Home Health & Hospice Week

While payment and HOPE tool provisions in the hospice proposed rule for 2025 may be getting the lion’s share of attention, other sections are also important for hospices to take in.

For example: The rule from the Centers for Medicare & Medicaid Services attempts to straighten out physician-related confusion in the hospice Conditions of Participation.

“To align the medical director CoP and the hospice payment requirements for both clarity and consistency, we are proposing technical changes to the CoPs by adding the physician member of the hospice [interdisciplinary group] as an individual who may review the clinical information for each patient and provide written certification that it is anticipated that the patient’s life expectancy is six months or less if the illness runs its normal course,” CMS spells out in the rule fact sheet.

CMS also proposes an “update to the medical director and admission to hospice care CoPs to clarify that if the medical director is unavailable, the physician designee may review the clinical information and certify the terminal illness.”

The National Association for Home Care & Hospice “is pleased that CMS is proposing regulatory text changes to clarify points of confusion pertaining to which physicians are able to certify terminal illness,” says NAHC’s Katie Wehri in a release.

“While these are not a change in policy for CMS, they are welcome ‘clean-up’ clarifications in the regulations to avoid Medicare survey or payment challenges related to these hospice certifications,” judges attorney Howard Young with law firm Morgan Lewis in Washington, D.C., in online rule analysis.

Other rule provisions include:

• CAHPS. Hospices will finally see some improvements to CAHPS patient satisfaction surveys — although maybe not as much improvement as they would like.

Based on a mode experiment in 2021, CMS proposes to add a web-mail mode (email invitation to a web survey, with mail follow-up to non-responders); a shortened and simplified survey; process changes including a prenotification letter and extended field period; two new, two-item Care Preferences measures; revisions to the existing Hospice Team Communication measure and the existing Getting Hospice Care Training measure; and the removal of three nursing home items and additional survey items affected by the rule.

These changes would take effect in fiscal year 2025, CMS’ Lauren Fuentes noted in the agency’s April 5 Open Door Forum for home health and hospice providers.

“While hospices have been requesting changes to the CAHPS Hospice Survey and will be happy to see some of these proposals, more work needs to be done to address the decreasing response rate and reasons for this,” Wehri assesses.

• Election Statements: “CMS is proposing regulation text changes … to clarify the requirements related to the election statement and [Notice of Election] in the CoPs,” the agency says in the rule fact sheet. “These regulation text changes do not change current policy but are intended to reorganize and more clearly distinguish the separate requirements for the ‘election statement’ and the NOE,” it says.

“These revisions focus on distinctions between the Election Statement language and the Notice of Election,” offers Melinda Gaboury with Healthcare Provider Solutions.

The clarifications are welcome, Wehri indicates.

Tip: “Hospice providers must remain vigilant to comply with documentation obligations,” Young recommends. That’s “evidenced by CMS’s [proposal] to clarify the difference between the often-conflated ‘hospice election’ and a hospice ‘notice of election,’ noting in its rulemaking commentary that ‘[a] complete election statement containing all required elements as set forth in [42 CFR] § 418.24(b) is a condition of payment’ and encouraging hospice providers, once again, to use the ‘Model Example of Hospice Election Statement’ to limit potential claim denials,’” he offers.

• SFP. CMS doesn’t mention the Special Focus Program, which will target poor-performing hospices for extra survey scrutiny, in the rule. “We appreciate commenters’ interest in the Hospice SFP as finalized in the CY 24 Home Health final rule (88 FR 77676). We continue to review comments and consider whether amendments are necessary,” the agency does say in the fact sheet. (See SFP details in HHHW by AAPC, Vol. XXXII, No. 39-40.)

CMS revealed in a Nov. 14, 2023 Open Door Forum that it wouldn’t make its first SFP selections until the end of this year, surprising many (see HHHW by AAPC, Vol. XXXII, No. 42).

Bottom line: “Staying abreast of regulatory and legal changes can be resource intensive,” Young acknowledges. But “hospices must ensure they have the resources and focus to abide by Medicare’s expectation that hospices dot those i’s and cross those t’s to avoid material survey deficiencies, claim denials, and audit takebacks,” he urges in online rule analysis.

Note: The proposed rule fact sheet is at www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2025-hospice-payment-rate-update-proposed-rule-cms-1810-p.