CMS Publishes Final Rule: Sweeping Changes to Home Health Agency CoPs

By on January 23, 2017

On January 13, 2017, CMS published its final rule revising the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in Medicare and Medicaid programs. The final rule implements the proposed rules published in the Federal Register October 9, 2014 (79 FR 61164), and becomes effective July 13 2017.

Among its many changes, the final rule redefines terms and establishes new standards for the content of comprehensive patient assessments, care planning, coordination of services, quality of care, quality of assessments and performance improvement (QAPI), skilled professional services, home health aid services, and clinical record keeping. The rule also makes changes to personnel requirements including limiting who can be an HHA administrator. To review the final rule in its entirety, click here.

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The Joint Commission Issues Clarification on Texting of Patient Care Orders

By on January 4, 2017

“The use of secure text orders is not permitted at this time.”

In 2011 the technology to provide for the safety and security of text messaging was not available, and at that time The Joint Commission (“TJC”) said it was not acceptable for practitioners to text orders for patient care and treatment.  Then in May of 2016, TJC acknowledged all of the technology and data privacy and security issues it had in 2011 had been addressed. As published in The Joint Commission Perspectives, TJC revised its position and said physicians could text message when done in accordance with standards of practice, laws and regulations, and policies and practices “as long as the system met specific requirements .”

Since then, however, TJC got together with CMS and recently issued updated recommendations that include the following:

  • Providers should have policies prohibiting the use of unsecured text messaging of PHI.
  • CPOE (computerized provider order entry) should be the preferred method for submitting orders, which are directly entered into the electronic health record.
  • If a CPOE or written order is not available, a verbal order is acceptable, but only when impossible or impracticable to use CPOE or written orders.
  • The use of secure text orders is not permitted at this time.After further review the call on the field, as it were, has been overturned.

This turnaround came about after TJC and CMS discussed the issues with numerous stakeholders, including text messaging platform vendors and experts in EHRs. The identified issues that led to the recent decision included:

  • Increased burden on nurses to manually transcribe text orders into the EHR.
  • Verbal orders are preferred when CPOE not used, because they allow for real-time clarification and confirmation of the order as it is given by the practitioner.
  • Text messaging could cause delay in treatment where a clinical decision support (“CDS”) recommendation or alert is triggered during data entry, requiring the nurse to contact the practitioner for additional information.

To view the Dec. 22, 2016 full text article on the TJC website click here to download.

 

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Tis the Season to be Giving – OIG Increases “Nominal Gifts” Limit

By on January 3, 2017

The Office of the Inspector General (OIG) announced this Holiday season that it is increasing the monetary value of gifts falling under the nominal value exception to Medicare’s Civil Money Penalty Law.  Under section 1128A(a)(5) of the Social Security Act [42 U.S.C. §1320a-7(a)], a person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil monetary penalties (CMPs) of up to $10,000 for each wrongful act. “Remuneration” includes waivers of copayments and deductible amounts (or any part thereof) and transfers of items or services for other than fair market value[1].

However, as the OIG explained in its December 7, 2016 “Policy Statement Regarding Gifts of Nominal Value to Medicare and Medicaid Beneficiaries,” Congress intended to permit inexpensive gifts of nominal value.  The OIG has previously interpreted “inexpensive” and “nominal value” to mean a retail value of no more than $10 per item or $50 in the aggregate per patient on an annual basis, noting that it would periodically review these limits and adjust them according to inflation, if appropriate.[2]

The OIG now believes that the figures from 2000 should be adjusted. Thus, as of December 7, 2016, the OIG has modified its interpretation of “nominal value” to mean having a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis.  The items may not be in the form of cash or cash equivalents. If a gift has a value at or below these thresholds, then the gift need not fit into an exception to section 1128A(a)(5).  Happy Holidays from the OIG.

[1] See section 1128A(i)(6) of the Act.

[2] See, e.g., 65 FR 24400, 24411 (Apr. 26, 2000).

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