Newsletter – January 2019
Happy New Year 2019!
New Year, New OASIS!
As we had discussed last Spring and throughout the year thereafter, OASIS D was scheduled to go into effect on January 1st, 2019. In addition to a list of new codes designed to increase the transparency of patient care, there are new questions, and a quick patient mental health assessment that go into the process now. Here’s a refresher on some of the new procedural codes to look out for:
- M1703 – Depression Screening. These are completed as often as 3 times over the course of the patient’s care; Start of Care, Resumption of Care, and at the time of Discharge.
- M1210 – Ability to Hear. These are completed on Start or each Resumption of care.
- M1200 – Vision. Also completed on Start of Resumption of care.
- C0100 – Cognition Patterns. This is the short mental health assessment, to be performed at all Start and Resumptions of Care.
- C1300 – Signs and Symptoms of Delirium
(For a complete list, check out our July 2018 newsletter at: https://certifiedhomecareconsulting.com/newsletter-july-2018/)
There have been several EMR’s reporting issues with OASIS D Exports. These issues should be completely resolved before the end of January, though the specific date will be provided by your chosen vendor for Electronic Medical Records software.
Medicare Part D Advantage Changes: Addition of Personal Care Services Reimbursement
Earlier this year, the Trump Administration expanded the services being covered for reimbursement under the insurance plan to include Personal Care and Daily Living services to further support seniors living independently at home.
Just about one-third of all Medicare’s enrolled recipients are actually enrolled into Medicare Advantage plans.
To date, not many Medicare Advantage insurance plan providers have had the time to put together an offering for members that includes these new supplemental services, as it was only introduced publicly this past Fall, and most already have the the plan adjustments completed by mid year to prepare for the open enrollment season, which occurs annually between November and December. The few that have will go into the 2020 season with the added advantage of new data in terms of early member adoption rates, and how predetermined levels of services provided might be enhanced in the upcoming plan year. Here are some of the plan features being set forth by the early adopters in the 2019 plan year:
- Up to 16 home delivered “healthy’ meals per health event, or no more than 64 meals per year. A qualifying health event may be a hospital discharge, or if a member is very overweight or has severe uncontrolled diabetes.
- Up to 60 one-way trips per year to health-related appointments or other covered services.
- Up to 124 hours of support from a home health aide or similar assistance.
- A $500 allowance for safety devices such as shower stools, reaching devices, or temporary wheelchair ramps.
- Up to 1 visit per week for adult day services.
- Up to 24 acupuncture and/or therapeutic massage visits.
These benefits currently vary based on region, and will surely continue to be refined as real-time implementation provides crucial data toward what variations to future offerings might best serve seniors opting for these plans, as well as what works best for insurance and care providers in rolling out these services.
These changes in Medicare Advantage Plan benefits represent a massive opportunity for non-medical home care agencies, as they were previously barred from seeking any reimbursement through Medicare for services provided to members because Medicare has traditionally covered medical necessities for it’s members, and not personal care or daily living assistance services where the rehabilitation process did not call for medical treatment. The support hours provided in the 2019 plans alone represent approximately $2,000 per patient newly available to these agencies.
Medical Home Health News
Home Health Agencies
The MassHealth moratorium affecting Home Health Service providers has been granted an additional 6-month extension by CMS, continuing to cite the growth in home health spending, and the number of new providers in the Commonwealth as risks to the integrity of the system, with the continued absence of a regulatory license process. This means that any Home Health Services provider that was not enrolled as a provider with MassHealth prior to February 11th, 2016 will not be able to become a provider for the network. This moratorium applies to MassHealth Waiver program enrollment as well. CMS Medicare continues to certify new providers in the Commonwealth with no changes to that process. The moratorium will be revisited by MassHealth on February 10th, 2019 to determine its necessity to continue in place.
Adult Foster Care Program (AFC), Shared Living and PCA/PCM
The MassHealth moratorium affecting Adult Foster Care providers has also been granted an additional 6-month extension by CMS. MassHealth has additionally added it’s Shared Living, and PCA/PCM programs to this moratorium. This means that any AFC provider that was not enrolled as a provider with MassHealth prior to April 1st, 2017 will not be able to become a provider for the network. The moratorium will be revisited by MassHealth on April 1st, 2019 to determine its necessity to continue in place.
Group Adult Foster Care (GAFC)
While no moratorium for this program has been announced and both the GAFC program director Allison Ananis and the director of Long Term Services and Supports (LTSS) Whitney Moyer have been emphatic in their assurances that the program is not going into moratorium, all agency applications have been on hold as the program undergoes revisions to it’s enrollment process since mid-June of 2018. Neither department has been able to provide a timeline as to the completion of these revisions, and the resumption of enrollment processing.
Beginning January 1st, 2019 CMS will be adopting the newest version of the OASIS program, OASIS – D to replace OASIS C-1. Several new elements are being added to this update, as well as some wording changes. The new elements include:
- Revised Coding
- Patient Independence Ratings
- 6 Point Assessment Scale
And much more. Call today to find out about ongoing training sessions.
ACHC, our preferred Accreditation partner for Home Hospice agencies (www.achc.org) will be making minor changes to their Accreditation requirements, mainly focusing on personnel and other in-office areas, in June of 2018. Keep an eye out for the full list of updates.
Please be sure that you understand your Emergency Preparedness Plan (EPP), Quality Assurance (QA) program, as well as the process and requirements involved in hiring of qualified personnel.