{"id":510,"date":"2018-10-02T18:23:00","date_gmt":"2018-10-02T18:23:00","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=510"},"modified":"2018-10-02T18:23:01","modified_gmt":"2018-10-02T18:23:01","slug":"survey-certification-proposed-regulatory-relief-wont-go-very-far-for-hhas","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2018\/10\/02\/survey-certification-proposed-regulatory-relief-wont-go-very-far-for-hhas\/","title":{"rendered":"Survey & Certification: Proposed Regulatory Relief Won’t Go Very Far For HHAs"},"content":{"rendered":"\n
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Patients over Paperwork initiative results in some small \u2014 very small \u2014 proposed changes.<\/em><\/strong><\/p>\n\n\n\n

A dab of regulatory relief is better than none at all \u2014 or is it?<\/p>\n\n\n\n

On Sept. 17, the\u00a0Centers for Medicare & Medicaid Services\u00a0<\/strong>dropped a 285-page proposed rule containing a multitude of ideas for reducing Medicare providers\u2019 regulatory burdens. The proposed changes would reduce providers\u2019 financial burden by $1.1 billion annually, CMS claims in a release about the rule. \u201cCMS developed the proposed rule in response to President\u00a0Trump\u2019s\u00a0<\/strong>charge to federal agencies to \u2018cut the red tape\u2019 and reduce burdensome regulations,\u201d the agency says.<\/p>\n\n\n\n

\u201cWe are committed to putting patients over paperwork, while at the same time increasing the quality of care and ensuring patient safety and bolstering program integrity,\u201d CMS Administrator\u00a0Seema Verma\u00a0<\/strong>says in the release. This rule is a \u201cmajor step forward\u201d in CMS\u2019s efforts \u201cto modernize the Medicare program by removing regulations that are outdated and burdensome. The changes … will dramatically reduce the amount of time and resources that healthcare facilities have to spend on CMS-mandated compliance activities that do not improve the quality of care, so\u201d they \u201ccan focus on their primary mission: treating patients.\u201d<\/p>\n\n\n\n

On one hand:\u00a0<\/strong>\u201cAny time CMS proposes something that will actually reduce the burden on providers, it is a good day,\u201d cheers consultant\u00a0Kathy Roby\u00a0<\/strong>with\u00a0Qualidigm\u00a0<\/strong>in Wethersfield, Connecticut.<\/p>\n\n\n\n

\u201cAny relief of regulatory burden is welcomed,\u201d agrees consultant\u00a0Pam Warmack\u00a0<\/strong>with\u00a0Clinic Connections\u00a0<\/strong>in Ruston, Louisiana.<\/p>\n\n\n\n

But experts aren\u2019t sure exactly how significant the relief the rule calls for will provide for home health agencies.<\/p>\n\n\n\n

For\u00a0<\/strong>example:<\/strong>The rule proposes \u201cto remove the requirement that Home Health Agencies (HHAs) provide a copy of the clinical record to a patient, upon request, by the next home visit. We propose to retain the requirement that the copy of the clinical record must be provided, upon request, within 4 business days.\u201d<\/p>\n\n\n\n

CMS just implemented the four-day requirement in the new Home Health Conditions of Participation that took effect in January. In its 2018 rulemaking, \u201cwe received feedback \u2026 that this requirement was impractical for HHAs to comply with because providing the record at the next visit may not allow enough time for HHAs to create a physical or electronic copy of the clinical record content, provide that copy to the next visiting clinician who may not be scheduled to come into the HHA office prior to the visit due to the nature of\u00a0home based\u00a0care and the significant travel that HHA clinicians must do in order to make patient visits, and successfully deliver the copy to the patient,\u201d CMS notes in this regulation published in the Sept. 20\u00a0Federal Register<\/em>.<\/p>\n\n\n\n

\u201cWe agree that providing the record at the next visit is not practical or even possible in some cases. Furthermore, we agree that retaining the 4 business day timeframe is an appropriate regulatory requirement. Therefore, we propose to remove the requirement that the requested clinical record copy must be provided at the next home visit,\u201d CMS says.<\/p>\n\n\n\n

It\u2019s good that CMS has recognized the problem with the current requirement. \u201cIf someone gets a request at 4:30 pm the day before the next visit, depending on the software the agency uses and how long the patient has been on service, it might well be impossible,\u201d notes\u00a0Julianne Haydel<\/strong>with\u00a0Haydel Consulting Services\u00a0<\/strong>in Baton Rouge, Louisiana.<\/p>\n\n\n\n

Another problematic scenario is when \u201cthere is\u00a0a SN\u00a0visit when the request is made, then if there is a PT or aide visit the next day,\u201d illustrates attorney\u00a0Liz Pearson\u00a0<\/strong>with\u00a0Pearson & Bernard\u00a0<\/strong>in Edgewood, Kentucky. \u201cThat would require a nearly impossible turn-around.\u201d<\/p>\n\n\n\n

The catch:\u00a0<\/strong>This change \u201cmay actually require agencies to provide records sooner if the next visit isn\u2019t scheduled for more than four business days from the date of the request,\u201d points out Washington, D.C.-based attorney\u00a0Elizabeth Hogue<\/strong>.<\/p>\n\n\n\n

For example, \u201cif the \u2018next visit\u2019 was not scheduled for seven days, the new proposal of four business days is actually more of a burden,\u201d Warmack explains.<\/p>\n\n\n\n

\u201cAnd whether it\u2019s four days later or the next visit, it\u2019s still a pretty short period of time,\u201d Hogue stresses.<\/p>\n\n\n\n

Not to mention:\u00a0<\/strong>\u201cPreparing and delivering the information is the same regardless of the time period allowed to do so,\u201d Hogue says.<\/p>\n\n\n\n

Another mitigating factor for burden assessment is staff training. HHAs just got done updating their policies and procedures and getting their staff trained on the next-visit timeframe. Now they\u2019ll have to go back and change it, experts note.<\/p>\n\n\n\n

Another point:\u00a0<\/strong>The four-day requirement, if finalized, \u201cstill is more burdensome than the requirements related to providing access under HIPAA,\u201d highlights attorney\u00a0Robert Markette Jr.\u00a0<\/strong>with\u00a0Hall Render\u00a0<\/strong>in Indianapolis. \u201cUnder HIPAA, when an individual seeks access to their PHI, the covered entity has 30 days to provide it. That provides a much greater level of flexibility than this four-day requirement,\u201d Markette says.<\/p>\n\n\n\n

\u201cIf they really wanted to reduce the regulatory burden, they would have dropped this requirement entirely and depended upon HIPAA,\u201d Markette says.<\/p>\n\n\n\n

Meanwhile:\u00a0<\/strong>Even if the change has a positive impact on burden weight, its relief is relatively \u201ctiny,\u201d Warmack points out.<\/p>\n\n\n\n

That\u2019s because \u201cthis is not something that comes up a lot,\u201d Pearson relates. \u201cGenerally when requests are made for clinical records, it\u2019s after the episode is over.\u201d<\/p>\n\n\n\n

A good, perhaps unintended, consequence of the change would be eliminating the current requirement\u2019s \u201cterrific incentive for deliberately missing a visit the patient needs,\u201d notes Haydel, who expresses hearty disagreement with the tactic.<\/p>\n\n\n\n

The other HHA-specific provisions in the rule, addressing aide competency and patient rights notice, likewise offer relief in only small doses.<\/p>\n\n\n\n

In the end, \u201cevery little bit certainly helps but, with these relatively small changes, perhaps it\u2019s the thought that counts,\u201d Hogue rues.<\/p>\n\n\n\n

\u201cThis attempt to reduce paperwork won\u2019t make much difference,\u201d Haydel believes. \u201cI certainly can\u2019t see how it will save providers a billion dollars.\u201d<\/p>\n\n\n\n

Note: The proposed rule is at\u00a0www.gpo.gov\/fdsys\/pkg\/FR-2018-09-20\/pdf\/2018-19599.pdf<\/a>.<\/em><\/p>\n\n\n\n

<\/em><\/p>\n\n\n\n

Source- SuperCoder<\/em><\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Patients over Paperwork initiative results in some small \u2014 very small \u2014 proposed changes. A dab of regulatory relief is better than none at all \u2014 or is it? On … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":253,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,15],"tags":[11],"class_list":["post-510","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance","category-home-health","tag-home-care"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/510","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=510"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/510\/revisions"}],"predecessor-version":[{"id":511,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/510\/revisions\/511"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/253"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=510"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=510"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=510"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}