Medicare Certified


Released Quarterly: October 2019

CAHSAH advocates and provides regular updates to its members on regulations that impact our industry. Some of the recent regulatory actions included:

LVN Scope of Practice Update: The Board of Vocational Nursing and Psychiatric Technicians (BVNPT), along with the Respiratory Care Board, continue to work to clarify the role and scope of practice for Licensed Vocational Nurses (LVNs) in caring for patients on ventilators. The BVNPT released draft proposed statutory changes for the scope of practice for LVNs. CAHSAH wants to ensure that providers review the proposed language and report any concerns and suggestions to CAHSAH so that we can provide a united response to the Board.

CMS Allows Pseudo Patients for Competency Testing: In regulatory provisions to promote program efficiency, transparency, and burden reduction as well as address fire safety requirements for certain dialysis facilities; hospital and critical access hospitals, CMS has relieved the burden for home health and hospice providers. The relief comes with a notable change of COP §484.80 in which home health aides may be checked for competency by using a “pseudo” patient.

Medicare Updates Claims Manual for PDGM: The Centers for Medicare & Medicaid Services (CMS) released Transmittal 4378/Change Request (CR) – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Revised and Additional Manual Instructions. This transmittal revises additional sections of the CMS Claims Processing Manual, Chapter 10, to support the implementation of the HH PDGM and creates new sections to describe the HH PDGM program.

CDPH Issues Power Outage Notification Requirements: The Department of Public Health (CDPH) has issued AFL-19-30 which specifies that all facilities must follow the guidelines on reporting power outages to their local licensing division.

Department of Public Health Issues New TB Testing Protocols: All hospice and home health providers are advised to review the California Department of Public Health’s latest release on TB testing protocols included in All Facilities Letter 19-28.

Payment Rates and Policies Proposed for Medicare’s New Home Infusion Therapy Benefit: The Centers for Medicare & Medicaid Services (CMS) issued its proposed home health rate update rule on Monday, July 11, 2019 which included further details about the implementation of the new home infusion therapy supplier benefit which becomes a permanent benefit for Medicare Part B beneficiaries in 2021.

Medicare Sequestration Cuts Extended: : President Donald Trump has signed the Bipartisan Budget Act of 2019 which includes an extension of the Medicare sequestration cuts for an additional two years. This across the board cut of two percent applies to all Medicare provider payments.

Medi-Cal Update for County Children’s Health Initiative: : Effective October 1, 2019, the delivery of benefits for the County Children’s Health Initiative Program (CCHIP), also known as Healthy Kids, will transition from their local plan to the MediCal Managed Care Plan (MCP) system.

US Department of Labor’s Overtime Rule Sets New Thresholds: : The US Department of Labor has issued a final rule which updates the earning thresholds necessary to exempt executive, administrative, or professional employees form the FLSA’s minimum wage and overtime pay requirements and allows employers to count a portion of certain bonuses and/or commissions toward meeting the salary level.

CDPH Licensure Renewal Update: : Renewal notices are sent to all entities licensed by the Department of Public Health 45-120 days prior to the license expiration date. It is the responsibility of the facility’s licensee to obtain a renewal notice.


CAHSAH has identified over 200 bills that will be tracked during the 2019 Legislative year. The following bills are CAHSAH’s “priority” legislation in relation to Medicare services:

AB 5 (Gonzalez) CAHSAH took an “Oppose Unless Amended” position on this bill which would codify the Dynamex decision relative to classifying independent contractors. The bill was passed by the Legislature without a carve out for home health and hospice providers and goes into effect January of 2020.

AB 714 (Wood) CAHSAH supports this bill which would provide an exemption for hospice agencies from the requirements to offer an opioid reversal drug and educate patients about opioid overdose. The bill was signed into law by the Governor and is effective immediately.

AB 1544 (Gipson) CAHSAH opposes this bill which would expand the scope of paramedicine into hospice services by individuals who are neither trained, licensed, nor regulated to provide such services. The bill failed passage by the Legislature.

 California Association for Health Services at Home
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