Compliance Monitor (6/7/2024)

Compliance Monitor (6/7/2024)

CHAP is always seeking resources and insights to enhance the knowledge of partners and customers. 

Be sure to download CHAP’s Compliance calendars for home health and hospice. 

Hospice Updates 

CMS recently updated the Hospice Certifying Enrollment Q&As with additional details about how claims are to be completed and how the edits are applied. At this time, CMS has not corrected or clarified the discrepancies we have identified between the Hospice Certifying Enrollment Q&As and the Claims Processing Manual. CMS though has specified, however, that the policies in the Q&A document supersede those in the March 26, 2024 updates to the Hospice Certification Requirements of the MLN Payment Processing publication. 

CMS Posts Revisions to the State Operations Manual (SOM) Appendix M-Hospice 

SUMMARY OF CHANGES:  

The hospice interdisciplinary group (IDG), care planning, and coordination of services CoP at 42 CFR 418.56 was updated to require that the IDG must include at least a social worker (SW), MFT, or MHC. The hospice is not required to include all three of these professions as members of the IDG and may choose (though is not required) to select more than one of these professions to serve as member(s) of the IDG. The definitions of the MFT and MHC disciplines (as defined at 42 CFR 410.53 and 410.54, respectively) have also been added to the hospice personnel qualifications CoP at 42 CFR 418.114(b) 

This transmittal includes revisions to the SOM Appendix M based on the recent federal regulation changes based on the CY 2024 Physician Fee Schedule final rule that was published on November 16, 2023, and titled Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program. The regulations in the final rule are effective as of January 1, 2024 

Read CMS Memo QSO-24-12-Hospice & FQHC/RHC – https://www.cms.gov/files/document/qso-24-12-hospice-fqhc/rhc.pdf 

NOW AVAILABLE IN QIES – Hospice Preview Reports for the August 2024 Refresh 

Providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. Once released in CASPER, providers will have 30 days during which to review their quality measure results.  Although the actual “preview period” is 30 days, the reports will continue to be available for another 30 days, or a total of 60 days. The preview period for the latest Provider Preview Report lasts from June 3, 2024, to July 3, 2024. CMS encourages providers to download and save their Hospice Provider Preview Reports for future reference, as they will no longer be available in CASPER after this 60-day period.   

Home Health Updates 

CMS Expanded HHVBP Model FAQs – May 2024 

An updated edition of the Expanded HHVBP Model FAQs – May 2024 is now available on the CMS Expanded HHVBP Model webpage. The FAQs assist HHAs in understanding common terms and essential elements of the expanded HHVBP Model. The HHVBP Team provides updates to the FAQs as needed and notifies HHAs who have signed up to receive communications when an updated version is available. The Expanded HHVBP Model FAQs – May 2024 document is available in FAQs & Model Guide Section on the CMS Expanded HHVBP Model webpage. 

FY 2025 SNF VBP Program June 2024 Quarterly Reports are Now Available 

The June 2024 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2025 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). 

These reports contain facility and stay-level data for the SNF 30-Day All-Cause Readmission Measure (SNFRM) for FY 2023, the FY 2025 SNF VBP Program performance period. These results will be used for the FY 2025 SNF VBP Program year scoring and incentive payment calculations that will take effect October 1, 2024. Performance scores and incentive payment multipliers for the FY 2025 SNF VBP Program year will be disseminated in the August 2024 Performance Score Reports. 

SNFs may submit corrections to their FY 2023 readmission measure rate up to 30 days following this report being made available, until July 3, 2024. Corrections are limited to errors made by CMS or its contractors when calculating a SNF’s readmission measure rate. SNFs must submit correction requests to SNFVBP@rti.org with the subject line “SNF VBP Review and Correction Inquiry” along with your SNF’s CMS Certification Number (CCN), SNF’s name, correction request, and reason for requesting the correction. 

These reports contain stay-level data protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Any disclosure of protected health information (PHI) or personally identifiable information (PII) should only be in accordance with, and to the extent permitted by, the HIPAA Privacy and Security Rules and applicable law. When referring to the contents of the report, use the Line Number (located in the leftmost column of the ‘2 – Eligible Stays’ tab) of the stay in question. 

To locate your new report in iQIES, please follow the instructions listed below: 

  1. Log into iQIES at https://iqies.cms.gov/ using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password. (If you do not have a HARP account, you may register for a HARP ID.) 
  1. In the Reports menu, select My Reports. 
  1. From the My Reports page, locate the MDS 3.0 Provider Preview Reports folder. Select the MDS 3.0 Provider Preview Reports link to open the folder. 
  1. Here you can see the list of reports available for download. Locate the desired SNF VBP Program Quarterly Confidential Feedback Report. 
  1. Once located, select More next to your desired SNF VBP Program Quarterly Confidential Feedback Report and the report will be downloaded through your browser. Once downloaded, open the file to view your facility’s report. 

For additional questions about accessing your SNF’s report, which can only be accessed in iQIES, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or by email at iqies@cms.hhs.gov. 

DME Update 

Learn about revisions to the manual (PDF), including 2024 update factors. 

All Provider Updates 

CMS Updates Stay of Enrollment Article 

The CY 2024 Physician Fee Schedule (PFS) Final Rule contains provisions about Medicare provider enrollment. One of these provisions is the creation of a new provider enrollment status labeled a “stay of enrollment.” Stay of Enrollment Stay of enrollment is a CMS action that’s less burdensome on providers and suppliers than a deactivation or revocation of your Medicare enrollment. A stay of enrollment (or “stay”) is a preliminary, interim status representing a pause in enrollment.  CMS revised the effective and implementation dates and the web address of CR 13449The effective date is May 30, 2024. https://www.cms.gov/files/document/mm13449-stay-enrollment.pdf

HHS Launches Heat and Health Tool 

HHS is launching a new tool to help communities prepare for extreme heat and prevent heat-related illness, especially among those most at risk. The Heat and Health Index (HHI) is the first nationwide tool to provide heat-health outcome information at the ZIP code level. The HHI will help state and local officials identify communities, at the zip code level, most likely to experience negative health outcomes from heat, ensure that outreach and medical aid reach the people who need it most, and help decision-makers prioritize community resilience investments. 

The new tool builds off existing HHS heat tools to help provide a more complete look at communities most at risk of negative health impacts from heat and complements CDC’s latest clinical guidance on heat for doctors and providers. The existing EMS HeatTracker  

Advancing Health Equity through Value-based Care: CMS Innovation Center Update and Next Steps 

Since 2021, the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation (Innovation Center) has been guided by a renewed vision to build “A health system that achieves equitable outcomes through high quality, affordable, and person-centered care.” Health equity is one of the five strategic objectives that guide the achievement of this vision. 

By making health equity a key component of the models, CMS aims to reach a more diverse group of healthcare providers and beneficiaries, connecting people with services they need to stay healthy, and helping to strengthen the health care workforce. 

As implementation yields new insights, the Innovation Center continues to refine approaches to advancing health equity. In a blog published today in Health Affairs Forefront, CMS provides an update on progress since last year and lays out new work in 2024 in three areas: 1) safety net provider participation in models to improve care for more beneficiaries, 2) data collection that supports whole-person care, and 3) payment innovations to narrow disparities. 

Read more about the CMS Innovation Center’s health equity progress in Health Affairs Forefront: https://www.healthaffairs.org/content/forefront/advancing-health-equity-through-value-based-care-cms-innovation-center-update 

FDA panel: Updated COVID-19 shots should target JN.1 lineage  

An FDA advisory panel unanimously recommended that the upcoming COVID-19 vaccines for the fall campaign target the JN.1 lineage, saying that current vaccines don’t offer as much protection against JN.1 and other subvariants that have been driving COVID-19 infections for months. The FDA is expected to follow the panel’s recommendation, and vaccine makers Moderna, Novavax and Pfizer said they are ready to supply the recommended vaccines in August if the agency approves the plan.  

Join CMS OMH and CDC for a forum on the Health Care Workforce and Health Equity Inclusion 

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) is excited to announce its next virtual forum titled “Health Care Workforce and Health Equity Inclusion,” cohosted with the Centers for Disease Control Office of Health Equity (CDC OHE) on Wednesday, June 12 from 11 am ET to noon ET.  

Join us to hear from representatives from CMS OMH and CDC OHE talk about how each organization is working to address challenges impacting our healthcare workforce and health equity inclusion. There will also be a guest presentation by Dr. Joel Weissman of Brigham and Women’s Hospital of Harvard University and Dr. Joy Lewis of the American Hospital Association on their recent study of health equity officers to understand how hospitals are addressing the effects of racism.  The session will conclude with a moderated Q & A and discussion. 

If you would like to attend, please register using the Zoom information below. We also welcome you to share this announcement and link with others in your networks. 

Zoom Registration Information 

CMS OMH/CDC OHE Health Care Workforce and Health Equity Inclusion virtual forum 

June 12, 2024, 11 am – 12 pm ET https://us06web.zoom.us/webinar/register/WN_1K8auFOiSnidQUHtwg8E2g 

Advancing Health Equity During Pride Month 

Members of the LGBTQI+ community face unique health care challenges that often vary by race, ethnicity, and income. Certain social determinants of health contribute to poorer health outcomes, mental health disparities, and barriers to accessing care (PDF). During Pride Month, help address the unique health care challenges facing this community. 

More Information:  

CMS Releases Updated Health Equity Fact Sheet Outlining Goals and How Health Equity Actions Align with CMS’ Six Strategic Pillars 

May 24: CMS released an updated Health Equity Fact Sheet on the Health Equity page and the Strategic Plan page/strategic pillars page. CMS infuses health equity — the ability for everyone to obtain their optimal health — in everything it does. CMS programs provide health coverage to nearly one in two Americans and are critical to helping to ensure that individuals and families have access to quality health care. CMS’ goal is to ensure that every person can access the care they seek at an affordable cost, aim to eliminate avoidable differences in health outcomes, and to provide the care and support people need to thrive. Health equity is foundational to the CMS Strategic Plan and addressed within each of our strategic pillars. The CMS health equity strategy builds on the Biden-Harris Administration’s commitment to advancing racial equity and support for underserved communities through the federal government, as described in President Biden’s Executive Orders 13985 and 14091. The Health Equity fact sheet outlines CMS’ Health Equity goals and how CMS’ health equity actions align with our six strategic pillars.  

Medicare Providers: Deadlines for Joining an Accountable Care Organization  

To participate in an Accountable Care Organization (ACO) for performance year 2025, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at: 

Participant taxpayer identification numbers can only appear on one ACO participant list. Resolve any overlaps by September 5. 

More Information: