Home Health & Hospice Week

New Q&As On Hospice MFTs, MHCs Shed Light On Some Questions, While Leaving Others Unanswered

Published on Fri Feb 02, 2024

MSWs will remain an important part of hospice, new guidance underscores.

The ability for hospices to include Marriage and Family Therapists and/or Mental Health Counselors in their interdisciplinary groups is now in effect, but providers are still fuzzy on some of the details.

A new question-and-answer set from the Centers for Medicare & Medicaid Services may clear up some of hospices’ nagging questions about the change that took effect on Jan. 1.

For example: “What discipline is appropriate to provide oversight to an MFT or MHC?” asks Question 12.

“The discipline to provide oversight of an MFT or MHC will be a policy decision of the hospice,” CMS responds. “We understand that each hospice may have unique needs based on their locality or patient population. Therefore, we are not proposing any requirements regarding the supervision of MFTs or MHCs.”

Many of the 14 Q&As covered in the five-page set are based on answers CMS gave in its November Open Door Forum for home health and hospice agencies. They review that hospices are not required to use MFTs or MHCs; that when they do use them, they must be direct W-2 employees; and that MFTs/MHCs don’t have to be enrolled in PECOS when working for a hospice (see HHHW by AAPC, Vol. XXXII, No. 43).

The Q&As also address information CMS referenced in its January forum, including that it will be a little while before official guidance on the change is cleared and released (see HHHW by AAPC, Vol. XXXIII, No. 3).

“We do not anticipate seeing this [guidance] in the immediate future,” the National Association for Home Care & Hospice confirms in its analysis of the Q&As.

Hospices should pay close attention to CMS’ guidance about social workers in the Q&As, however. “Even if a hospice chooses to hire one of these [MFTs or MHCs], they will still need to have a dedicated social worker on their team,” stresses consultant Melinda Gaboury with Healthcare Provider Solutions.

“A hospice must provide both counseling and social work services,” CMS says in Question 13. “All social work services must be provided by, or under the supervision of a qualified social worker with a Master of Social Work (MSW) degree.”

The Q&As also address whether an MFT or MHC can complete the comprehensive assessment when they are not in the IDG. “If an MFT or MHC is not a member of the IDG, they are not able to complete the comprehensive assessment and develop the plan of care. The IDG members are responsible for the assessment of the patient,” the agency explains.

As for when the MFT or MHC are in the IDG, CMS has indicated that “the SW, MFT or MHC are able to conduct a psychosocial assessment in accordance with their state scope of practice,” NAHC relates.

Consulting state and local laws and requirements is important when complying with the new changes, CMS emphasizes throughout the Q&A set.

Plus: “It’s important to note that if therapists or counselors are hired, they must be direct employees and cannot be contracted,” Gaboury stresses in her Monday Minute with Melinda vlog. “They can be salaried, hourly, or per diem employees, but the key is that they must be considered direct employees. This also means that they can serve as volunteers, as volunteers are considered employees of the hospice,” she adds. CMS confirms that in Question 4.

Another thing: Hospices should keep in mind that for now, there is no way to report the MFT and MHC visits on claims. That’s because “CMS has not developed identifying codes for the MFT and MHC services,” NAHC points out.

That also means that “the MFT and MHC services cannot be billed as part of the Service Intensity Add-on (SIA),” the trade group adds.

CMS has updated its hospice cost report form to reflect MFT and MHC costs, however, points out trade group LeadingAge. On Worksheet A, CMS has revised instructions “for line 36 to include the costs of marriage and family therapy services and mental health counseling services effective for services on or after January 1, 2024, in accordance with the Consolidated Appropriations Act of 2023,” the agency notes in a transmittal released Jan. 19.

The update includes a few other “minor changes” to the report, notes consulting and accounting firm The Health Group in Morgantown, W. Va. They include the addition of a cost report Level 1 edit requiring Worksheet S to identify the cost report submission as a full, low, or no utilization filing. “The cost report cannot be submitted electronically if the report contains any Level 1 edits,” The Health Group reminds in its newsletter.

For now, hospices can shape their policies and practices on the guidance in the Q&As and cost report instructions while they await more official guidance. v

Note: The Q&As are at www.cms.gov/files/document/ hospice-open-door-forum-qa.pdf. The revised cost report instructions are at www.cms.gov/files/document/r6p243i.pdf.