Two Certified Home Health Agency (CHHA) Updates
ICD-10
On July 6th, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) announced efforts to help providers get ready for ICD-10 followed by guidance and FAQs (most recently updated on Aug. 18, 2016). See the ICD-10 website for more resources.
Jimmo v. Sebelius – Judge Orders CMS to Provide More Education per Settlement in “Improvement Standard” Case
In an Opinion and Order released on Aug. 18th, Chief Judge Christina Reiss, the judge in Jimmo v. Burwell – the “Improvement Standard case” – ordered the federal government, through CMS, to comply with the Settlement Agreement that she approved in January 2013. LeadingAge NY reported on this latest pending case in March.
It required CMS to remedy certain revisions in the Medicare Benefit Policy Manual and to make revisions in the inadequate educational program that was critical to the original Settlement Agreement. The Secretary of Health & Human Services must propose corrective action for consideration by the plaintiffs in the case within 45 days of Judge Reiss’ Order. As the Judge stated, “Plaintiffs bargained for the accurate provision of information regarding the maintenance coverage standard and their rights under the Settlement Agreement would be meaningless without it.”
The plaintiffs had consistently provided proof to CMS since January 2014 that the agency’s educational program failed to communicate the necessary information to the providers and contractors that make the front-line decisions in the Medicare program.
The settlement agreement was to clarify that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be declined based upon the absence of potential for improvement or restoration. As we have previously reported, this decision is not an expansion of coverage, but just clarifies existing policy.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871