Home Health & Hospice Week

Warning: CMPs can cost up to $10K per day.

Medicare has released a bevy of hospice survey protocol revisions, but hospices have gotten a little more breathing room on the toughest survey changes ahead — civil money penalties and payment suspensions.

Background: Like the other hospice survey revisions, the Centers for Medicare & Medicaid Services finalized enforcement remedies in the 2022 home health final rule published in November 2021. They included three remedies required by the Con­solidated Appropriations Act of 2021 — CMPs, payments suspensions, and temporary management — and two added by CMS — directed plan of care and directed in-service training.

“The more significant impacts for hospices will come from the remainder of the HOSPICE Act, which makes survey findings more consequential for hospices by allowing the potential imposition of civil monetary penalties based on condition-level survey deficiencies and the potential temporary suspension of payments for new admissions,” predicts attorney Adam Royal with law firm Husch Blackwell in Austin, Texas.

Under CMPs, hospices could see penalties of up to $10,000 per day, CMS indicated in the 2022 rule. And those fines can rack up quickly and put an agency out of business before it knows what hit it, experts warn.

Payment suspensions are also punishing, but at least hospices won a concession from CMS in the final rule. The agency scaled back suspensions to apply only to new patients, rather than to all patients.

Not all providers will shoulder the burden of all remedies equally. Surveyors would take a providers’ size and quality assurance/performance improvement programs into consideration when determining remedies, according to the 2022 rule. And CMS suggested six factors it would use to determine which enforcement remedy to apply and at what level, ranging from the extent to which the deficiencies pose Immediate Jeopardy to patient health and safety to the extent to which the hospice is part of a larger organization with documented performance problems.

Exactly when enforcement remedies will hit remains unclear. CMS hasn’t indicated when it will issue implementing guidance in revisions to the Medicare Program Integrity Manual, Chapter 10, the National Association for Home Care & Hospice notes.

Note: The 2022 final rule is at www.govinfo.gov/content/pkg/FR-2021-11-09/pdf/2021-23993.pdf.