HOME HEALTH VALUE BASED PURCHASING FREQUENTLY ASKED QUESTIONS Updates in Red

1. What is the contact information of the Home Health Value-Based Purchasing (HHVBP) Helpdesk? General HHVBP The HHVBP Helpdesk can be reached by email at HHVBPquestions@cms.hhs.gov). The Helpdesk number is1-844- 280-5628 and hours are Monday through Friday, 8:30 AM to 6:00 PM Eastern time. 2. What is a CCN? A CCN is a six digit (all numeric) CMS Certification Number. It is the agency provider number. 3. What payers are included in the Model? The payment adjustments in the HHVBP Model apply to only Medicare PPS claims. The measures in the HHVBP Model include all payers that are currently included in the measure calculations: OASIS-Based Measures include Medicare fee-for-service, Medicare Advantage, Medicaid fee-for-service, and Medicaid managed care Claims-Based Measures include only Medicare fee-for-service HHCAHPS Measures - include Medicare fee-for-service, Medicare Advantage, Medicaid feefor-service, and Medicaid managed care New Measures o Herpes Zoster (Shingles) Vaccination - includes Medicare beneficiaries, including Medicare fee-for-service and Medicare Advantage (Medicare managed care) beneficiaries o Advance Care Plan - includes all payers 4. When can we anticipate receiving regulatory updates on the HHVBP Model from CMS? 5. We have a Parent- Branch CCN involved in the HHVBP demonstration - the parent location is in one of the HHVBP States and the branch is not. Should the branch location complete the Shingles/ACP form even though they are not in one of the (9) VBP states? When changes are needed for the HHVBP Model, regulatory updates will be included in the HH PPS Notice of Proposed Rulemaking and upon review of and response to public comments then included in the HH PPS Final Rule. After the final rule is published, CMS will present any changes to the HHVBP Model via a webinar. Changes would be effective January 1st of the next calendar year. Yes, because it is the parent CCN that determines inclusion in the Model. If the parent location is in one of the (9) selected HHVBP states and the branch is in a non HHVBP state, the patients in the branch would still be included in the model. 6. Can we take a photo of the patient s advance directive document in the home since they often do not have extra copies and will not let us take their copy to the office to make copies? ACP/Shingles (New Measures) Form No, per Compliance we are not allowed to photograph documents due to HIPAA concerns related to photos of anything that contains patient identifiable information. Agencies are not required to obtain a copy of the ACP. The requirement is to document in the EMR whether or not the patient has executed an advance care plan. As per guidance in 42 CFR 489.102: document in a prominent part of the individual's current medical record, or patient care record in the case of an individual in a religious nonmedical health care institution, whether or not the individual has executed an advance directive. 1

HOME HEALTH VALUE BASED PURCHASING FREQUENTLY ASKED QUESTIONS Updates in Red ACP/Shingles (New Measures) Form 7. Can we collect ongoing care information and document based on a phone call with the patient or caregiver or must this be from an actual visit? Telephone conversations can be counted as a discussion with HHA staff about an advance care plan or surrogate decision maker, for the HHVBP Model measures. However, while the Advance Care Plan New Measure does not specify that the conversation must occur in person or via telephone, the regulations at 42 CFR 489.102 do state that this process can occur at any time prior to providing care, including the first visit. 8. Is the form in KL Training? Not at this time. The ACP/Shingles report is currently being reviewed for updates. In the 9. Any tips on how and when to run the Advance Care Planning/Shingles report in KL? Filters, date time frame, etc to help MCP manage these? 10. The directions imply that I have to complete the form at DC and Transfer and Home Death. Please clarify this. 11. Where does the clinician find the Advanced Care Plan/Shingles form? interim we recommend using View Online Activity workflow The ACP/Shingles report is currently being reviewed for updates. In the interim we recommend using your View Online Activity workflow process and filter by the ACP/Shingles form and status. Yes the form needs to be completed at transfer (both #6 and #7), at agency discharge, and death at home. It is possible that a patient has multiple transfers before discharge from the agency. Due to this recent clarification from CMS on the transfer timepoint, the ACP/Shingles Form in KL is being revised to capture data at all required time points. The form is in the State Specific section on clinicians ipad Main Menu My Forms section. Once created it will be located in the My Shared Forms folder on their main menu. Once created, it can also be found it in the patient s record in the Clinical Notes section. 12. Who can create the Advanced Care Plan/Shingles form? The form can be created and assigned by proxy to a specific clinician by the MCP or QAM and the form can be created and/or updated by an RN, LPN, PT, OT, SLP, PTA, COTA, and MSW. Note: The Advance Care Plan New Measure does not specify a discipline, therefore any agency personnel could have the discussion related to the advance care plan or surrogate decision maker. Home health agencies are expected to follow their own policies and procedures that are consistent with their own State s laws in deciding who will provide information and discuss advance care planning. 13. The handout instructs that the form stays in pending until DC/TRANSFER/HOME DEATH and then the clinician finishes the documentation. Can you clarify the process to complete the form? 14. How do we document more than 1 conversation during ongoing care since there is only one text box for each topic in the ONGOING CARE section of the form? 15. How do we initiate the Advanced Care Plan/Shingles form for existing patients? The assessing clinician at DC/TRANSFER/HOME DEATH finishes the Advance Care Plan/Shingles Vaccine Form documentation along with DC/Transfer Summary, OASIS (when required) and DC visit documentation. The MCP/QAM performs the final QA of the DC/TRANSFER/HOME DEATH and at that time s/he will review the form to ensure documentation completed and apply the QA mark and Complete the Advance Care Plan/Shingles Vaccine form. In the Ongoing Care section, below previous documentation, add the date and content of each additional discussion. For all current patients (already admitted), initiate a form and begin the conversation documentation in the ONGOING CARE SECTION of the form. 2

16. If the form is not initiated at SOC, what should be done? 17. Do we need to change the form status to shared or does it automatically save that way? 18. If patient is transferred and then ROC - do we complete at ROC and then at time of dc - do we pull another form? 19. In regards to the Advanced Directive/Shingles, please confirm it is to be started on all new patients regardless of payor? 20. Does the branch need to track any aspect of the form other than initiation and updating in regards to reporting up to CMS in Oct/Jan/etc? ACP/Shingles (New Measures) Form The form is in the VBP SOC packet so it should be initiated at SOC. If it is missed, the MCP/QAM should follow up with the admitting clinician and remind them to create the form. New Advanced Care Plan/Shingles forms should be regularly initiated on all new SOCs during the entire VBP Pilot. No, it is already a shared form. No, ROC is not reportable event for this measure. Any changes that may need to be documented at ROC would be included in the ONGOING CARE section of the form. Yes, the form is to be completed on all patients in the 9 HHVBP states, regardless of payor. Yes. The form must be updated timely and marked complete by the MCP/QAM upon discharge, transfer, and/or death at home. 21. Please explain the data collection periods and data entry process for the New Measures. New Measures Data collection for all of the New Measures begins on July 1, 2016. Data collection is for a full quarter, therefore, the first data collection period begins on July 1, 2016 and ends on September 30, 2016. The second data collection period begins on October 1, 2016 and ends on December 31, 2016 and reporting is quarterly thereafter. Data entry into the HHVBP Secure Portal will be required to be completed by the 7th day of the month after the end of the quarter. For the first quarter of data collection, agencies will be able to enter data into the HHVBP Secure Portal from October 1, 2016 through October 7, 2016. For each quarter, agencies will be given 7 days after the end of the quarter to enter their New Measures data into the HHVBP Secure Portal. 3

22. For the new measure denominators, the calculation is not based on actual patients served but on the number of patients that are discharged, transferred or died? For New Measures, if a patient is on service in Sept 2016 and is still on service on Oct 2016 does this same patient get counted both time points? 23. For the measures that specify the patient s age (Advance Care Plan; Herpes Zoster Vaccination), could you clarify if this refers to the patient s age at SOC/ROC or Discharge/Transfer? 24. What does it mean to offer the shingles vaccine? Does an agency need to actually administer the vaccine or can they offer it when another provider will administer the vaccine? New Measures The New Measures Templates available on the HHVBP Connect website outline the specific data collection requirements for each of the 3 New Measures. For the Herpes Zoster Vaccination measure and the Advance Care Plan measure, data are collected for patients who were discharged from the HHA, transferred to an inpatient facility, or died during the reporting period. The term during the reporting period refers to the data collection quarter. For the first data collection period, this would include patients who were discharged from the HHA, transferred to an inpatient facility, or died during the period of July 1, 2016 through September 30, 2016. Related to your specific question for September and October (2 different reporting periods), an agency would include the same patient in multiple reporting periods if that patient experienced any of the events (discharge, transfer to inpatient facility, or death) during the reporting period. Patients are included in each reporting period that they have a qualifying event of discharge, transfer, or death, even if that means they are reported more than once in the same quarter, or if they are reported in more than one quarter. Home health agencies will report data based upon the patient's status at discharge, transfer to an inpatient facility, or death. The New Measures Template for Herpes Zoster Vaccine, asks, How many patients were then offered the vaccine by the HHA prior to home health discharge, transfer to an inpatient facility, or death during the reporting period? In this question, offered includes agencies who offer to administer the vaccine and also agencies who offer to assist in coordinating the administration of the vaccine by another provider (e.g. the patient s physician or pharmacy). 4

25. What is an advance care plan and a surrogate decision maker? 26. The Advance Care Plan New Measures Template, items J M states, How many patients with an advance care plan had the following information documented in the advance care plan (Medical treatment preferences, mental health/behavioral treatment preferences, cultural/social, etc.). Question: Are these preferences, items that are expected to be in the advanced directives, DPOA (durable power of attorney), living will? 27. Our agency puts information on end of life planning in our Admission Packets, can we count this as providing information on an advance care plan? 28. For the Advance Care Plan measure, what is the difference between did not wish and unable to provide an advance care plan or name a surrogate decision maker? New Measures Advance care planning provides patients with an opportunity to consider, discuss, and plan their future care with health professionals. The advance care plan measure includes patients who have an advance care plan or surrogate decision maker documented in the medical record AND also patients in which the agency has had a discussion related to an advance care plan or surrogate decision maker documented in the medical record. Advance Care Plan Document is a legal directive specifying the patient s future healthcare decisions for a time when they are not able to make their own healthcare decisions. The advance care plan document is typically referred to as an advance directive. Examples of advance care plans/advance directives include a living will, durable power of attorney for health care, Physician Orders for Life-Sustaining Treatment (POLST), Medical Orders for Life- Sustaining Treatment (MOLST), Do-Not- Resuscitate (DNR) Orders, or other legally valid documents recognized under State law. Surrogate Decision Maker - (also known as Legal representative, Agent, Attorney in fact, Proxy, Substitute decision-maker ) is a person designated and authorized by an advance directive or State law to make a treatment decision for another person in the event the other person becomes unable to make necessary health care decisions. Items J-M in the New Measures Template for Advance Care Plan gather information on the types of information that may be found in an advance care plan document. All types of information (items J-M on the Advance Care Plan New Measures Template) are not required in all advance care plan documents. In an agency s data collection processes at the patientlevel, it is possible to have zero for all of these fields for some individual patient advance care plan documents if their advance care plan document contains no preferences and simply provides a surrogate decision maker. However, it is required that HHAs collect information on items J-M and report this information quarterly via the HHVBP Secure Portal. No. The intent of this measure includes communication with the patient and/ or their caregiver. If, in addition to providing written information, you have a conversation with the patient and /or caregiver, this would meet the requirements for providing information on advance care plan. Patients who do not wish to provide an advance care plan or surrogate decision maker have had a discussion with the agency staff related to an advance care plan or surrogate decision maker but chose to not pursue an advance care plan or surrogate decision maker. Patients who were unable to provide an advance care plan or surrogate decision maker may have no one they could name or have personal reasons for why they needed to delay pursuing establishing the advance care plan or surrogate naming by the time of home health discharge, transfer to an inpatient facility, or death. 5

29. For the measures being reported through the HHVBP Secure Portal, i.e., flu vaccine taken by employees, when will the reporting of these measures begin? How often is it required to enter the information on the New Measures in the portal? 30. For the first submission of the New Measures in October 2016, will HHAs be exempt from submitting influenza data since the data collection period is outside of flu season? 31. For the Staff Influenza Vaccination measure, can you please expand on the definition of "affiliation" for licensed independent practitioners? Do you mean all referring physicians? 32. For the Staff Influenza Vaccination measure, where do we count staff that are providing services through a contracting agency such as contracted therapists? 33. For the Staff Influenza Vaccination measure, do we only count staff who visit patients? New Measures Data for New Measures should be entered in the HHVBP Secure Portal beginning on October 1, 2016, for the period covering July 1 - September 30 2016. New measure information should be submitted for each quarter throughout the Model. No. Agencies who wish to receive the total number of available points on their Total Performance Score for New Measures should submit data each quarter for each measure. For the Influenza Vaccination Coverage for Home Healthcare Personnel measure only, data collection does not begin until October 1, 2016. Therefore, for this measure only, agencies should enter zeroes for the first data collection period submission. The data entry for the first data collection period will be completed on the HHVBP Secure Portal from October 1, 2016 through October 7, 2016. An affiliated practitioner: Includes: Practitioners with a contractual or legal relationship with the agency to provide services to either the agency staff or the agency patients (i.e. MD, DO), advanced practice nurse, physician assistant) A physician who is not an employee of the agency, but provides services such as Medical Director, Board Member, or Clinical Consultant Does not include: Clinical service contracts for agency staff (such as employee assistance programs or workrelated injury programs) Practitioners who are ordering home health services or making referrals to the agency (if this is their only relationship with the agency) Other licensed personnel such as therapists, nurses, social workers, or dieticians/nutritionists. For agencies that have contractual relationships with Accountable Care Organizations (ACOs) or that have similar contractual arrangements, physicians, advanced practice nurses, and licensed physician assistants ( if making referrals is their only relationship with the agency) Data will not be collected for contracted staff providing services through a contracting agency because they are not included in the measure definition. This is not to be confused with per diem or part time staff who are included in this measure in the employee denominator category if they receive a direct paycheck from the agency. No. HHAs will count all employees, licensed independent practitioners, and adult students/trainees and volunteers, even if the personnel have no encounters with patients. 6

34. For the Staff Influenza Vaccination measure, do we count employees only for October through December then report NA for the January through March quarter or will be penalized for not reporting the same data twice? 35. Can you clarify what required documentation means in the employee flu vaccine new measure general question: How many of the HHA employees provided documentation for receiving the flu vaccine from a setting outside of the HHA? Does this mean the HHA needs a copy in the HR record of the consent form from where the employee received the flu vaccine? Or is the employee signing the HHA s consent/declination form and marking received at X on X date sufficient? New Measures Data is reported for the flu season. It is possible that HHAs will enter the same information for multiple quarters if there is no change in their data from quarter to quarter. Agencies who wish to receive full points on their Total Performance Score for New Measures should submit data each quarter for each measure. Per CDC Guidelines, acceptable forms of documentation include a signed statement or form, or an electronic form or e-mail from the health care worker (HCW) indicating when and where he/she received the influenza vaccine, or a note, receipt, vaccination card, etc. from the outside vaccinating entity stating that the HCW (HHA employee, licensed independent practitioners, and adult students/trainees and volunteers) received the influenza vaccine at that location. Verbal statements are not acceptable for the purposes of this measure 7

36. Why is it required that local branch leadership obtain Secondary Point of Contact (SPOC) access to the Secure Portal? 37. Is the recommendation is to have 2 Secondary Points of Contact (SPOC) per Provider # not per branch? Accessing the Secure Portal Local branch leadership is required to access the Secure Portal to obtain Interim Performance Reports and use the New Measure Summary section to export results. The recommendation is to have 2 SPOCs per branch, not by Medicare provider number. We suggest the Branch Director of each location and 1 additional person per branch request SPOC access. 38. How do I unlock my EIDM account? After three unsuccessful attempts to login, your account will be locked. After 60 minutes have elapsed since your last failed attempt, your account will be unlocked. You will then be required to enter your valid login credentials and multifactor authentication to unlock the account. If unsuccessful, contact CMS XOSC Tier 1 support at 1-855-267-1515 or CMS_FEPS@cms.hhs.gov. 39. Why is my SSN required to register for the HHVBP Secure Portal? 40. I have registered for the HHVBP Secure Portal; however, I cannot enter it because I did not receive a security code sent to my email as requested. What do I do? 41. Does asking security questions for CMS registration for the HHVBP Secure Portal based on a person's credit report in any way at all effect their credit score? 42. During the registration process my identity was not able to be verified as I do not have any credit cards and have no loans. What can I do? Identity Verification is important in the process of providing sufficient information (e.g., identity history, credentials, or documents) to a service provider for the purpose of proving that a person or object is the same person or object it claims to be. Individuals requesting electronic access to CMS protected information or systems must be identity proofed prior to being given access. The social security number will be used for verification purposes only. EIDM does not share SSNs with any other federal or private agency. a) check your SPAM and junk mail folders to ensure you did not receive an email from NoReply@cms.hha.gov b) check to be sure you are using the type of Multi-factor Authentication (MFA) that you originally selected when you set up your account. For example, if you signed up for text messaging as the mode for MFA, you will receive a text message c) be sure you entered the email address or phone number correctly d) If you are still experiencing technical issues with gaining access to the HHVBP Secure Portal or HHVBP Connect, please call: (844) 280-5628. The credit inquiry for HHVBP registration is a soft inquiry, and therefore does not impact your credit score. There is a manual process for verifying your identity if you do not have any credit cards or loan information. To complete the manual identity verification process, please contact the CMS Help Desk at HHVBPquestions@cms.hhs.gov. Note that you will need a copy of your photo ID to complete this process. 8

43. I incorrectly chose email instead of email one-time pass code in the MFA Device. How do I undo this? Accessing the Secure Portal After you enter your user id in the EIDM Portal login process, at the bottom of the screen you can click the link to select to register another MFA Device and it will take you through that process (see below). 44. I signed on a few months ago and I am set up as the Primary POC role. How do I change that to the Secondary POC role? 45. When and how will individuals be notified that they have been approved as secondary points of contact? 46. If I want to access reports only, do I need to follow through with the Enterprise Identity Management (EIDM) registration? Review the materials for HHVBP Session 4: Requesting Access to the Secure Portal. Begin with the steps on slide 18 of the presentation handouts and use the HHVBP Secure Portal Registration Steps instruction sheet. You will receive a system generated email within 2 weeks notifying you that access has been granted. Yes. In order to access reports, you will need to register with Enterprise Identify Management (EIDM) and obtain a User ID. This is the first step to gaining access to the HHVBP Secure Portal where interim 1 and annual performance reports and annual payment adjustment reports can be viewed. 9

47. Will the branch be responsible for manually entering the new measure data? Entering Data in the Secure Portal Data entry of the new measures into the HHVBP Secure Portal has been centralized at the division level. 48. Who will be making the calculations for the agency? Will this be automated? 49. Will the baseline data be individual, or based on all the other agencies in the nine states in the Model? 50. How can I find our individual HHA baseline and performance level data? 51. How many episodes and measures are required for a CCN to qualify for a score? 52. When reviewing performance data, should I look at each branch separately or rolled up by provider # (CCN)? 53. Are the achievement and benchmark thresholds calculated the same way as the CASPER report outcomes are calculated or the same way that the data on Home Health Compare is being calculated? TPS and Baseline Reports CMS will calculate the official TPS. The baseline data consists of both individual HHA level data as well as aggregate HHA dat HHAs will have access to their own quality measure data from 2015. HHAs will also have access to the Benchmark (mean of top decile of 2015 within each state and cohort) and the Achievement Threshold (median of all the HHAs in 2015 in each state and cohort). These are the reports that will be accessed through the Secure Portal. The Individual HHA baseline and performance level data will be made available beginning in the July 2016 Interim Performance Reports that will be posted on the HHVBP Secure Portal and quarterly thereafter. According to the HHVBP scoring methodology, there must be at least 20 completed episodes for a measure to qualify for a score and at least (5) available measures to qualify for a Total Performance Score. CMS is looking at the CCN roll-up data and not the individual branches. There are two different methodologies used for adjusting the HHA s scores on these two different reports. On the CASPER Reports, the HHA s scores are compared with the national performance for a comparable case mix of patients. On Home Health Compare, the HHA s scores are adjusted based on the HHA s predicted value compared with the national predicted value for an outcome so that the HHA can be compared to all other HHAs based on the same standard. The HHVBP Model uses the adjustment methodology used for reporting scores on Home Health Compare as this is the HHA-to-HHA comparative methodology that is most appropriate. The agency s scores on the HHVBP performance reports may not match the Home Health Compare scores due to the timing of the data pull for these two sets of scores. 10

54. Patients who are recertified but not discharged are not included in the calculation of the outcome measures until their quality episode ends at transfer, discharge, or death. How will the patients that are only recertified (not discharged, transferred, or died during the reporting period) impact the Total Performance Score on the HHVBP Model as not all patients in the agency are included? 55. Do you have the Course ID numbers in Kindred Link for the measure specific education? The calculation of outcome measures requires a completed quality episode. Patients who are not discharged, not transferred, or have not died within the reporting period will not be included in the calculation of the outcome measures as they do not have a completed quality episode. Patients who do not have a completed quality episode will not be included in the calculation of the Total Performance Score. KAH Learning Courses: 56. Could you tell me how I can assign a course to a clinician through kindredathomelearning.com? You must have supervisor level access and the ability to enroll learners must be enabled in order to access the" Training and Enrollment option. 11