Home Health & Hospice Week

Get used to the 36-month rule for hospices.

Life is about to get harder for some hospices, thanks to a tightening of Medicare enrollment procedures.

The Centers for Medicare & Medicaid Services is “finalizing several provider enrollment regulatory changes to prevent and address hospice fraud, waste, and abuse in the future,” CMS says in a fact sheet about its 2024 home health payment rule. “These provider enrollment provisions related to hospice ownership and management will strengthen protections against hospice fraud schemes and improve transparency,” the agency maintains.

The changes include:

• Subjecting hospices to the highest level of provider enrollment application screening, which includes fingerprinting all 5 percent or greater owners;
• Expanding the home health agency change in majority ownership (CIMO) provisions to include hospice changes in majority ownership;
• 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;
• 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.

The CIMO changes reference the 36-month rule. “Given concerns about lack of scrutiny on new hospice owners, as well as issues with entities and individuals ‘flipping’ Medicare certifications before a hospice has ever seen a Medicare beneficiary or hired an employee, CMS is extending the ‘36-month’ rule that applies to home health agencies to hospices,” the National Association for Home Care & Hospice notes in its rule summary.