Home Health & Hospice Week

Where will CMS land on these hot button Special Focus Program issues?

The Special Focus Program is looming large on hospices’ horizon. Get more insight into the forthcoming regulatory proposal for the program that targets poor performers by scanning a new report on the topic.

In addition to selection criteria (see story, p. 139), Technical Expert Panel and listening session participants weighed in on these critical topics:

• Public reporting. Some elements of the hospice SFP are likely to be very much like the similar program for skilled nursing facilities called the Special Focus Facility list. One of those could be the “yellow warning icon” displayed on Care Compare that indicates the agency is on the list for extra scrutiny.

“TEP members urged that a large, prominent icon be displayed next to each SFP hospice” on Care Compare, the report says. “Some noted that the current icon used for the nursing home page is too benign and could be misinterpreted (e.g., a website error), however others noted the importance of maintaining consistency with the SFF program by using the same icon,” it continues.

Again, stay tuned to see exactly how CMS decides to display a hospice’s SFP status. CMS also seems to be contemplating whether Care Compare should suppress quality data for SFP hospices and whether the site should display ownership type information for hospices on the list (for-profit, nonprofit, etc.).

• Graduation criteria. Back in the 2022 home health final rule, CMS discussed allowing an SFP hospice to graduate from the program once it completes two consecutive six-month standard surveys with no CLDs cited, Abt notes. “This is the same procedure used by the SFF program,” it adds.

However, “the TEP also suggested additional criteria, including consideration of [standard level deficiencies] and substantiated complaints,” the report says. And it also proposed transitioning to annual surveys before going back to surveys once every three years.

• Termination criteria. SFF procedures for termination are in flux, and CMS seems open to ideas on this a bit more than in other areas.

TEP members suggested “progressive enforcement,” such as starting with “minor remedies” like civil money penalties and graduating to termination, according to the report. Then “members … broadly agreed that after 18 to 24 months (three-to-four SFP surveys), if a hospice in the program shows little or no improvement, they should be placed on the termination track,” it notes.

• IDR. CMS should “consider creating an informal dispute resolution process and/or expanding the list of corrective actions available for SFP hospices” as a “future action,” the report indicates.

Watch for: Stay tuned for the home health proposal rule for these and many other particulars of the SFP.