Home Health & Hospice Week

Regulatory provision could add to your burden.

A regulatory proposal that looked like it might increase hospices’ flexibility instead seems destined to add to their headaches. So indicated multiple callers in the Aug. 30 Medicare Open Door Forum for home health and hospice agencies.

In the 936-page 2024 Physician Fee Schedule proposed rule, the Centers for Medicare & Medicaid Services aims to implement a provision from the Consolidated Appropriations Act, 2023. “The CAA 2023 established the new Medicare benefit category for [Marriage and Family Therapist] MFT services and [Mental Health Counselor] MHC services furnished by and directly billed by MFTs and MHCs,” CMS gives as background in the rule.

“In accordance with the statute, we propose to revise § 418.56(a)(1)(iii) to specify that the [hospice interdisciplinary group] must include a social worker (SW), an MFT, or an MHC,” the rule says. And “we believe that with the introduction of MHC and MFT into the hospice [Conditions of Participation], it is important to also include these new disciplines into the personnel qualifications at § 418.114,” CMS adds.

What hospices thought that meant: Many providers believe the rule would allow hospices to use MFTs and MHCs, not require them to, multiple providers told CMS in the question-and-answer portion of the Zoom call.

What it really means: Hospices must have a MFT and MHC available for patients, when needed, CMS’ Mary Rossi-Coajou told forum attendees. “Currently, the interdisciplinary team consists of a doctor, a registered nurse, a social worker, or a pastor or other counselor,” Rossi-Coajou explained. “Specifically the [CAA] proposed language would be, social worker, marriage and family therapist, or mental health counselor, depending on the preferences and needs of the patient,” she said.

Hospices asked her to clarify that statement several times and lamented the change. “In our area, the mental health professionals are very hard to come by,” one provider told CMS in the call. “So I was hoping it would be … [have] a type of counselor available that may be one of your choice, not required,” she explained. “That could be an issue,” she worried.

The CMS official seemed a bit more frustrated with hospices’ misunderstanding as multiple providers asked her to repeat the interpretation and stated that wasn’t their understanding of the law. “If your social worker can handle what the issues are that the patient is experiencing, then you can use your social worker,” Rossi-Coajou detailed. “Because that’s how you’re going to document it. But if they need something more, the therapists have to be available.”

CMS does seem to give hospices one break on this provision. “These extra therapists, are they to be W-2 employees?” one hospice asked in the forum.

“Since they’re not included in core services, they can be contractors,” Rossi-Coajou allowed.

Hospices still have a chance to change CMS’ mind on this policy that will increase their burden. Providers may comment on the Physician FS proposed rule until Sept. 11 at www.federalregister.gov/documents/2023/08/07/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other. A link to the rule PDF is also at that site.

Note: For other hospice topics addressed in the forum, see story below.