Home Health & Hospice Week

Open Door Forum focuses on hospice issues with nursing homes, drugs. If you rely on contracted nurses to keep your hospice operation running, you'll be getting a break from surveyors.

The Centers for Medicare & Medicaid Services has told surveyors to back off on the condition of participation requiring hospices to directly employ their nurses.

Back in 2002 during widespread nursing shortages, CMS let hospices off the hook by allowing them to qualify for "extraordinary circumstance" exemptions to the COP requiring hospices to furnish their core services (including nursing) with direct employees. Under the exemption, hospices can use contracted nurses to complement their direct employee nurse work force.

The problem: The original nursing exemption expired this Sept. 30.

The solution: CMS has extended the exemption for two more years, to Sept. 30, 2006, according to an Oct. 14 letter to state surveyors (S&C-05-02).

To take advantage of the exemption, hospices must show good faith efforts to hire enough nurses and notify state agencies that they are electing to use the exemption, a CMS official reminded in the Nov. 9 Open Door Forum for home care providers.

Surveyors will check to make sure hospices meet the exemption criteria during usually scheduled and complaint-triggered surveys, the memo notes. The exemption doesn't apply to other types of staff, only nurses.

Many hospice providers attended the Forum at their regional offices after CMS extended the invitation. Despite numerous technical difficulties, hospices did pose their questions and hospice issues were the main focus of the event. Other hospice topics addressed include: Nursing home - hospice relationships. Several participants voiced concerns over nursing home residents' freedom of choice in selecting a hospice provider. Large nursing home chains that also have hospice divisions allow only their own hospice to serve their residents, observers have charged.

Back in February 2002, CMS gave its blessing to such arrangements in a question-and-answer set furnished to regional home health intermediary Palmetto GBA's hospice coalition meeting (see Eli's HCW, Vol. XI, No. 7, p. 59).

While the Balanced Budget Act of 1997 requires hospitals to allow access to all providers regardless of business relationships, the same does not hold true for nursing facilities, CMS said in response to a Palmetto inquiry for clarification on the matter.

Like supplies bundled under the home health prospective payment system, residents pick the nursing facility and all of that facility's contractors, including the hospice. Residents "must decide if they wish to receive hospice services from that NF or whether or not they will go with another NF," CMS said in the Q&A. "As long as the patient is satisfied with the choice of NF and hospice, even though it may be the only hospice the NF contracts with, then we accept it."

Nevertheless, in the [...]