Home Health & Hospice Week

CMS stays neutral regarding format of contracts with nursing homes.

If you thought you had your contracts with your nursing home partners all ironed out, think again.

In the June 27 Federal Register, the Cen-ters for Medicare & Medicaid Services published a rule requiring "that long-term care (LTC) facilities (that is, SNFs and NFs) that choose to arrange for the provision of hospice care through an agreement with one or more Medicare-certified hospice providers will have in place a written agreement with the hospice that specifies the roles and responsibilities of each entity" (see Eli’s HCW, Vol. XXII, No. 24).

"The specific requirements for the written agreement are consistent with the written agreement requirements that are already set for hospices," CMS’s Danielle Shearer noted in the July 9 Open Door Forum for home care providers. "However, because this final rule is written from the point of view of the long term care facility, and because it went through the public comment process and was slightly changed during that process, there are slight differences between the requirements for the hospice provider and the requirements for the long term care provider," Shearer warns.

Upshot: "We encourage hospices to coordinate with their long term care partners to make sure that their written agreements that they have now are up to date and in compliance with both sets of the regulations," Shearer advised.

Question: Attorney Connie Raffa of Arent Fox in New York City asked CMS officials if they had an opinion on a new trend of nursing homes requiring hospices to sign individual contracts naming each patient rather than one general contract covering all patients in a nursing home. Individual contracts would make it difficult to comply with the rule to have the contract signed and in place before hospice service begins for the patient.

Answer: Nursing homes are free to structure their contracts any way they like as long as the contracts comply with the regulatory requirements, Shearer responded. "That is a business practice that we intend to keep our nose out of." Further, "we try to interfere as little as possible in contractual relationships," she added.

The new LTC facility requirement takes effect Aug. 26.

 Other issues addressed in the forum include:

•  Quality measure NQF 0209. In its proposed hospice payment rule for 2014, CMS wants to ax the current two quality measures hospices are reporting and instead use a seven-item Hospice Item Set (HIS), according to the rule (see Eli’s HCW, Vol. XXII, No. 16). But don’t quit collecting that quality data quite yet.

First, the rule isn’t yet finalized, noted CMS’s Robin Dowell in the forum.

Second, even if the rule is adopted as proposed, CMS still would require hospices to collect data on the current measures through 2014, impacting 2015 payment rates, Dowell pointed out.

That means to prepare for the next hospice quality reporting data submission in April 2014, "providers should currently be collecting NQF 0209 data on all admissions through Dec. 26, 2013," Dowell explained. If CMS sticks to its proposal, 2014 will be the "one last time" that hospices report NQF 0209, "Percentage of patients who were uncomfortable because of pain on admission to hospice whose pain was brought under control within 48 hours," she confirmed.

•  Quality reporting training. Keep an eye out for CMS to post new HQRP training materials in late summer, Dowell said. The materials will include a data reporting user guide and a Powerpoint presentation on the topic. Watch for the materials at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/index.html.