Compliance Monitor (7/19/2024)

Home Health Updates

Care Compare Quarterly Refresh – July 2024 

The July 2024 quarterly refresh for the Home Health Quality Reporting Program is now available on Care Compare. For this refresh, Home Health (HH) Outcome and Assessment Information Set (OASIS) will be based on the standard number of quarters. 

For additional information on the COVID-19 public health emergency’s impact on public reporting, please see the HH QRP COVID-19 Public Reporting Tip Sheet in the downloads section of the HH Quality Reporting Training webpage and the FY 2022 Hospice Wage Index and Payment Update Final Rule (HH Rider). 

The HHVBP CY 2024 Annual Performance Report – What You Need to Know! 

The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on Tuesday, August 13 at 3:00 p.m. ET, to educate providers about the Calendar Year (CY) 2024 Annual Performance Report (APR). This webinar will include a discussion of the CY 2024 APR, how to interpret the report, the appeals process, the applicable quality measure results based on CY 2023 performance, and the corresponding payment adjustment applied to FFS claims submitted for services with a through-date in the CY 2025 payment year.  

Registration is open and can be completed online through Zoom.  

If you have questions about accessing resources or feedback regarding training, please email the PAC Training Mailbox. Content-related questions should be submitted to the HHVBP Help Desk 

NOW AVAILABLE IN iQIES – Preview Reports and Star Rating Preview Reports for the October 2024 Refresh 

For this refresh, Home Health (HH) Outcome and Assessment Information Set (OASIS) and HH QRP claims-based measures have been updated. All OASIS and claims-based measures are now based on the standard number of quarters. 

The October 2024 Star Rating Preview Reports now include the addition of the number of episodes in the numerator for each measure score, in addition to the number of episodes in the denominator. 

The October 2024 refresh also includes the removal of two claims-based measures from public reporting: 

• Acute Care Hospitalization During the First 60 days of Home Health (ACH) 

• Emergency Department (ED) Use without Hospitalization During the First 60 Days of Home Health 

Due to the removal of the ACH measure from public reporting, the October 2024 refresh also contains an update to the Home Health Quality of Patient Care Star Ratings. The Home Health Within-Stay Potentially Preventable Hospitalization (PPH) measure will replace the ACH measure in the Quality of Patient Care Star Ratings calculations. For more information, see the download section of the HH QRP Star Ratings page (https://www.cms.gov/medicare/quality/home-health/home-health-star-ratings) 

Negative Pressure Wound Therapy: Prevent Claim Denials 

In 2022, the improper payment rate for negative pressure wound therapy was 39.1%, with a projected improper payment amount of $31.9 million (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices E and G). Learn how to bill correctly for these services. Review the negative pressure wound therapy provider compliance tip for more information, including: 

• Denial reasons and how to prevent them 

• Documentation requirements  

All Provider Updates

HHS Secretary Xavier Becerra Declares Public Health Emergency for Texas in Response to Hurricane Beryl 

U.S. Department of Health and Human Services Secretary Xavier Becerra today declared a Public Health Emergency (PHE) for the state of Texas to address the health impacts of recent severe weather. The declaration follows President Biden’s and gives the Centers for Medicare & Medicaid Services (CMS), healthcare providers, and suppliers, greater flexibility in meeting the emergency health needs of Medicare and Medicaid beneficiaries.  

Read the Press Release 

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the launch of the Guiding an Improved Dementia Experience (GUIDE) Model, with almost 400 participating organizations building Dementia Care Programs (DCPs) serving hundreds of thousands of Medicare beneficiaries nationwide.  

DCPs represent a wide range of health care providers, including large academic medical centers, small group practices, community-based organizations, health systems, hospice agencies, telehealth organizations, and other practices. 

The GUIDE Model aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services. The GUIDE Model will be tested by the CMS Innovation Center. It is a key deliverable from President Biden’s April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers, and it addresses key goals of the National Plan (National Plan) to Address Alzheimer’s Disease. 

Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key support services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, people with dementia and their caregivers will have access to a care navigator who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations. 

For a list of participants, please visit https://www.cms.gov/files/document/guide-participant-list.xlsx. 

Interested in GUIDE? 

• For more information, please visit the GUIDE Model webpage  

• Learn how GUIDE is clearing the path for high quality dementia care 

• You can also contact the model team at GUIDEModelTeam@cms.hhs.gov  

To stay up to date on model announcements, events, and resources, sign up for the GUIDE Listserv via the CMS.gov email subscription service page: https://public.govdelivery.com/accounts/USCMS/subscriber/new 

Guiding an Improved Dementia Experience by Clearing the Path for Comprehensive, High-Quality Dementia Care 

On July 1, 2024, CMS launched the Guiding an Improved Dementia Experience (GUIDE) Model with 390 participating organizations building Dementia Care Programs that will serve hundreds of thousands of people with Medicare nationwide. The GUIDE Model aims to increase access to much-needed support for people living with dementia and their caregivers.  

Read the full blog. 

CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically 

Learn about the CMS Health Information Handler (CMS HIH), a free service to help you upload and submit your medical documentation electronically to your Medicare Administrative Contractor using the following formats: 

• Portable document format (PDF) 

• Extensible markup language (XML) 

• JavaScript object notation (JSON) 

Respond electronically to prior authorization and additional document requests:  

• Unlimited number of transactions 

• Fast, safe, and secure environment 

• Easily accessible 

The benefits of the CMS HIH include: 

• Hosted on CMS Amazon Web Services cloud 

• Adheres to all CMS security and privacy standards 

• Accommodates small or large users 

Contact cmshih@cms.hhs.gov to learn more and get started. 

Standing TEP for the Development, Evaluation, and Maintenance of PAC and Hospice QRP Measurement Sets Summary Report – Now Available 

The Centers for Medicare & Medicaid Services (CMS) has released the Standing Technical Expert Panel (TEP) for the Development, Evaluation, and Maintenance of Post-Acute Care (PAC) and Hospice Quality Reporting Program (QRP) Measurement Sets Summary Report.  This report summarizes input provided by a TEP on December 15, 2023, on the development of additional cross-setting measures for the PAC and Hospice QRPs, and filling measurement gaps with CMS’ Universal Foundation measures.  This cross-setting TEP is a standing TEP that will reconvene annually, or on an as-needed basis, to support the evaluation, development, and maintenance of the PAC and Hospice QRP measurement sets until 2028. 

This report can be found in the Downloads sections of the following web pages: 

Home Health Quality Measures webpage 

Hospice QRP Provider and Stakeholder Engagement webpage 

ASPR TRACIE Resources (visit their website at https://asprtracie.hhs.gov/) 

• Volunteer Management Topic Collection (Updated) 

During large-scale disasters or extended health emergencies, healthcare facilities may need to augment their teams (often with volunteers) to continue to provide patient care or support patient care services. The resources in the Volunteer Management Topic Collection include strategies, legal information, and planning templates to assist healthcare facilities with incorporating volunteers into their disaster management plans.  

• After the Flood: Mold-Specific Resources 

The ASPR TRACIE team collected the following public messages, fact sheets, checklists, guidance documents, and other educational resources related to mold. We include pre-scripted (and, in some cases, already recorded) PSAs, as they are tangible and ready-to-implement examples of risk communication materials that can essentially be used immediately.   

• Tips for Retaining and Caring for Staff after a Disaster 

This tip sheet assumes that a facility is operational after an event and that certain pre-planning and continuity of operations considerations are already in place. Here we share general promising practices—categorized by immediate and short-term needs—for facility executives to consider when trying to retain and care for staff after a disaster.