State Variance Approval
for HFS 133.20(3) Review of Plan and Implementation of Medicare Prospective Payment System
of BQA 00-063 (PDF, 20 KB) - includes attachment
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Date: August 21, 2000 DSL-BQA-00-063
To: Home Health Agencies HHA 24
From: Jan Eakins, Chief, Provider Regulation and Quality Improvement
Via: Sue Schroeder, Director, Bureau of Quality Assurance
The purpose of this memorandum is to provide you with information related to Wisconsin
Administrative Code, HFS 133.20(3), Review of Plan, and the relationship of this state
rule to the implementation of the federal Medicare Prospective Payment System (PPS).
Review of Plan
Effective October 1, 2000, the Bureau of Quality Assurance (BQA) will rescind
the January 17, 1990 memorandum # 90-007 that allowed a variance to Wisconsin
Administrative Code HFS 133.20(3), Review of Plan. This variance allowed home health
agencies to have a maximum of 62 days to review the plan of treatment/plan of care. As of
October 1, 2000, the attending physician and agency staff must review the plan of care at
least every 60 days or as often as the severity of the patients condition requires.
The 60-day plan of care review will be applicable to all patients (Medicare,
Medicaid, and Private Pay) served by a licensed only and/or licensed and Medicare
certified home health agency.
This change will conform with the federal Health Care Financing Administration (HCFA)
amendment to the home health regulations at 42 CFR 484.18(b) that changes the timing of
plan of care reviews from 62 to 60 days effective October 1, 2000. The specific federal
language is noted in the July 3, 2000, federal PPS final rule, page 41211.
One Time Variance
Effective immediately, BQA will also grant a one-time variance to the 60-day plan of
care review timeline at HFS 133.20(3).
This variance is being granted to be in concert with the federal Health Care Financing
Administration one time grace period for the plan of care recertification period (90 days
rather than 62 days) to facilitate the transition of all Medicare skilled patients to the
prospective payment system (PPS) effective October 1, 2000.
With the implementation of PPS, all Medicare skilled patients on service at the home
health agency prior to September 1, 2000, are required to have an OASIS routine follow-up
assessment (OASIS B-1 8/2000,) conducted in September.
For Medicare patients only, due for follow-up recertification in August, the
home health agency can obtain a verbal order to extend the existing plan of care into
September. The OASIS assessment would also be delayed until September. All plans of care
for the Medicare PPS patients developed during September will be allowed to span a maximum
of 90 days. All plans of care within the grace period must have an end date no later than
November 29, 2000.
Medicare skilled patients admitted during September will require a start of care (SOC)
assessment. The initial plan of care for each Medicare PPS patient would cover the SOC
date and end no later than November 29, 2000. Follow-up assessments and plan of care
reviews, subsequent to November 29, 2000, would cover each additional 60-day period until
BQA finds that granting this variance will not jeopardize the health, safety or welfare
of home health patients.
During the transition to PPS, BQA home health surveyors will not be citing 42 CFR
484.18(b) and HFS 133.20(3) deficiencies related to the 60-day timeline for Medicare
Prospective Payment patients only. Private pay and Medicaid only patients are excluded
from the one time HFS 133.20(3) variance. This one-time state variance and federal
grace period does not preclude the home health agency from meeting federal and state
requirements to have physician orders for the provision of services.
Compliance with the 60-day timeline for plan of care reviews for Medicare PPS patients
will resume after November 29, 2000.
Attached is a document entitled OASIS Considerations for
Medicare Patients that contains additional guidance regarding PPS and OASIS.
Questions related to the plan of care reviews and applicability to OASIS can be
directed to Barbara Woodford, Home Health Nurse Consultant at firstname.lastname@example.org (replaced by Marianne Missfeldt, (715) 836-4036).
Questions related to survey protocols can be directed to Jane Walters, Health Services
Section Northern Unit Supervisor (replaced by Jan Heimbruch, email@example.com
(608) 243-2086) and Juan Flores, Health Services Section Southern Unit Supervisor
(replaced by Cremear Mims, firstname.lastname@example.org (414)
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