Center for Medicare and Medicaid Services (CMS)

CMS Hospice Election and Addendum Form:

It has been strongly recommended that hospice providers consider utilizing the CMS hospice election and addendum form to avoid issues in medical review.  You can access the form at:

https://www.cms.gov/files/document/model-example-hospice-election-statement.pdf.

 

Implementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attending Physician Services

Beginning January 1, 2022, an RHC or FQHC can bill and get payment under the RHC AllInclusive Rate (AIR) or FQHC Prospective Payment System (PPS), respectively, when their employed and designated attending physician provides services during a patient’s hospice election.  For more information, go to:  https://www.cms.gov/files/document/mm12357-implementation-gv-modifier-rural-health-clinics-rhcs-and-federally-qualified-health-centers.pdf.

 

Fiscal Year 2023 Hospice Payment Rate Update Proposed Rule

On March 30, CMS issued a proposed rule on Medicare hospice payment policies.  Please note the following proposals:

  • A permanent cap on negative wage index changes greater than a 5% decrease from the prior year (regardless of the underlying reason for the decrease) for hospices in the FY 2023 proposed rule.
  • Hospices would see a 2.7% increase in their payments for FY 2023. Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual market basket update for FY 2023.
  • A statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed cap amount for FY 2023 is $32,142.65 (FY 2022 cap amount of $31,297.61 increased by 2.7%.
  • Provides an update on the development of a patient assessment instrument, titled HOPE, which would contribute to a patient’s plan of care when adopted. This includes an update on the BETA testing and results that will be achieved during this phase of testing, such as burden estimates and timepoints for collection, as well as additional outreach efforts that will be conducted during and after BETA testing and during our future plans for adoption.
  • Discusses potential future quality measures within the HQRP based on HOPE and administrative data, including HOPE-based process measures and hybrid quality measures, which could be based upon multiple sources that include HOPE, claims, and other data sources.
  • Announces a potential future update to the CAHPS Hospice Survey, which is used to collect data on experiences of hospice care from primary caregivers of hospice patients. CMS is providing an update on a mode experiment whose goal was to test the effect of adding a web-based mode to the CAHPS Hospice Survey.
  • Seeks information on Health Equity Initiative within the HQRP by describing current assessment of health equity within hospice.
  • Seeks input on a potential future structural measure as well as responses to specific questions that would further inform future efforts.

You can review the proposed rule at:  https://www.federalregister.gov/public-inspection/2022-07030/medicare-program-fy-2023-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting.

 

Texas News and Information:

Texas Medicaid Healthcare Partnership (TMHP) 

Texas Medicaid Hospice and Congressional HR 2471Telehealth and Face to Face Visits

  • A couple of weeks ago, TNMHO shared the following information with you:  Congress passed HR 2471, Consolidated Appropriations Act 2022.  A section of this legislation includes an extension of the flexibility for you to do face to face physician recertification virtual for 151 days after the end of the PHE.  The PHE is predicted to end sometime this summer.  It is unknown if Texas Medicaid will follow HR 2471.  You can read the act at: https://www.congress.gov/bill/117th-congress/house-bill/2471/text.
  • In addition, as noted in the posting, we reached out to Texas Medicaid hospice policy to ascertain whether they would be following HR 2471.  Medicaid hospice responded with the following:  we will not allow an extension of the telehealth COVID-19 flexibilities or allow telehealth permanently.

HCSSA Vaccine Authority Emergency Rule Extended Effective March 28

HHSC Long-term Care Regulation has extended Vaccine Authority for Home Health and Hospice Agencies for home and community support services agencies.  To review, go to:  https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/long-term-care/hcssa/hcssa-covid-vaccine-authority.pdf.

HCSSA COVID-19 Response Emergency Rule Revised Effective March 24

Hospice providers, please read this emergency rule very carefully!  It defines criteria for screening staff, clients, and household members for COVID, to require that related staff must comply with a long term care facility infection control protocols when entering to provide essential services.

HHSC Long-term Care Regulation published a revised HCSSA COVID-19 Response Emergency Rule. It became effective March 24, 2022.

The revised rule:

  • Points to guidance from HHSC rather than the CDC.
  • Removes the requirement for staff and visitor screenings to be documented.

You can access the rule at:  https://www.hhs.texas.gov/sites/default/files/documents/govdelivery/hcssa-emergency-rules.pdf.

 

Supportive Palliative Care and Palliative Care Accreditation

Hospice providers who provide in-home supportive palliative care (SPC) must hold a license home health (LHH) category.  This must be done prior to seeking a palliative care accreditation with an accreditation company (AO).  Please note the following information:

  • State statute which does not provide for provisional licensure, HCSSAs must have a license to provide any services to even one client in Texas.
  • Each of the AOs is aware of changes in state licensing standards and interpretations posted on the Health and Human Services Commission (HHSC) website to ensure their standards and practices in the state are appropriate.
  • The accreditation process includes a review of service delivery in addition to the review of policies and procedures in accordance with the AO standards which must meet or exceed state licensing standards. Although the AO may have a procedure whereby it begins the accreditation process with a prospective agency to provide guidance and initial discussion, this is not dictated by HHSC.
  • The steps a hospice agency seeking to provide SPC to non-hospice elected clients may include reaching out to the desired AO for guidance and information prior to obtaining the LHH category, but no accreditation can be conveyed without appropriate licensure.

 

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.