Home Health & Hospice Week

New rule clarifies restrictions on who can certify terminal diagnosis.

The feds may be watching more closely to see if hospices have the right documentation to support patients' admissions.

Though the Centers for Medicare & Medicaid Services has not changed the rules regarding who can certify a patient as terminally ill for purposes of hospice admission, the agency did go to the trouble of spelling out certain requirements in a rule published in the Federal Register Aug. 31.

The rule, "Hospice Wage Index for Fiscal Year 2008," primarily provides CMS' annual update to the hospice wage index. But it's noteworthy that CMS chose to clarify regulations regarding the terminal diagnosis.

If a patient has an attending physician, both that physician and the hospice medical director must initially certify the terminal diagnosis.

Don't make this mistake: But a tripping point for some hospices may be that a nurse practitioner who meets certain standards can qualify as an "attending physician" under Medicare. However, even a nurse who qualifies as an attending physician can't make the terminal diagnosis certification.

"In the event that a beneficiary's attending physician is a nurse practitioner, the hospice medical director must certify or recertify the terminal illness," advises Carolyn Buppert, an attorney in Bethesda, MD.

The final rule makes no substantive changes from the proposed rule released May 1, according to a CMS official. Other topics addressed in the rule include:

• Effective Jan. 1, Medicare's adjustment for geographic wage index will depend on where care was provided, not on where a hospice provider is based. "All payment rates (routine home care, continuous home care, inpatient respite and general inpatient care) will be adjusted by the geographic wage index value of the area where hospice services are provided," says the rule.

• If a hospice is in a rural area with no hospital wage data, it will use hospital wage data from contiguous core-based statistical areas (CBSA) to determine the wage index values for the rural area.

Similarly, in urban labor markets with no urban hospital from which to derive hospital wage data, CMS will use all CBSAs within a state to calculate a state-wide urban average index.

Note: To read the regulation, go to www.cms.hhs.gov/center/hospice.asp. CMS' clarification regarding terminal diagnosis is on page 41.