New HHA CHOW Rules Finalized

Good Morning MFS Bloggers and Happy Holidays!!!!

In CMS’s final rule published on November 2nd, 2010, a Change in Majority Ownership occurs when an individual or organization acquires more than a 50 percent direct ownership interest in an HHA during the 36 months following the HHA’s initial enrollment into the Medicare program or the 36 months following the HHA’s most recent change in majority ownership (including asset sale, stock transfer, merger, and consolidation). This includes an individual or organization that acquires majority ownership in an HHA through the cumulative effect of asset sales, stock transfers, consolidations, or mergers during the 36-month period after Medicare billing privileges are conveyed or the 36-month period following the HHA’s most recent change in majority ownership.

Unless an exception in (b)(2) of this section applies, if there is a change in majority ownership stock of a home health agency sale (including asset sales, stock transfers, mergers, and consolidations) within 36 months after the effective date of the HHA’s initial enrollment in Medicare or within 36 months after the HHA’s initial enrollment in Medicare or within 36 months after the HHA’s most recent change in majority ownership, the provider agreement and Medicare billing privileges do not convey to the new owner. The prospective provider/owner of the HHA must instead:
(i) Enroll in the Medicare program as new (initial) HHA under the provisions of 424.510 of this subpart.
(ii) Obtain a State survey or an accreditation from an approved accreditation organization.
(b)(2)(i) The HHA submitted two consecutive years of full cost reports. For purposes of this exception, low utilization or no utilization cost reports do not qualify as full cost reports.
(ii) An HHA’s parent company is undergoing an internal corporate restructuring, such as a merger or consolidation.
(iii) The owners of an existing HHA are changing the HHA’s existing business structure (for example, from a corporation to a partnership (general or limited); from an LLC to a corporation; from a partnership (general or limited) to an LLC and the owners remain the same.
(iv) An individual owner of an HHA dies.

New Therapy Regulations

Good Morning MFS Bloggers,

Beginning in 2011, as amended in CMS’s final rule at 42 CFR 409.44 on November 2nd, 2010, at least every 30 days a qualified therapist (instead of an assistant) must provide the needed therapy service and functionally reassess the patient in accordance with §409.44(c)(2)(i)(A). Where more than one discipline of therapy is being provided, a qualified therapist from each of the disciplines must provide the needed therapy service and functionality reassess the patient in accordance with §409.44(c)(2)(i)(A) at least every 30 days.

If a patient is expected to require therapy visits, a qualified therapist (instead of an assistant) must provide all of the therapy services on the 13th therapy visit and functionally reassess the patient in accordance with §409.44(c)(2)(i)(A).

If a patient is expected to require 19 therapy visits, a qualified therapist (instead of an assistant) must provide all of the therapy services on the 19th therapy visit and functionally reassess the patient in accordance with §409.44(c)(2)(A).

Please review the final rule for more detail. Have a great day! CP

RAP's

Good Morning MFS Hoem Health Bloggers,

The RHHI recently posted an article on RAPs as they were noticing various errors within their system when receiving RAP from providers throughout the country.

Per the RHHI, RAP's will cancel as they normally do when any final claim posts to the Common Working File (CWF) or when the final claim is not received on time from the home health agency (i.e., within 60 days of the date the RAP was processed or 120 days from the start date of the episode).

Home Health Agencies often mistakenly resubmit RAPs because they do not receive payment on the RAP and believe that the RAP was not posted to CWF. The RAP does exist, so the RHHI requests that home health agencies do not resubmit another RAP unless the RAP auto-canceled because the final claim was not submitted on time. When the RAP is processed, it will go into a "P" status, but does not receive payment and receives a "Z" no pay code because of an open MSP record. The home health agency should not send a request for the RAP to be cancelled or adjusted. The home health agency provider should submit the final claim with the correct information and/or MSP codes. If the final claim was previously submitted and has been rejected (R status), check to see if it has posted to the CWF. If so, then the home health agency provider must submit an adjustment request once they have received payment from the primary insurer, a denial or have information documenting Medicare is primary.

Have a great week!!!! Chris