Home Health & Hospice Week

No final approval letter from the MAC? You could be included.

The definition of who counts as a new provider for enhanced oversight purposes may surprise you.

When the Centers for Medicare & Medicaid Services said it was going to start “placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional period of enhanced oversight,” it set a fairly broad definition of who that is.

According to an MLN Matters article released July 11, “for the period of enhanced oversight, new hospices include those:

• Newly enrolling in the Medicare Program (starting July 13, 2023)
• Submitting a change of ownership (CHOW) that meets all the regulatory requirements under 42 CFR 489.18
• Undergoing a 100 percent ownership change that doesn’t fall under 42 CFR 489.18.”

FYI: “A change of ownership under 42 CFR 489.18 includes: (1) in the case of a partnership, the removal, addition or substitution of a partner, unless the partners expressly agree otherwise, as permitted by applicable state law, constitutes a change of ownership; (2) for a corporation, the merger of the provider corporation into another corporation, or the consoli­dation of two or more corporations, resulting in the creation of a new corporation constitutes a change of ownership,” explain attorneys Sean Fahey and Brian Jent with law firm Hall Render in online analysis.

Plus, CMS specifies that “you may be affected if you:

• Got final approval for Medicare enrollment on or after July 13, 2023
• Started the enrollment or certification process before July 13, 2023, but haven’t received a final approval letter from your Medicare Administrative Contractor (MAC)
• Got approval on a change of ownership request on or after July 13, 2023.”