NAHC Regulatory Affairs

The Regulatory Affairs division is responsible for keeping abreast of current federal regulations and government policies that affect an agency's day to day operations as well as its long term business planning. The regulatory staff is often the first to learn of regulatory changes that have both direct and indirect effects on the home health and hospice industry. This up to the minute tracking of key regulatory events enables members to stay ahead of the curve in a rapidly changing health care environment.

Providers have access to a knowledgeable and experienced team with whom they can interact on an individual basis to assist in understanding complex regulatory mandates.

Unraveling the complexities of OASIS, the home health prospective payment system, and most recently, the expedited determination process for original Medicare beneficiaries, are just a few examples of how the regulatory staff has assisted its members.

NAHC continues to work with officials at CMS to bring forth provider concerns on current and impending federal regulatory and policy issues and their impact on the home health and hospice industry.

Documents labled with a are viewable by NAHC Members only.

Home Health PPS 2011 Final Regulation

The Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare Home Health Prospective Payment (HH PPS) rates for calendar year (CY) 2011. Link CMS-1510-F

	NAHC Report Article 11/12/2010: A Closer Look: Home Health Face-to-Face Encounter under the 2011 PPS Rule
	NAHC Report Article 11/2/2010: CMS Issues Final Rule on 2011 Home Health Payment Rates, Hospice and Home Health Face-to-Face Encounter Requirements, and More
	NAHC Report Article 11/3/2010: A Closer Look: CY 2011 Home Health Payment Rates Explained
	PPS Overview Webinar
	New HCPCS G Codes for Home Health Service
NAHC responses to PPS Update questions Note: A number of questions await CMS clarification
	PPS 2011 Face-to-Face Q & A
	PPS 2011 Face-to-Face Q & A; December 17, 2010
	PPS 2011 Payment Q & A
	PPS 2011 Therapy Services Q & A
	PPS 2011 36 Month Rule Q & A
PPS Face-to-Face Encounter Model Letters and Tools
	1. Model Patient Letter
	2. Model Patient Information
	3. Model Notice Potential Discontinuation of Care
	4. Model Notice Nonacceptance
	5. Model Notice of Termination
	6. Model Generic Letter Physician
	7. Model Referring Physician Letter
	8. Model Referring Source Notice
	9. Model Physician Referring Overview Face-to-Face
	10. Model Guide to Documentation
Hospice Face-to-Face Encounter and Related Requirements
	CR 7337/Transmittal 141: New Hospice Certification Requirements and Revised Conditions of Participation (CoPs)
	1. Model Hospice Patient Information on Face-toFace Encounters
	2. Model Hospice Patient Letter
	3. Model Face-to-Face and Narrative for Recerticication of Terminal Illiness for Hospice
	4. Model Physician Face-to-Face and Narrative for Recertification of Terminal Illness for Hospice
	5. Hospice Face-to-Face Q & A

NAHC Resources

2012 Physician payment rates for care plan oversight and home health certification and recertification

The updated 2012 physician payment rates reflect rates for dates of service January 1, 2012, through February 29, 2012. Section 301 of the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA) prevents a payment cut for physicians that would have taken effect January 1, 2012. An update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012. We will resume selling our Physician Payment for Homecare & Hospice Services  publication once Medicare physician payment rates have been established for the remained of 2012.

2012 Physician payment rates for care plan oversight and home health certification and recertification

NAHC PECOS LookUp Tool Kit

Welcome to the National Association for Home Care & Hospice’s (NAHC) PECOS LookUp Tool. This tool contains the latest PECOS dataset along with the latest PECOS Pending dataset available to NAHC as supplied by CMS and will allow you to check your physician’s existence in the PECOS database.

NAHC PECOS LookUp Tool Kit

Red Flags Rule: NAHC Guidance and Sample Policy

Medicare Influenza Vaccine Guide for Providers

Emergency Preparedness Resources

The packet was developed by the NAHC Emergency Preparedness Workgroup and provides tools to assist agencies, patients and their families, and agency staff develop emergency preparedness plans. The guide has been updated to include the OASIS-C.

Emergency Preparedness Packet for Home Health Agencies-2010

The four page disaster planning guide was developed by the Department of Homeland Security to assist home health providers and their patients.

Preparedness Planning for Home Health Care Providers

Pandemic Influenza Preparedness Resources

Home Health Care During an Influenza Pandemic: Issues and Resources

OSHA - Occupational Safety and Health Administration

	Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers
	Guidance on Preparing Workplaces for an Influenza Pandemic

Regulatory Blueprint for Action

2011 Regulatory Blueprint for Action

Proposed Regulations
Proposed regulations are preliminary federal rules that are established by the various government agencies and published in the Federal Register.

Comments on Proposed Regulations
Proposed regulations have a thirty to ninety day comment period where by all interested persons may submit written comments on the proposed rules prior to a final action.

PPS Update Rule 2011
	NAHC HH PPS 2011 Comments
	Exhibit A: Dobson DaVanzo Report "Analysis of Home Health Prospective Payment System Notice of Proposed Rulemaking for Calendar Year 2011"
	Exhibit B: Lewin Report "Evaluation of the Proposed Coding Adjustment for Home Health Prospective Payment System for CY 2011"
	Exhibit C: Hospice Association of America "Face-to-Face Encounter:" Letter to CMS

Home Health Statute and Regulations
After comments to a proposed rule are analyzed by the respective government agency, a final regulation is published in the Federal Register. These final regulations are what govern the implementation of Federal programs.

Home Health Regulations

	Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012; Final Rule
	Medicare Program: Home Health Prospective Payment System Refinement and rate Update for Calendar Year 2008
	Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2009
	Home Health Basis, purpose, and scope
	Requirements for Payment
	Plan of Care Requirements
	Skilled Services Requirement
	Dependent Services
	Allowable Administrative Costs, Place of Service Requirements, and Visits
	Excluded Services
	Criteria for Skilled Service and the Need for Skilled Service
	Examples of Skilled Nursing and Rehabilitation Services
	Particular Services Excluded from Coverage

Medicare Statute

	Definition of Home Health
	Conditions and Limitations of Payment for Services (Provides skilled nursing, therapies, plan of care, and homebound requirements interspersed with other provider requirements)
	Limitation on Liability When Claims are Denied
	Waiver of Recovery of Payment
	Exclusions from Coverage

Local Coverage Determinations

Decisions by a fiscal intermediary or carrier whether to cover a particular service:

Beneficiary Notices
Home health agencies are required to provide notice of Medicare non-coverage of services to beneficiaries.

CMS Beneficiary Notice Initiative web site

Medicare Home Health Prospective Payment System (PPS)
Home health agencies are paid prospectively, based on a case-mix system, for their services. The Centers for Medicare & Medicaid Services (CMS) offers detailed information about the PPS methodology and payment calculations on its web site.

	CMS Home Health Center
	CMS Home Health Prospective Payment Question & Answers
	Home Health PPS Pricer
	Home Health Consolidated Billing List 2009
	2011 PPS Payment Calculator-Urban
	2011 PPS Payment Calculator-Rural

Medicare Home Health Conditions of Participation and Guidance to Surveyors
In order to be certified as a provider of Medicare services home health agencies are required to comply with certain regulations. The regulations and instructions to State surveyors are available on-line.

Medicare Home Health Conditions of Participation and Guidance to Surveyors

OASIS-C
The Centers for Medicare & Medicaid Services (CMS) requires home health agencies to use a standardized assessment tool for all Medicare and Medicaid patients. OASIS-B1 is being replaced wiith OASIS-C effective for all assessments completed on or after January 1, 2010. The following documents have been provided by CMS to assist home health agencies transition to and train their staff in OASIS-C.

	OASIS-C August 2009 Version
	OASIS-C Guidance Manual
	OASIS-C Q&A 1/2011

OASIS-C Training Video
“OASIS-C: What You Must Know”  NAHC has arranged for a free video link to the 4 hour preconference from the NAHC Annual Meeting for all home health agencies. The presenters were the CMS contractors who were responsible for the development and testing OASIS-C. This video, with synchronized session handouts, provides: an overview of the design of OASIS-C; in-depth information on the new and revised OASIS items; conventions for accurate OASIS coding; and guidance for implementation. The content and materials presented during the conference were approved by CMS. This free four-part video can be accessed at: www.dcprovidersonline.com. The power point presentation and additional materials (including the OASIS-C data set, Conventions, and Item Usage chart) can be found by scrolling down to Program 900 at: 2009 Annual Meeting Handouts.

Consumer Assessment of Health Providers and Systems (CAHPS)
The term CAHPS refers to a comprehensive and evolving family of surveys that ask consumers and patients to evaluate the interpersonal aspects of health care. CMS and AHRQ have developed a Home Health CAHPS tool for surveying home health patients. Results of these surveys will be publicly reported on Home Health Compare in late 2010 or early 2011. Participation is voluntary, but Medicare payments may be reduced for agencies that do not participate.

Detailed information about the HH CAHPS