAL NEWS – CMS / MEDICARE / OIG / DEA / ETC.
October 2016
All Providers
New Resources on Nondiscrimination Rule Posted
Attention: All Providers
HHS OCR has posted new resources for providers to address the Nondiscrimination Rule requirement to include taglines and notices in the top 15 languages. Beginning on October 17, 2016, covered entities will be required to post Notices of Nondiscrimination and Taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services. OCR has posted a FAQ Document and a table of the top 15 languages for each state. Note that there is no requirement to use the exact list of languages that OCR has if you have developed a list that differs somewhat from theirs.
As a reminder, the notices and taglines are posted in a large number of languages. View the translated materials online.
OIG Exclusion List Updated
Attention: Human Resource Staff of All Providers
The updated list of excluded providers has been posted by the OIG. All providers need to regularly compare the list to its employee, physician and contract vendor list to ensure there is no relationship with any of the excluded individuals or companies. It is best practice to review the full list in case someone was added to the list through activities in another state. All of the updated files are posted at https://oig.hhs.gov/exclusions/exclusions_list.asp.
CMS Issues New Emergency Preparedness Rule
Attention: All Providers
CMS has issued the final rule, Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, which will add a new Condition of Participation for hospices at 418.113 and for home health providers at 484.22. The rule will publish in the Federal Register on September 16. While the rule is effective November 15, 2016, providers will have until November 15, 2017 to implement the requirements of the rule.
CMS took a full three years to review comments they received on the proposed rule and carefully consider the final requirements. They determined that existing regulations are not comprehensive enough, particularly in regard to employee training, communication and coordination with other entities in the community and state, and for contingency planning. CMS notes in a press release that providers will have to meet four best practice standards as follows:
1. Emergency plan: Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier.
2. Policies and procedures: Develop and implement policies and procedures based on the plan and risk assessment.
3. Communication plan: Develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems.
4. Training and testing program: Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan.
We have pulled the sections relevant to hospices into a separate document. Included is the new Condition of Participation and the comments and CMS responses. Also, the Regulatory Impact Analysis section is included as this gives insight into what CMS expects it to cost in terms of staff time and finances to implement.
CMS is developing additional resources and will have a training course ready early next year. In the meantime, they have additional information on the Survey & Certification – Emergency Preparedness webpage. The final rule will publish officially in the Federal Register on September 16.
Survey & Certification Letter Related to Emergency Preparedness Compliance
Attention: Hospice & Home Health Providers
CMS has issued a Survey & Certification Letter, “Notification of Final Rule Published – Emergency Preparedness, S&C: 6-38-ALL,” to state survey agencies to address the requirements to comply with the new Emergency Preparedness final rule by November 16, 2017.
Home Health & Hospice Providers
Attention: Hospice & Home Health Providers
Review the September 2016 Home Health and Hospice Medicare Advisory to ensure your agency is current.
CMS Publishes Transmittals
Attention: Hospice & Home Health Providers
CMS has published transmittals on topics of interest to all providers. Below is a summary of each. View each change request for full details. These transmittals do not require action from providers.
• CR9617: – Adding a Foreign Language Tagline Sheet to Medicare Summary Notices (MSNs) – CMS is requiring the Medicare Administrative Contractors (MACs) to add a new last page to the Medicare Summary Notices (MSNs) to comply with the Final Rule for Section 1557 of the Nondiscrimination Provision of the Affordable Care Act. This page will contain foreign language taglines in 15 different languages and must be implemented by the October 28. This information is shared to make you aware in case patients or families ask questions.
• CR9396: Update of Payment Suspension Instructions – This transmittal addresses revisions to the payment suspension instructions in the CMS Program Integrity Manual (Pub. 100-08), Chapter 8, Administrative Actions and Statistical Sampling for Overpayment Estimates. This CR addresses actions the ZPIC will take to coordinate with the MACs when suspension of payment for a provider is warranted. This is effective November 23, 2016.
Multiple Managers & Staff
OIG Releases Report on Hospice Election Statements & Certifications of Terminal Illness
Attention: All Hospice Staff
The Office of Inspector General (OIG) has released the second report for this year based on general inpatient stays – Hospices Should Improve Their Election Statements and Certifications of Terminal Illness (OEI-02-10-00492). This study was conducted because prior studies had shown that election statements were misleading and physician involvement in care planning was not as expected. Election statements and certifications of terminal illness were reviewed from a random sample of 565 GIP stays in 2012. OIG will be providing to CMS a list of those hospices whose records were incomplete or erroneous.
OIG found that hospice election statements were missing required information or had other vulnerabilities in more than one-third of GIP stays. Most significant is that 19% did not specify that the beneficiary was electing Medicare hospice. In addition, the forms did not always include a statement to indicate that the beneficiary was waiving coverage for certain Medicare services (12%) or that hospice care is palliative rather than curative (9%). There was also incorrect or missing language about other aspects of the Medicare Hospice Benefit.
OIG had concerns with physician aspects in 14% of stays. In 10% of stays there was no physician narrative or it included only a diagnosis. The attestation statement was absent from 5% of the narratives. The findings suggest to the OIG that physicians had limited involvement in determining eligibility for hospice care.
The OIG has four recommendations for CMS as follows: (1) develop and disseminate model text for election statements; (2) instruct surveyors to strengthen their review of election statements and certifications of terminal illness; (3) educate hospices about election statements and certifications of terminal illness; and (4) provide guidance to hospices regarding the effects on beneficiaries when they revoke their election and when they are discharged from hospice care. CMS agreed with the first 3 recommendations and will continue to monitor revocations and discharges.
Quality Staff
CMS Posts CAHPS Hospice Survey Materials
· Quality Assurance Guidelines – The CAHPS Hospice Survey administration protocols are contained in the CAHPS Hospice Survey Quality Assurance Guidelines Version 3.0 (QAG V3.0). Access the QAG V3.0 and a document outlining the major changes in the QAG on the Quality Assurance Guidelines webpage. Review the changes to ensure compliance.
· CAHPS Hospice Survey Training Materials – CMS has posted the agenda and PowerPoint slides for the September 28, 2016 CAHPS Hospice Survey Training session. They are available on the Training Materials webpage.
Compliance Staff
Life Safety Code Survey Process Addressed
Attention: Hospice Facility Managers & Safety Officers
CMS has issued Transmittal 159, Revisions to the State Operations Manual (SOM), Appendix I – Survey Procedures for Life Safety Code Surveys. The purpose of this transmittal is to reinstate guidance to Life Safety Code surveyors regarding the survey procedures for Task 4, Information Gathering. This guides the LSC surveyors on what to assess as they determine compliance. It also adds more specific information regarding sharing specific regulatory references or tags during the exit conference within Appendix I of the SOM. This exit conference language is similar to what has been addressed by CMS previously.
Review PEPPER!
Attention: Home Health & Hospice Managers & Compliance Staff
Many providers have not retrieved their PEPPER and TMF wants to stress the importance of retrieving the report. This report summarizes a provider’s Medicare claims data statistics for areas that have been identified as at higher risk for improper Medicare payments. The information can be used identify areas where a provider may be at higher risk for improper payments and can guide quality improvement activities.
Go to https://pepperresources.org/ to access the report and training materials.
Palliative Care Providers
Part B Medicare Advisories Posted
The October 2016 Medicare Part B Advisory and Part B Medicare Advisory for September 2016 are available. Please review for Medicare policy and coverage updates as well as announcements for upcoming provider education opportunities. Please remember to share this information with your staff.
Jane Moore
CEO
Missouri Hospice & Palliative Care Assn.
600 Monroe Street
Suite 300
Jefferson City, MO 65101
Phone 573-634-5514
Fax 573-635-0659
Please save the date for the Midwest Conference October 2-4, 2016 Tan-Tar-A Resort
Have you signed your aides up for EDNA? Mohospice.telspanexam.com