Tag Archives: PCRs

What PCR reprieves, CoPs delay could mean

Future-gazing: A delay or not?
Either way,  there’s work to do!

It seemed almost too good to be true, like some April Fool’s Day prank offering false hope to home health agencies braced for a new onslaught of federal regulations.

Just one day before home health agencies in Florida expected to join Illinois agencies in a long-fought Pre-Claim Review (PCR) demonstration by the Centers for Medicaid and Medicare Services, two announcements by CMS changed the game. At least for now.

 After months of deadlock, a temporary reprieve from massive new regulatory changes – not just in Florida but nationwide – suddenly shifted from highly unlikely to plausible.

 CMS announced Friday that it would grant Florida a second reprieve from the PCR demonstration scheduled to begin April 1, suspend for at least 30 days the PCR program in Illinois which has been underway since August, and possibly give home health agencies an additional six months to prepare for new Conditions of Participation in the Medicare program.

   “These two developments made for an interesting Friday in home health,” said J’non Griffin, owner and president of Home Health Solutions LLC. “The PCR delay in Florida really was an 11th hour save. The clock was ticking, and agency personnel were attending last-minute PCR training workshops every day last week in cities all across Florida to get the information and training they needed to be ready for the PCR launch.”

 But brand new CMS administrator Seema Verma, who was just confirmed to her position at the Department of Health and Human Services on March 13, was also seeking information last week. She asked to meet directly with home health care providers and advocates from both Florida and Illinois, where the nation’s first PCR demonstration began last summer. The new CMS administrator said she wanted to hear their concerns about the impact of increasing regulatory demands on home health.

   Following that meeting, CMS on Friday announced plans for a 60-day public comment period to seek information that will be evaluated in determining whether to delay the implementation of new CoPs, standards which are widely expected to be difficult, time-consuming and costly for agencies to put into place. Under the current timeframe, agencies are required to meet new CoPs by July 13. The six-month delay, if approved, will give agencies until January, 2018, to make the necessary changes.

Soon after that announcement, word came from CMS that the PCR demonstration in Florida would no longer begin on April 1 as scheduled — and that the ongoing PCR demonstration in Illinois would be suspended for at least 30 days. CMS offered no further timetable for PCRs to resume, but promised a 30-day notice will be provided before that happens.

Relief, hope — and politics

Home health professionals across the country greeted Friday’s news with a mixture of relief and cautious hope for a changing climate in Washington D.C. regarding federal regulations on home care.

New Health and Human Services Secretary Tom Price has been described as knowledgeable about and supportive of many home health issues by William Dombi, Vice President of Law for the National Association of Home Care. At the 2017 Illinois Home Care and Hospice Conference last month, Dombi painted Price as a potential ally for home health, telling attendees that Price was considering supporting a CoPs delay.

But less than 100 days into a new administration, the Department of Health and Human Services headed by Price is still coming together, with many of its senior positions still unfilled.
And, as battles continue between lawmakers over the government’s specific role in health care, many of our nation’s health care policies have yet to be determined, much less put into place.

“It’s definitely a good sign for top officials in D.C. to actively seek input from home health and listen to our concerns, but there are still a great many unknowns right now,” J’non said. “No one really knows exactly how all this is going to play out.”

The future of PCRs and CoPs

What will the delays in Florida and Illinois mean for PCR demonstrations?

Industry experts believe it is likely that CMS will make changes to the PCR model before continuing with the demonstration first launched in Illinois last August. The demonstration in that state proved to be so chaotic, confusing and largely unsuccessful in its initial months that CMS was forced to pull the plug on expansions planned for Florida the following October and into Texas, Michigan and Massachusetts by the beginning of the year.

With the issues that plagued Illinois corrected, what might the revised demonstration look like?

“It really isn’t possible to say for certain at this point,” J’non said. “It seems more important to note that the PCR demonstration will go forward. This is a delay, and not a repeal. Agencies in all states still need to add PCR readiness to their ongoing training efforts.”

Under the current model, agencies in states where the PCR demonstration operates have the choice to participate or not. However, those who do not submit the proper paperwork for review prior to filing actual claims will automatically lose 25 percent of any Medicare reimbursement on claims not previewed.There has been no word at this time that the 25 percent reduction for non-participation will change.

While dramatic, last-minute PCR suspensions in Florida and Illinois grabbed most of the attention on Friday, the CMS announcement regarding a possible delay in the implementation of new Conditions of Participation could have a more immediate impact on most of the nation’s 30,000 home health providers.

The implementation of most new CoPs would be delayed until January 13, 2018, under the proposed rule.

Agencies would have extra time to meet some of the Quality Assurance and Performance Improvement (QAPI) standards required. Phase-in requirements would give agencies until July 13, 2018, to implement performance improvement projects, allowing six months after the January 2018 start date to collect the data they will be required to use in their data-driven performance improvement projects beginning in July 2018.

Administrators would be affected 
   Additionally, the proposed rule would grandfather all administrators employed by agencies prior to January 2018, so that they do not have to meet the new personnel requirements identified in the revised CoPs. 

  Of particular interest to agency administrators is what new personnel requirements will mean for future employment, and their ability to move from a grandfathered position at their current agency to an administrator position at a different agency.

Under the new CoPs, administrators who do not meet the requirements would lose their grandfathered exemption when they leave one agency to take a position at another agency, J’non said.
The clock is ticking

One of the primary arguments for delay of a start date for new CoPs has been concern about the lack of interpretive guidelines, which Surveyors will use to evaluate whether agencies have met the standards.

Agencies have expressed concerns they are not certain exactly what Surveyors will be looking for, particularly in the areas of data-driven performance improvement projects.
CMS agreed, in its announcement on Friday, that there is merit to that argument, and that is one of the reasons the delay is being considered.

“With so many other major clinical and operational changes to implement in such a short period of time before July 13, which is the start date effective under current law, there has been growing concern in the industry about the lack of time in which to put all of it into place,” J’non said.

   New Conditions of Participation were approved in January, giving agencies only six months to make the required changes. It was the first time in almost three decades that CMS addressed the standards set out for home health agencies under CoPs.

“With such a limited amount of time, agencies really need to be making the necessary changes now, without waiting on interpretive guidelines,” J’non said. “Guidelines are more for the benefit of Surveyors. Agencies must meet the standards as they are set out in the CoPs.

“It’s important to remember that the delay is only under consideration at this point, and the July 13 start date could remain in effect,” she said. Many agencies will not have the resources to make necessary changes on their own, especially under the current time frame, and will need to outsource much or all of the work, J’non said.

Even if the delay is approved, and extra time is granted, many of the new requirements will be so labor-intensive that agencies will still need to rely on outsourcing, she said.

Delays aren’t repeals

  J’non offered this advice to agencies wondering what these delays may mean and how they will affect preparation timelines:
“It’s important to note that, as with PCRs, a possible delay is not the same thing as a repeal,” J’non cautioned. “Agencies need to proceed as if the July 13 start date will remain in effect. If they wait, and the start date is not delayed at the close of the 60-day comment period, it will be too close to July to be able to implement the required changes by the deadline.”

EDITOR’S NOTE: This article first appeared in The Absolute Agency, a free monthly e-newsletter published by Home Health Solutions as a best-practices guide for agency administrators.
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