Federal News and Information

Centers for Medicare and Medicaid Services (CMS) Medicare Enrollment in PECOS: Faster & Easier Application Process — Coming Summer 2023

Submitting and tracking Medicare Enrollment applications in PECOS is about to get easier and faster. Starting this summer, PECOS will have features to better meet your needs. Watch this 2-minute video or read these FAQs to learn more about:

  • A single application for multiple enrollments
  • Pre-population of data and an application that’s tailored to you
  • Enhanced capability to add or delete group members
  • Real-time processing checks and status updates
  • Re-validation reminders

The PECOS redesign will include a robust Knowledge Base with extensive content to help answer questions about enrollment, how to use all the new features, and much more.  We’ll provide you with regular updates on the PECOS redesign over the coming months. For more information, visit Introducing PECOS 2.0

 

Medicare Enrollment: Maintain the Same Owners in All Enrollment Records

Make sure that provider and supplier ownership information is consistent across all enrollment records under your Tax Identification Number (TIN).

If an individual or organization has 5% or more partnership interest or ownership (direct or indirect), you must list them on all enrollment records under your TIN.

If there’s different ownership information under your TIN, CMS will mail you a letter explaining that we’ll apply the ownership information from the most recent application with an ownership change to all enrollment records under your TIN.

If the information in the letter is correct, you don’t need to do anything.

If the information in the letter isn’t correct, submit an updated 855 enrollment application to your Medicare Administrative Contractor or National Provider Enrollment contractor. You’ll need to update the enrollment record of each individual enrollment.

Going forward, we’ll apply change of ownership updates from the application to all enrollment records under the TIN.  Send questions to ProviderOwnership@cms.hhs.gov.

 

HQRP Quarterly Update for 4th Quarter of 2022 is Available

The Hospice Quarterly Update for the fourth quarter of 2022 is now available. This update includes Hospice Quality Reporting Program highlights from October to December 2022, events and engagement opportunities for the first quarter of 2023 (January – March 2023), and selected questions and answers from the Hospice Quality Help Desk. Please navigate to the HQRP Requirements and Best Practices page to download this document.

 

Value-Based Insurance Design Model: Learn about the Hospice Benefit Component

Currently, when a patient enrolled in Medicare Advantage (MA) elects hospice, Fee-for-Service Medicare becomes responsible for coverage and payment of most services, while the MA plan remains responsible for certain services like supplemental benefits. Under the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model, participating MA plans are financially responsible for all Part A and B benefits, including the hospice benefit and supplemental benefits. CMS is assessing how this affects care delivery and quality of care, especially for palliative and hospice care.

 

For CY 2023, 15 participating MA organizations offer 119 plan benefit packages through the Model. We’ll send information and resources to affected hospices this month. Learn more about the Hospice Benefit Component  to prepare for future years.

 

National Hospice and Palliative Care Organization (NHPCO)

TNMHO informed you early in January 2023 about the concerns on a national level of the recent entry of large numbers of newly created hospice organizations in several states which has heightened long-standing concerns among hospice leaders about the adequacy of Medicare certification, accreditation, and enforcement processes.  NHPCO along with LeadingAge, the National Association for Home Care and Hospice and the National Partnership for Healthcare and Hospice Innovation met with CMS to discuss options for strengthening the hospice integrity program.  The group made 34 recommendations.  The five key points are as follows:

  • Limit enrollment of new providers with a targeted moratorium on new hospices: Use existing CMS moratorium authority to limit enrollment of new hospice providers in counties with troubling rates of explosive licensure and Medicare certification growth.  
  • Enforce against non-operational hospices by revoking Medicare enrollment and increasing site visits: Investigate Medicare provider numbers that show aberrant gaps in Medicare billing. Revoking enrollment of non-operational hospices prevents them from being sold to inexperienced providers for a profit.
  • Develop hospice “red flag” criteria: Identify Medicare certification application “triggers” related to specific areas of concern that would prompt CMS to investigate an applicant before certification could be approved. Red flags should include:
  • Co-location of multiple hospices at single address.
  • A single hospice administrator overseeing multiple
  • A patient care manager or other hospice leadership
    staff serving multiple hospices.
  • A hospice company that appears to be hidden
    behind a shell company.
  • Require surveyors to confirm ability of hospices to provide all four levels of care:  Surveyors must ensure hospices have the ability to provide all four levels of care, including General Inpatient Care (GIP) and respite contracts, as well as provision for continuous home care (CHC) and afterhours care.
  • Add hospice administrator and patient care manager qualifications to Medicare hospice Conditions of Participation (CoPs): Add education and/or qualifications to the hospice CoPs for these key personnel, including minimum years of experience or a combination of education and experience. 

 

Palmetto

Provider Self-Determined Aggregate Cap Limitation Form Due February 28, 2023

Hospice providers please be aware of the above.  Click for directions.

 

  

Texas News and Information

Health and Human Services Commission (HHSC)

Home and Community Support Services Agency (HCSSA) Relocation

PL 2023-04 (replaces PL 2014-28) HCSSA Medicare Relocation Questionnaire was released on January 17, 2023.  When a certified HCSSA relocates, you are relocating the license and the certification.  You cannot relocate without prior notification to HHSC).  You will do this, via TULIP.  In addition, CMS has steps you must take as well.  This PL explains what a provider must do prior to relocation.  Access the PL and its attachments

 

PL 18-20 (ALL) (Revised) (Replaces PL 13-04 and 18-07) Incident Reporting Requirements was revised and released on January 19, 2023.  This letter describes the information that a provider must include in an initial reportable incident report made to HHSC Complaint and Incident Intake (CII) and in the provider investigation report (PIR) submitted to CII. This version deletes references to the CII voicemail system as it is no longer available.  Review

 

Certified Nurse Aide (C.N.A.) Update

The nurse aide registry currently does not have a back log.  Renewals are being processed within 10 working days.  If a nurse aide has submitted for renewal and has not been renewed within 10 working days of submission of the renewal, please have the nurse aide reach out via email at NurseAideRegistry@hhs.texas.gov or by phone at 512-438-2050.

 

A New Emergency Communication System

Providers will begin to use an emergency communication system called Blackboard Connect This system will be used to send emergency and outreach notifications through email, phone, voice and text if available. Administrators and alternate administrators MUST sign up in this system.  Other staff are allowed to do so; however, be sure that administrators and alternate administrators do so!

HHSC sent out PL 22-32 on November 28, 2022.  This is NOT an option!  The letter explains how to do this.  This is effective January 24, 2023.  Access Here.

 

Infection Control Handbook

HHSC Released the infection control handbook.  You can access it two ways:

  1. Click for PDF.
  2. On the website HERE. If you go to the HCSSA webpage, scroll down midway to “Resources”.

 

 

 

Disclaimer:  The Texas and New Mexico Hospice Organization publishes the Regulatory Update as an information only item.  TNMHO has no attorneys nor does it represent the state and federal governments.  All legal questions or concerns should be directed to your attorney or the governments involved.