Home Health & Hospice Week

Watch out: Deactivation threshold now down to just 6 months.

The 36-month rule isn’t the only enrollment change to hit hospice providers this year.

“The government isn’t reinventing the wheel for hospice” when it comes to enrollment and survey changes, noted attorney Meg Pekarske with law firm Husch Blackwell in the firm’s Hospice Insights podcast. Many of the changes are already standard in the home health and skilled nursing facility sectors, Pekarske observed.

In the 2024 home health final rule, the Centers for Medicare & Medicaid Services finalized an array of enrollment revisions that affect hospices as of Jan. 1. They include:

• Subjecting new hospices to the highest level of provider enrollment application screening, which includes finger­printing all 5 percent or greater owners. “Revalidating hospices will remain subject to moderate risk level screening,” however, point out attorneys Trey Andrews, Varsha Gadani, and Kelly Bauer with law firm McGuireWoods.
• Clarifying that the definition of “Managing Employee” includes the administrator and medical director of a hospice.
• Reducing the period of Medicare non-billing for which a provider or supplier can be deactivated from 12 months to six months. In other words, “CMS will be able to deactivate providers and suppliers that have not submitted any Medicare claims for six consecutive months,” Andrews, Gadani, and Bauer explain. “If CMS deactivates a provider or supplier, the provider or supplier will remain enrolled in Medicare, but its billing privileges are stopped, and such privileges can be reactivated only upon the submission of specified information,” they detail.
• Revising provisional periods of enhanced oversight (PPEOs).
• Increasing the reapplication bar from three years to 10 years, for those denied enrollment.
• Restricting prescribing from felons. “A physician or other eligible professional (regardless of whether he or she is or was enrolled in Medicare) who has had a felony conviction within the previous 10 years that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries may not order, refer, certify, or prescribe Medicare-covered services, items, or drugs,” the rule says.

“These provider enrollment provisions related to hospice ownership and management will strengthen protections against hospice fraud schemes and improve transparency,” CMS maintains in a fact sheet about the final rule. v

Note: The rule fact sheet is at www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-final-rule-cms-1780-f.