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Home Health & Hospice Week

Hospice:

Two More Years Of Nursing Relief Cushions Hospices

Published on Thu Nov 11, 2004

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 Nov. 9 forum, a CMS official urged hospices to report any possible patient choice improprieties to their regional offices. "CMS is always concerned about access and inhibition of access to care," the staffer said.

  • Rural demonstration. Hospices were eager to know when CMS will kick off the rural hospice demonstration project. Under the demo enacted in the Medicare Modernization Act last year, CMS will choose three providers to furnish hospice care in rural areas in facilities with fewer than 20 beds. The areas must be places where Medicare beneficiaries are currently unable to receive hospice care for lack of an appropriate caregiver, CMS explains.

    Details about the project will be out next June, and a tentative start date for the demo is January 2006, a CMS official heading up the project said in the forum.

  • Part D. Hospices won't see any changes from the coming prescription drug benefit, CMS said in the forum. Despite the fact that hospices' drug costs are surging, they still will be responsible for the medications related to their patients' terminal diagnoses. 

    Editor's Note: The nursing exemption letter is at     www.cms.hhs.gov/medicaid/survey-cert/sc0502.pdf.

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