Information Update September 7, 2011 Nursing homes directed to repay hospice for bed hold days The TennCare Bureau has clarified its position on nursing home "bed hold days" for hospice patients. In an August 23rd memo to the state's nursing homes (attached), the TennCare Bureau directs nursing homes to stop the practice immediately and reimburse hospice for any bed hold days that were previously billed to them. The memo goes on to direct hospice to reimburse the TennCare MCOs for these same days. It is important for THO members to review your previous nursing home claims and work with your nursing home partners to identify where bed hold days have been billed and paid. Also note that this is a clarification of a rule that TennCare has had in place so there is no grace period for past claims. TennCare Bureau clarifies MCO payments for date of death The TennCare Bureau has communicated with all three TennCare MCOs its position on payments for the date of death: our state Medicaid program will follow the Medicare policy. So no matter what time of day the hospice patient expires, the room and board should be reimbursed for that day. According to the Medicare hospice manual Section 402.5, Date of Discharge: For the day of discharge from an inpatient unit, the appropriate home care rate is to be paid unless the patient dies as an inpatient. When the patient is discharged deceased, the inpatient rate (general or respite) is to be paid for the discharge date. This policy only applies to hospice residents in the nursing home. According to the Bureau, reimbursement of room and board for the date of death and/or discharge is NOT covered for long term care claims, unless the patient dies or is discharged after noon. This policy is not changing. VA to offer free, web-based EPEC training for physicians and other disciplines Our local Veterans Administration has partnered with Vanderbilt School of Medicine to offer free Education in Palliative and End-of-Life Care for Veterans (EPEC) training for physicians, nurses, and other disciplines. The training will be provided in one-hour modules over a two-week period later this month. The VA is asking each participating site to register and then each participant will complete additional registration materials. In order to receive CME/CEUs participants will need to complete all 20 modules. All non-physicians will receive a Certificate of Attendance that they can submit to their credentialing body to transfer over to their proper credits. Participants who do not wish to receive CMEs/CEUs do not have to participate in all modules. Note that the program is limited to 100 participants and the registration deadline is September 12. THO Website set to launch members-only section As you know, the Tennessee Hospice Organization has made several changes to its website in 2011. The most recent of these improvements is a new members-only area where users can login and find past THO newsletters under News and Information, along with data reports from the Joint Annual Report in the Data and Statistics section. Also in News and Information, members have access to an archive of the Hospice News Network (HNN), a weekly news summary of media stories relevant to hospice care. E-mails with login instructions, including user name and password, are being sent to all member agencies this week. Each member organization will have a single account, which can be accessed by anyone in the organization who is given the user name and password.
Tennessee Hospice Organization Information Update September 7, 2011 Upper Cumberland Hospice Conference is only weeks away The Upper Cumberland Hospice Conference - Hospice Care: It's Not What You Think, set for Friday, Oct. 21, at the Tennessee Tech University Whitson-Hester School of Nursing in Cookeville. This conference will address the vision of good hospice care and how to overcome barriers to earlier referrals. The event is open to physicians, nurses, social workers, discharge planners, chaplains and the community at large. CEU credits will be available for an additional fee. More information, including conference agenda, will be shared as details are finalized. Please contact Skeeter Flowers at skeeter.flowers@gentiva.com with questions. Alabama Hospice Organization invites Tennessee hospices to conference The 2011 Alabama Hospice Organization State Conference will be held Oct. 9 through 11 in Montgomery, Ala. Details about the conference, included registration and hotel information are available online at www.alhospice.org/files/2011conferencesavethedate.pdf. Louisiana and Mississippi to host chaplain and social worker meetings The Louisiana-Mississippi Hospice & Palliative Care Organization will be hosting conferences for chaplains and social workers in the coming months and have extended invitations to Tennessee at their member rate. The chaplain conference is September 23 in Ridgeland, Miss. (registration deadline is Sept. 16) and will be offered again on Nov. 11 in Shreveport, La. (registration deadline is Nov. 4). Details are available at www.lmhpco.org/blahdocs/uploads/lmhpco_chaplain_conference_bro_2011_265.pdf. The conference for social workers will be held Oct. 20 and 21 in Ridgeland, Miss. The conference will be presented again in January in Shreveport, La. Details are available online at www.lmhpco.org/blahdocs/uploads/lmhpco_social_workers_bromsla_2_3339.pdf. ~ Page 2 ~
IMPORTANT MEMO STATE OF TENNESSEE BUREAU OF TENNCARE DEPARTMENT OF FINANCE & ADMINISTRATION 310 Great Circle Road NASHVILLE, TENNESSEE 37243 DATE: August 23, 2011 TO: FROM: SUBJECT: Administrators of Medicaid Nursing Facilities Directors of Hospice Agencies Patti Killingsworth, Chief of Long Term Care Bed hold days NOT COVERED for hospice room and board It has come to our attention that some Nursing Facilities may be billing to hospice agencies and some hospice agencies may be paying and in turn billing to MCOs charges to hold beds in a Nursing Facility when a person has elected to receive hospice services in the facility. Bed hold days are NOT a Medicaid covered service for persons receiving hospice services in a Nursing Facility. Pursuant to TennCare Rule 1200 13 01.03(9), up to 10 bed hold days per year may be reimbursed only for persons receiving Level I Nursing Facility reimbursement, and in accordance with requirements set forth in that section. Persons present in the facility and receiving hospice services may be counted for purposes of establishing the facility s occupancy as set forth in Rule 1200 13 01.03(9)(a)(4). However, bed hold days are not reimbursed for persons receiving Level II Nursing Facility reimbursement or hospice services. As is the case with any non covered service, decisions about whether to hold a bed and the responsibility for payment for held beds that are non covered services are a contractual matter between the facility, the patient and/or their responsible party, and the hospice agency (as applicable). Any reimbursement made by an MCO to a hospice agency for days that a hospice patient was not actually in the facility receiving hospice room and board services constitutes an overpayment of Medicaid funds, as these services are not covered. Pursuant to 6402 of the Affordable Care Act, providers have 60 days from discovery to return any overpayments you have received and avoid additional liability under the State and Federal False Claims Acts. Nursing Facilities should repay the hospice agency for any claims billed to and paid by the hospice agency in error. Hospice agencies should repay the MCO for any claims billed to and paid by the MCO in error. Because this is existing policy which has always been in effect, recovery is not limited to any particular time period.
TennCare and our contracted MCOs will be reviewing to ensure that any charges for bed hold days provided to hospice patients paid in error are recovered. If you have any questions about this memo, please contact your TennCare MCO or the Long Term Care Division.
OFF LABEL/UNAPPROVED USAGE All faculty have been informed that if any unapproved or off label use of a product or device is to be referenced at this educational activity, the faculty member is responsible to disclose that the product is either investigational or it is not labeled for the usage being discussed to the audience at the time of the educational activity. CONFLICT OF INTEREST AND FACULTY DISCLOSURE This continuing nursing education activity has been reviewed by members of the Veterans Affairs Tennessee Valley Healthcare System Provider Unit to ensure the educational activity materials and content are fair, balanced and free of bias. No conflicts of interest have been disclosed by any faculty participating in the educational activity. NON-ENDORSEMENT The Tennessee Nurses Association and the American Nurse Credentialing Center on Accreditation recognizes this activity as continuing education for nurses. This recognition does not imply the approval or endorsement of any commercial product(s) associated with this educational activity. Education in Palliative and End-of- Life Care for Veterans Approved Provider Status: The Veterans Affairs Tennessee Valley Healthcare System is an approved provider of continuing nursing education by the Tennessee Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. - This educational activity provides 20 contact hours for registered nurses for successful completion (attendance at the entire educational activity is required in order for participants to receive a certificate documenting successful completion of the activity ). Attendance is verified by participants completing the "sign-in" sheet and evaluation for the activity. - This activity will no longer be authorized for continuing education credit after September 19, 2013. - Vanderbilt School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. - Vanderbilt School of Medicine designates this live activity for a maximum of 20 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Live Meeting Presentations September 19 30, 2011 11:00 am CT/12:00 pm ET 1:00 pm CT/2:00 pm ET Purpose: To increase the knowledge and skills in providing end-of-life care for Veterans. Objectives: 1. Identify 2 options for end-of-life care in the VA health care system. 2. List 3 ways to communicate effectively with patients who have advanced illness, their families, caregivers, and members of the interdisciplinary care team. 3. Describe approaches to assessing and managing symptoms based on the patient s goals of care at the end-of-life. 4. Identify 3 potential psychological, social, and spiritual needs of Veterans with advanced illness. 5. Describe ethical and legal principles related to advanced care planning. Sponsored by Vanderbilt School of Medicine Department of Medicine in conjunction with the TVHS Geriatric Research, Education and Clinical Center (GRECC), the United States Department of Veterans Affairs MidSouth Healthcare Network, VISN 9 Hospice & Palliative Care Programs, and the Meharry Consortium GEC
Presentations Monday, Sept 19, 2011 11:00 am CT/12:00 pm ET Plenary 1: Introduction to EPEC Dr. James Powers 12:00 pm CT/1:00 pm ET Module 1: Goals of Care Debora Traugott Tuesday, Sept 20, 2011 11:00 am CT/12:00 pm ET Plenary 2: Ethics and Law Dr. Karen Clark 12:00 pm CT/1:00 pm ET Module 2: Advanced Care Planning Kim Schroerlucke Wednesday, Sept 21, 2011 11:00 am CT/12:00 pm ET Plenary 3: Settings of Care Shelli Storey 12:00 pm CT/1:00 pm ET Module 3: Breaking Bad News Dana Franklin Thursday, Sept 22, 2011 11:00 am CT/12:00 pm ET Module 5: Psychological Symptoms Dr. Noelle Liwiski 12:00 pm CT/1:00 pm ET Module 8: Psychosocial Issues Jeanine Bledsoe Friday, Sept 23, 2011 11:00 am CT/12:00 pm ET Module 12: Loss Grief Bereavement Jennifer Crane 12:00 pm CT/1:00 pm ET Module 16: Spirituality in Palliative Care Kevin Holmes Monday, Sept 26, 2011 11:00 am CT/12:00 pm ET Module 6: GI Symptoms, Constitutional Symptoms, Dyspnea Patricia Smith 12:00 pm CT/1:00 pm ET Module 7: Whole Patient Assessment Dr. Lisa Vuocolo Tuesday, Sept 27, 2011 11:00 am CT/12:00 pm ET Module 10: Life Sustaining Treatments Dr. Sumi Misra 12:00 pm CT/1:00 pm ET Module 11: Last Hours Lynn Winegar Wednesday, Sept 28, 2011 11:00 am CT/12:00 pm ET Module 4: Pain Management Patricia Smith 12:00 pm CT/1:00 pm ET Module 9: Vets from Different War Eras Marleen Burns Thursday, Sept 29, 2011 11:00 am CT/12:00 pm ET Module 13: Request to Hasten Death Dr. Lisa Vuocolo 12:00 pm CT/1:00 pm ET Module 14: Sudden Illness Dr. James Powers Friday, Sept 30, 2011 11:00 am CT/12:00 pm ET Module 15: Professional Self Care Georgia Carruth 12:00 pm CT/1:00 pm ET Module 17: Teamwork in Palliative Care Dr. Sumi Misra To Register: Send an email to Linda.Baldwin2@va.gov, or call 615-695-2180 by September 12, 2011. Registration is limited to 100 participants. Live Meeting invitations will be sent to registrants prior the educational series.