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Hospice Committee MeetingNovember 5, 201510:00AMVia Conference CallMinutesCall to orderMinute approval – approved.Additions to agenda ReportsExecutive DirectorAttended NAHC Conference last week with Don Gillespie. Met with forum of states prior to conference (Barry met with all of his colleagues.) Theresa Forester, hospice specialist was there – 2016 payment rule, wage index, cap issues, diagnosis coding issues, HQRP submission requirements. Good overview provided from national perspective.A lot of questions about Medicaid at the forum. Many states with questions/concerns especially re: Medicaid funding and expansion. House and senate passed road funding (total of $475 million that will need to come out of next year's budget, which could impact R&B budget for next year.)March 10 State Legislative Day in Lansing – please put on your calendar and plan to attend! Need representatives from hospice to address concerns and issues related to our business with legislators and staff. Reimbursement – during forum of states meeting, concern raised for all segments. Many issues with home care and contractors – very aggressive, expensive. Meeting on Nov. 18 at 9:30am at the MAHC office with Reimbursement Committee meeting with Head Auditor person at BC/BS re: audits and concerns. Please plan to attend or have someone from your agency attend! Great discussion with Hospice and Palliative Care Association of MI, Tim Grunwal (Director) – encouraged that we will be partnering with them at our Annual Conference. Will share more at December meeting!Annual Conference re: hospice presenters. Carla Braveman cannot attend, looking for feedback and ideas/suggestions for presenters.NGS/CMS Any questions for Sherri, please email her directly or email Amy, Barry, Mary @ MAHCAttended hospice meeting and CMS town hall meeting; Sherri to give update at Dec. meetingMILARA Met on Oct. 16, 2015; next meeting January 5, 2016State survey division org structure change (in pencil, not yet finalized…probably finalized in January 2016.)Hospice falls under 2 people Matt Jordan (license survey) and Rick Brummette (state survey).Casper report – state is not able to pin point or identify timeframe of data that shows up on Casper report. Top 10 survey deficienciesMILARA and state surveyor group working on educationMultisite application: is this required to take pts prior to approval or can patients be services by parent corporationAnswer: parent location can file for branch, must be fully functioning, but they fall under parent office within 30 mile from Parent Corporation. If farther than 30 miles, must be justified.No rule that you can't see pts during application process.Multisite has to have staff, oversight from parent, IDG and fully functioningLinked to parent site by licensing and provider numberNew provider numbersIf accrediting body is required to do new survey must obtain licensure first from state, then see pts and work towards accreditation and deemed status6 months state will do post licensure surveyStartups must have accreditation/deemed status – can't do this until state grants licensureIn Michigan: 115 certified hospices; 3 that are license only; 80 deemed, 35 non deemed, 13 residencesCivil monetary penalties (CMP) process:If you have survey and they find deficiency, have to submit POCIf condition level, they will resurveyIf still deficient, that is when CMP can come into effectState does write-up/grid – they submit to CMS. CMS determines CMPCMP would start from date of revisit until correctedOnce agency states corrected, state comes back out to audit. If state clears, then CMP stopsCan have multiple CMPsPay after issue resolvedAppeal – goes thru ALJ process. If no appeal, 35% reduction of payment$1000 dollar's per day rangeOnly one CMP in MI – approx. $5,000/day for 25 days for that agency (Stacie believes this was a HC)3 Home Care agencies threatened by CMP – only 1 of 3 was fined (see above)Barry putting together a letter re: state survey division getting access to CASPER data requesting they provide additional data CASPER relates to only non-accredited agenciesCMS has additional data that they are unwilling to give to agencies/MAHCState Survey concerns addressed with Rick Brummette – surveyors coaching agencies to drop accreditation. This is a trend on Home Health side (agencies dropping accreditation.) Hospice licensure surveyor making statement that hospice's do not need accreditation, that the state can handle surveys. Barry shared with Rick BrummetteAnalyst responded that she found that hard to believeConcern registered at the meetingReminder: MAHC members have discounts for accreditation for CHAP and ACHC! Can get code by calling MAHC office. State Survey concerns continueProvide education or workshops/forms Involve surveyorsRequest thresholds for state surveys for deficiencies vs. individual surveyors making decisions Larry Horvath will be at this year's Annual Conference and will bring a surveyor with him. EducationJanet retied from Hospice of Lansing in October – CONGRATS!!!!Need more sessions related to Hospice. MILARA coming to give update to hospice. Invited NGS – no response yet. 3 open hospice sessions at this time. Carla Braveman unable to attend this year – suggested Simione group re: payment reform. Katie Wehri suggested by Ranee. She works with NHPCO and NAHC – is a great resource. Presented at the forum of states. Amy and Ranee attending CAPC conference next week – can pass along recommendations for presenters to CindyEnclara Pharmacia as a recommendation for pain or symptom management/educationAny/all suggested presenters to Cindy by Nov. 25 if possibleICD 10 coding conference on Feb. 2 & 3 at MAHC office. Portion of training reviews hospice coding! Last ICD 10 training in August had good representation from hospice and hospice participants had great, positive feedback! Fraud workshop rescheduled to January 27, 2015 at the MAHC office. Major focus on agencies being ready/prepared should a physician following patients be indicted (i.e. How will you get orders signed?)Need a hospice member to participate on Education Committee to represent hospice education offerings. Idea to create a sub-committee of education committee for hospice specific education needs to include HPCAM membersNew business Hospice Presenters/Topics for Annual ConferenceSee above Room and Board:Is this a federal or state reg/requirement (Amy to follow-up on this)If federal, can take to the national groupsIf state, can take to the state Old business TB Administrative RuleBarry attended the meeting with MILARAAmendments, with CDC recommendations, would eliminate requirements for TB testing related to employees and othersPatient at facilities:Eliminate chest x-ray per CDC may not be necessary (implement risk assessment questionnaire to determine if chest x-ray to completed) EmployeesEliminate 2 step TB test to 1-step with addition of risk assessment to be completedState Survey Discussion – addressed aboveFY16 Hospice Payment Rule re: Tiered Payment/Modified "U"One agency looking at the required G codes between RN and LPN visits in last 7 days (will software do this, will this have to be manually entered)One agency's financial department working on models to identify how the change may impact reimbursement starting Jan. 1, 2015Is anyone building in ways to track what we get paid vs. what visits we make?FY16 Hospice Payment Rule re: Coding – ICD10 and Unrelated Diagnosis, Etc.Rule is clear that you have to code and document all diagnoses, whether they are related or notHospice medical director documenting why dx or medication is NOT related. Is there a certified test for coders for hospice specifically? Other Open discussionNext meeting December 3, 2015 at the MAHC Office ................
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