Home Health & Hospice Week

Keep an eye peeled for interpretive guidance on the topic.

Hospices have caught a much needed break in the physician fee schedule final rule for 2024.

Proposed: The Consolidated Appropriations Act, 2023 “established the new Medicare benefit category for [Marriage and Family Therapist and Mental Health Counselor] services furnished by and directly billed by MFTs and MHCs,” the Centers for Medicare & Medicaid Services explained in the 2024 physician fee schedule proposed rule published back in August. CMS then proposed adding them into the hospice Conditions of Participation personnel requirements. Many providers believed the rule would allow hospices to use MFTs and MHCs, not require them to, but CMS seemed to propose the requirement in the rule. (See more details of the proposal in HHHW by AAPC, Vol. XXXII, No. 31.)

Finalized: “CMS is finalizing its proposal to modify the requirements for the hospice Conditions of Participation (CoPs) to allow social workers, MHCs or MFTs to serve as members of the interdisciplinary group (IDG),” CMS says in its PFS final rule fact sheet. “The hospice IDG will only be required to include one SW, one MFT, or one MHC,” CMS spells out in the final rule scheduled for publication in the Nov. 16 Federal Register. “The hospice is not required to include all three of these professions as members of the IDG,” the agency clarifies.

However, “the MFT or MHC must be hired as a direct employee which would include the options of hiring full time, part time or per diem,” CMS adds. “This may alleviate some of the staffing challenges that hospices may experience by allowing more flexibility in the recruitment and hiring process,” the agency offers.

Hospices can also “enter into arrangements with another Medicare-certified hospice to obtain core hospice services … under extraordinary or other nonroutine circumstances,” CMS points out.

Tip: “The ‘extraordinary circumstance’ provision is generally a short-term temporary event that was unanticipated,” the National Association for Home Care & Hospice points out in its rule analysis.

Proposed: CMS proposed language requiring that the determination regarding whether a social worker, MFT or MHC serve as a member of the IDG would depend on “the preferences and needs of the patient.”

Finalized: “We … understand that hospice[s] may have IDG team members pre-selected to serve on specific teams, and it may be administratively impractical to change a member based on the needs of one patient,” CMS says in the final rule. “Therefore, we are not finalizing the requirement that the SW, MFT, or MHC be a member of the IDG ‘based on the needs and preferences of the patient,” the agency allows.

However, “while we are modifying the proposed requirement, we stress that hospices have always had the option to have non-IDG staff that provide care for the patient to attend the IDG meetings to share patient status, issues/concerns, and recommendations,” CMS adds.

Watch for: Still have questions? Forthcoming guidance may help. “Additional information regarding the implementation and execution of these proposals will be provided in the hospice interpretive guidance, which will be published following the publication of this final rule,” CMS says in the final rule.

NAHC is hoping it will answer a lingering question. The trade group “believes that the services provided by MFTs and MHCs will be considered ‘core services’, which means that when utilizing these disciplines a hospice must have an employment arrangement with the MFT or MHC. However, it also appears that CMS will not expect that all hospices will have a MFT and/or a MHC under an employment agreement,” NAHC says in its member newsletter. “We will be looking to responses to questions that we are submitting to CMS and forthcoming interpretive guidance on this issue to resolve any remaining uncertainty,” it says.

And even though this change is included only in the physician payment rule, hospices had still better keep on top of it.

“While we understand publishing the proposed rule and finalizing these requirements in a hospice rule may have been more apparent to the hospice industry, due to the hospice wage index publication dates and the CAA 2023 implementation requirements; it was determined that the CY 2024 PFS rule was the best rulemaking vehicle to propose and finalize the CAA requirements,” CMS says in the final rule. “Therefore, all the hospice CoP information and requirements related to MHCs and MFTs are published in this final rule, and there are no plans to republish this information in a separate hospice rule.”

Note: The hospice MHC/MFT CoP change provisions start on p. 1,456 of the 2,709-page rule at https://public-inspection.federalregister.gov/2023-24184.pdf.