Home Health & Hospice Week

Plus: Stay tuned for missing CAHPS data in preview reports.

Failing to comply with a recently finalized Medicare requirement could put a big old target on your agency’s back when it comes to fraud and abuse scrutiny.

The Centers for Medicare & Medicaid Services appears to be cracking down on reporting of hospices’ managing employees, which it clarified in the 2024 home health final rule (see HHHW by AAPC, Vol. XXXI, No. 39-40). After specifying that the definition of “managing employee” includes the administrator and medical director of a hospice, CMS updated the Medicare Program Integrity Manual with that requirement in December in Change Request 13333.

Related article MM13333 notes that “CMS revised the definition of managing employee. For purposes of this definition of managing employee, this includes, but isn’t limited to, a hospice or skilled nursing facility (SNF) adminis­trator and a hospice or SNF medical director.”

Now CMS is hammering home that message. “CMS recently clarified that hospice and skilled nursing facility medical directors and administrators are always considered managing employees for Medicare provider enrollment purposes. You must report all current managing employees,” the agency said in its Feb. 8 MLN Matters newsletter. “If you haven’t reported a medical director or administrator, report them now,” CMS stressed.

CMS’ Adam Rubin emphasized that same info in the agency’s Feb. 22 Open Door Forum for home health and hospice agencies. A managing employee “means a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the provider or supplier,” CMS explains in its newly updated Medicare Program Integrity Manual. That includes staff “either under contract or through some other arrangement, whether or not the individual is a W-2 employee of the provider,” the manual clarifies.

Still confused? You can submit questions to CMS at ProviderEnrollment@cms.hhs.gov, the National Association for Home Care & Hospice notes.

Reporting Med Directors May Spook Docs

“While the definition of a ‘managing employee’ is often vague and can be subject to multiple interpretations, CMS made clear in the final rule that every hospice’s designated administrator and designated medical director will be considered ‘managing employees’ for purposes of Medicare enrollment,” note attorneys Howard Young, Jacob Harper, Kathleen McDermott, David Yates, Felicia Alexander, and Rachel Lamparelli with law firm Morgan Lewis.

Why it matters: “Typically, few hospices report their medical director as a ‘managing employee,’ and few physicians wish to be formally disclosed in such a capacity on Medicare enrollment forms,” the Morgan Lewis attorneys note in online analysis of the rule. “This change will result in nearly every hospice in the country needing to update their PECOS or 855A enrollment materials and further update these forms when personnel change,” they say.

One bit of relief is that hospices don’t have to report every substitute. “Because a Medical Director designee would only be in place if the normal Medical Director was unavailable, they wouldn’t need to report a designee as a managing employee,” NAHC advises.

This requirement is part of CMS’ effort “to enhance the oversight of hospice providers throughout the United States,” the Morgan Lewis attorneys highlight. Along with “greater scrutiny of hospice owners and managing employees,” CMS plans to combat hospice fraud with “increased reliance on survey findings and quality indicators in the Special Focus Program … and new restrictions on the ownership and transfer of hospice programs,” the lawyers note.

Other hospice topics addressed in the forum include:

• Care Compare preview reports. CMS’ Jermama Keys noted in the forum that Care Compare preview reports were available for hospices for the May refresh. But a number of providers reported that they had received only claims and Hospice Item Set-based data, not data from CAHPS surveys.

In the forum, CMS’ Lori Luria explained that the CAHPS data would be coming later and apologized for the confusion.

On Feb. 26, CMS sent providers an email reiterating that message. “The Hospice CAHPS Provider Preview Reports for the May 2024 refresh (Hospice CAHPS Survey data from Q3 2021 – Q2 2023) are delayed by 2 weeks and will be available on 2/28/2024,” the agency finally disclosed.

Hospices in the forum asked if they’d have an extended window to review the late-arriving data. “The 30-day preview period for CAHPS data will begin the same day reports become available,” CMS says in the Feb. 26 message.

Meanwhile, the latest round of data is now up on Care Compare thanks to the February refresh.

• CAHPS survey response problems. Multiple providers took the opportunity to express their frustration at lackluster response rates for CAHPS surveys. Many survey recipients think the survey request is some sort of fraud or scam, one provider lamented.

“Our scores are constantly low, making it seem like we’re not a good agency, but it’s … beyond our control,” the hospice provider told CMS in the forum.

The survey is lengthy, containing 47 questions measuring Communication with Family, Getting Timely Help, Treating Patient with Respect, Emotional and Spiritual Support, Help for Pain and Symptoms, Training Family to Care for Patient, Rating of this Hospice, and Willingness to Recommend this Hospice, CMS notes on the CAHPS website.

Nearly a year ago, CMS reported findings from a CAHPS survey mode experiment it ran. A mail-telephone combination yielded the highest response rate at 45.3 percent, but a web-mail pairing was close behind at 39.7 percent.

To date, CMS hasn’t made any proposed changes to the CAHPS survey or its collection. Stay tuned to the 2025 hospice proposed rule expected in April for potential developments on this front. CMS sent the regulation to the Office of Management and Budget for approval on Feb. 16, according to reginfo.gov.