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Clinical Operations Committee Minutes

February 21, 2013
9:30-11:00 a.m.
I.        Call to Order
II.     Introductions
III.   Approve Minutes
·        No changes or additions: approved
IV. Agenda Additions
·        Referrals from facilities & physician orders
·        Info on article Medicare to cover HH chronic disease & therapy
·        Modifier to add G & Q codes
·        Proposed change HHABN to other
·        Update from MPRO
V.     Executive Director’s Report
·        Challenges facing the industry – “kick the can” into the new year. Days from decisions related sequestration. Sequestration has become a regular word & has an impact to Medicare reimbursement as we go forward. Deadlines Congress is facing & they may not act. 2% across the board cut, which is devastating to providers. Phone calls have been made to Congressional reps. Barry will call DC on Tues in relation to these calls. May see a later fix down the road, uncertainty and anxiety; will continue to request that Congress & senators to address and restore Medicare funding. Competitive bidding for HME’s & attempts to reduce HME’s. Don’t have to honor the bidding. Will impact the number of HME suppliers. Gives an early window to CMS’ attempt to reduce HME providers. Negotiations may be implemented to other providers of VNS, Hospice, etc. Decisions are substantial and this is a critical time.
·        National Association Walk for Home Care. Working with the State associations; 43 of the other states. March 17th -20th are the dates; all encouraged to attend.
·        May 8th State legislative date. Meet at the State Capital at 1030 on the 4th floor. 1st floor N. wing for lunch & meetings with Legislators. Issue at the State level is the expansion of Medicaid. Affordable Care Act discussions. Expansion of Medicaid on the table now and we need to convey the message that the expansion is critical. Controversial across the nation, but positive to move through the State of MI. Our job to support MI expansion of Medicare funding. 10% State to 90% Federal match. This will be the primary message on the 8th, up until July. Budget for MI begins on the fiscal year Oct. July is the target date.
·        Licensure is another issue that is pending at the State level. Fraud & abuse is the major topic, HHA, CNA’s are another issue. 8 hour requirement for CNA’s under an RN under a certified facility; LTCF. Those that have eliminated their HHA program is another issue. Licensure is about a year off from doing this. Meeting with State Medicaid Director set to resolve this issue. Reached out to National League of nursing to assist to resolve the issue.
·        Question re: HHA certification program. Anything coming through MHHA it is hoped that MHHA will be able to correct the issue regarding HHA certs. Meeting with State next week to try & develop a program.
·        MHHA changing name to Michigan Association of Home Care. Drive of the name change is the importance of private care. Agencies looking at more PD care, starting up a Hospice. This is driving diversity and to recognize that we are better served under one umbrella. Shaving off politics through organizations that have multiple businesses. Membership committee active in developing the brand for the new name. New logo presented, but several weeks from making the announcement.
·        There have been changes to the MHHA website.
·        ACHC discount program available. MI will have licensure for Home Care. Not currently accredited; position agency for accreditation.
VI. Announcements/Reports:
A.     Regulatory Update
1.      NGS
·        Meeting last week. HH cert results for 2012. CA & WI workload for NGS. 199 claims reviewed. 15 of claims denied. Payment error rate was 4.4%. Go into reasons for the denials. Incorrectly coded accounts; documentation did not support the diagnosis/coding. Two claims not medically necessary. HH utilization for paid claims is reflected and the top 5 dx codes. For MI rehab, ortho care and after care encounter are the top 3. DMII and HF round out top 5. HH visits, episode for beneficiary at 1.49% with a 10% LUPA rate. Outliers at 1/2% for MI. MI is doing very well in regards to the outcome of the report. Visits per beneficiary & episode 11.25 PT visits per beneficiary and 8.66 per episode. Only those paid by NGS (Medicare only).
·        Changes with NGS’ website. Will be more user friendly. Work with the job aides that are available on the NGS site. Related to billers who don’t know a lot about HH. Update from Mike Davis with NGS. Recently at DC – new contract with J6.
·        Change with the ID # – contracting number; will be sending out a letter to notify providers with the change. Chain providers will be retained if you have a provider chain within CA & WI . Will have the presentation available to view on MHHA website. Users use job aids on the NGS; can ask questions go to:, resources, tools and materials for job aides. Billing MSP, most using MSP. Webinar about MSP in general, but no one on call that knows about HH specifically. Will be coming out with a revision with the F2F article. Will come from CMS and NGS will advise as soon as they receive approval from CMS. CMS will be sending a Change Request to NGS.
2.      MDLARA
·        Do not meet until March 7, 2013. Need a new chair for the committee. Paula to be stepping down. Have a representative for Hospice. Bring anonymous concerns to MDLARA from MHHA and bring information back to this group. Gives updates on complaints. Rick Brummett is the new lead from the State, new in position, but getting more confidence and sharing more information. Looking for more info on Hospice licensing. Barry encouraged the members to take an active role in participating in the committee and represent MHHA. It builds relationships with the State and does not require a lot of time.
3.      BCBSM
·        Met on January 24th. Topics discussed are in the newsletter. Discussed PD nursing. Have not been able to establish a network for these providers. Not paying providers for CMS service. Fraud & abuse is a problem in the State and encourage reporting. Best way to contact them; use the provider consultant first. BC Network and BCBS credentialing has been merged. They are still two separate entities, and have two separate applications. No plans to release the moratorium for providers and stated that they have enough providers now. If patients are not calling & c/o, then they are not going to add providers. Request to add both codes for HH. Amb Infusion, those who are a HIT provider HH infusion providers can also apply to be ambulatory infusion providers. Although certs are good for 60 days, Therapy orders are only good for 30 days. Will continue to hear about the BC association and MI is closer to other States as to what they are doing and trying to get out of the public act. Legislation vetoed last year. Spring is a timeline for setting standards for PD. June meeting requested.
4.      Education Committee
·        Thursday 2/28/13, First annual Telehealth vendor showcase at 0900, here at MHHA & runs until 1630.
·        Sign in at 0800 March 3rd-4th 2013 Showcase for Exam on 3/6 at 1100.
·        April 4th & 5th is the MHHA Collaboration with Access to present a career opportunity which is web-based.
·        MHHA conference in TC. May 22nd-24th at the Grand Traverse. Focus is on increasing technology. There will be a scavenger hunt and dinner provided on Thursday night. Presentations on smart phone, infusion pumps, security necessary for HIPAA, etc. Call now to reserve your rooms. Rates good for 2-nights after the conference.
5.      Regulatory/QI Committee
·        To meet after Clinical Operations. Working on ICD-10 prep guidance.
VII. Sub-Committee/Task Force Reports:
A.     IV Therapy/Infection Prevention
·        Meeting on a monthly basis to complete IV Infusion manual. Will not be meeting this morning d/t low attendance and will meet next in March. Anyone is welcome to attend.
B.     Psych Home Care
·        Has not met
C.     Rehab Subcommittee
·        No report. Will try to meet today or next month.
VIII. New Business
·        None.
XI. Sharing Segment
A.     Survey Report
·        CLIA inspection (year ago OSHA). They said it was educational and called before she came. Just had OSHA fair, so staff had supplies all up-to-date. Looked at supplies, policies, Glucometers, PT/INR’s, equipment. No violations found. Gave a few recommendations. Stayed approx. 1 hour.
·        CHAP survey last week. 2 surveyors on Tues, 3-day visit. Very time limited; home visits day 1. 10 visits and requesting MR at the same time. Surveyors found 3 areas. Hand washing, care plan not specific enough and HHA not following the care plan. Recommending 3 standard level deficiencies. Wanted all reports by unduplicated census. Had to pull out all single status and pulled out recerts. Deemed status survey. Book prepared HH specific 70% already prepared. Will bring to the next meeting.
·        RAC received for HME on electronic wheelchairs. Account was from 2010; potential for 2 more RAC’s upon approval from CMS.
B.     Agenda Additions
·        Submit referrals and orders: SNF referrals and obtaining MD orders. The SNF MD is not signing the orders. Marketing staff pressuring intake staff – claim Intake holding up progress and referrals going to other agencies. Primary will not sign orders without seeing the patient and will not address the issue of the SNF MD not signing the orders. Recommendation – When you get the referral, identify who the MD will be – make contact. Get the family involved, and get the MD involved. Give the referral up if the patient wants to go somewhere else.
·        Chronic Disease: Law suit where HH were discharging patients d/t no progress (maintenance patients). What are other agencies doing? One the patient reaches their plateau, what to do. Visit once or twice a week? Describes maintenance therapy – article? Chris, Attorney to bring information from conference in TX. Will be going to HH related sessions. One year to notify MD’s and billing. Watch the codes that you use for the therapy visits. Payment is based on the need for skilled services; splitting the need for criteria vs. skilled services.
·        Q-Codes service location: HH will be required to add these location of service codes mid-2013. Hospice has been doing for years. What is the difference between Assisted living vs. retirement center? Open door forum from 2/20 recording became available yesterday – was discussed.
·        HHABN proposed change to two different forms. Comment period ended 2/2013. You will use the ABN that everyone else uses-all need to use the same ABN for Option box 1. HHCCN-Home Health Change of Care Notice. New form that will need to be used for Option boxes 2&3. Announcement made in December and requested comments. No notice yet on effective date (attachment-Supporting Statement for the Home Health Change of Care Notice).
·        Affordable Care Act & Medicaid Expansion: 26 States ended up not creating their own health exchanges. Michigan will follow the federal government’s recommended plan.
·        Readmissions: SNF conference: conversation d/t hospital discharges occurring on Friday. Readmissions happen on Tues., d/t patient not being ready to be discharged or the SNF was not ready to accept the patient. Hospitals need to realize that if they spend a little more money on the weekend for staffing, then the patient’s would not be readmitted or SNF should increase staffing on the weekend so that they are ready for the admissions from the hospitals.
·        Patient’s Perception of the Affordable Care Act: will pay for background checks for any HH? Chris Garfield will f/u to research to see if he can provide input.
·        MPRO Update: Work performed in the Lansing area regarding care transitions project. The abstract is on the MPRO website at MPRO is finding that hospitals are more willing to work with MPRO regarding reducing readmissions. Safety the Date: State Wide summit May 29th 0800 $59.00 Reducing avoidable readmissions regarding care transitions. Disparities link at HHQI-Best Practice Intervention out.
·        CBR running reports and they are obtaining the wrong data from facilities.
X. Next meeting March 21 at 9:30.

Michigan Association for Home Care
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