New Mexico Register:

REGULATION AND LICENSING DEPARTMENT BOARD OF SOCIAL WORK EXAMINERS repealed and replace rules which are effective March 13, 2022. Topics covered are:  application, reciprocity, and disciplinary actions.  To review, go to:   https://www.srca.nm.gov/nmac/nmregister/pdf/xxxiii05.pdf.   

 

Federal News and Information:

Telehealth and the Public Health Emergency (PHE)

Congress passed HR 2471, Consolidated Appropriations Act 2022.  A section of this legislation includes an extension of the flexibility for you to do face to face physician recertification virtual for 151 days after the end of the PHE.  The PHE is predicted to end sometime this summer.  It is unknown if Texas Medicaid will follow HR 2471.  You can read the act at: https://www.congress.gov/bill/117th-congress/house-bill/2471/text.

 

Palmetto:

Hospices are to Report Post-Mortem Visits with the Modifier PM

  • Medicare is finding through the Medical Review process that hospices are not correctly reporting post-mortem visits with the modifier PM on their claims. These reporting errors will be counted as an error in the review process and may cause service intensity add-on (SIA) payments to be applied incorrectly on the claim.
  • Hospices shall report visits and length of visits (rounded to the nearest 15-minute increment), for nurses, aides, social workers and therapists who are employed by the hospice, that occur on the date of death, after the patient has passed away, with modifier PM. The reporting of post-mortem visits, on the date of death, should occur regardless of the patient’s level of care or site of service. Post-mortem visits occurring on a date subsequent to the date of death are not to be reported.
  • Date of death is defined as the date of death reported on the death certificate. Hospices shall report hospice visits that occur before death on a separate line from those which occur after death.
  • For example, assume that a nurse arrives at the home at 9 p.m. to provide routine home care (RHC) to a dying patient, and that the patient passes away at 11 p.m. The nurse stays with the family until 1:30 a.m. The hospice should report a nursing visit with eight 15-minute time units for the visit from 9 p.m. to 11 p.m. On a separate line, the hospice should report a nursing visit with a PM modifier with four 15-minute time units for the portion of the visit from 11 p.m. to midnight to account for the 1 hour post mortem visit.
  • If the patient passes away suddenly, and the hospice nurse does not arrive until after his death at 11 p.m., and remains with the family until 1:30 a.m., then the hospice should report a line item nursing visit with a PM modifier and four 15-minute increments of time as the units to account for the 1 hour post mortem visit from 11 p.m. to midnight.

Resource: Medicare Claims Processing Manual, Chapter 11 — Processing Hospice Claims (PDF), section 30.3 — Data Required on the Institutional Claim to A/B MAC (HHH).  https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf.

 

Texas News and Information:

HHSC Provides Guidance for Requesting COVID-19 Testing Supplies for Providers Without CLIA Waivers (PL 2022-09)

HHSC Long-term Care Regulation has published PL 2022-09 Process for Requesting Testing Supplies for Providers Without a CLIA Waiver on March 15, 2022.  You can access the letter at: https://www.hhs.texas.gov/sites/default/files/documents/pl2022-09.pdf. This letter describes the process for ALF, HCS, HCSSA, ICF and TxHmL providers without a CLIA waiver to enroll for the GenBody-100 COVID-19 Test Administrator Courses through the Prepare Texas website and request testing supplies.  The letter also advises providers who have a CLIA waiver what provide letter to follow and form to use.

The following letter affects hospice inpatient care facilities:

  • GL 22-1002 Emergency Hospital Off-Site Facilities and Designation of Licensed Hospital Space in Response to COVID-19
    • This letter addresses the passage of an emergency rule for hospital off-site facilities and designation of licensed hospital space in response to COVID-19. This emergency rule permits a currently licensed hospital to request HHSC approval to temporarily operate an off-site inpatient facility, including hospital space designated by another currently licensed hospital for use as an off-site facility, without obtaining a new license to more effectively treat and house patients in response to the COVID-19 pandemic. This letter explains the emergency rule and the application process.  You can access the letter at:  https://www.hhs.texas.gov/sites/default/files/documents/gl22-1002.pdf.    If you have questions, contact [email protected].

Medicaid Hospice Contract Processing Issues:

TNMHO is aware of the processing problems Medicaid hospice providers are experiencing with their initial application, renewals, acquisitions etc.  Our inability to get contracts done timely affects the care that we provide our patients and their families. TNMHO has begun to meet with legislative staff to request legislative assistance in obtaining resolution to the delays by HHSC in processing timelines.

Certified Nurse Aides (C.N.A.)

Any hospice using certified nurse aides, please be aware of this provider letter and additional information.

PL 2022-04 (Revised) Training Requirements for Nurse Aides and Nurse Aide Training and

Competency Evaluation Programs was released on March 1, 2022.  This letter goes into detail about the training expectations for C.N.A.’s regardless of where they practice.  Once the training is completed, the C.N.A is required to keep the information in case HHSC asks to see the certificates. Do not submit the certificate information to HHSC.    For more information, go to:

https://www.hhs.texas.gov/sites/default/files/documents/pl2022-04.pdf.

Hospice providers choose to hire certified nurse aides as allowed under 42 CFR 418.76 (a).  Hiring a C.N.A is 1 of the 3 options listed.

42 CFR 418.76 (a) Standard: Hospice aide qualifications.

(1) A qualified hospice aide is a person who has successfully completed one of the following:

(i) A training program and competency evaluation as specified in paragraphs (b) and (c) of this section respectively.

(ii) A competency evaluation program that meets the requirements of paragraph (c) of this section.

(iii) A nurse aide training and competency evaluation program approved by the State as meeting the requirements of § 483.151 through § 483.154 of this chapter and is currently listed in good standing on the State nurse aide registry.

You can read the entire rule at the following link:

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/subject-group-ECFR74797288a614803/section-418.76.  

If you choose to hire a C.N.A, you must comply with the HHSC rules outlined under 26 Texas Administrative Code Chapter 556:  https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=26&pt=1&ch=556&rl=Y.

Based on rule, HHSC staff cannot accept other trainings that your C.N.A. staff completed nor do they review and approve courses.

When a local health department refuses a HCSSA report, the HCSSA report to the regional DSHS office. Agencies experiencing these challenges may report incidences to DSHS directly via the COVID-19 mailbox at [email protected].

Disclaimer:

The Texas and New Mexico Hospice Organization publishes the Regulatory Update as an information only item.  TNMHO has no attorneys nor does it represent the state and federal governments.  All legal questions or concerns should be directed to your attorney or the governments involved.