Federal News and Information
Public Health Emergency and Medicaid Resources to Support State Efforts
When the COVID-19 Public Health Emergency (PHE) and the Families First Coronavirus Response Act (FFCRA) continuous enrollment condition end, states must return to normal eligibility and enrollment operations. States will have up to 12 months to initiate a full renewal for all individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). This CMS article offer 10 ideas on how to be prepared, go to: https://www.medicaid.gov/resources-for-states/downloads/top-10-fundamental-actions-to-prepare-for-unwinding-and-resources-to-support-state-efforts.pdf.
Hospice Coalition Questions and Answers; March 24, 2022
Palmetto released the questions and answers proposed to them in March of 2022. Topics covered are: VBID billing and payment, verification of benefit periods, process’ for dispute resolution forms, processing times for the form 855A, general inpatient care update, targeted probe and educate, primary and secondary diagnoses and long lengths of stay. To review, go to: https://www.palmettogba.com/palmetto/jmhhh.nsf/DID/7R0706B09Q#ls.
Are you a new hospice? Are you aware that you must comply with the Hospice Quality Reporting Program? If you do not comply WILL lose money!
Hospice Quality Reporting Program (HQRP) Compliance
Most new hospices are not aware that all Medicare-certified hospice providers must comply with the individual submission requirements of Hospice Quality Reporting Program (HQRP) or be subject to a percentage point reduction in their annual payment update (APU). The payment reduction is currently two percent of the APU for existing hospices but is increasing to four percent of their APU beginning in FY 2024 for all 2022 non-compliance hospices. Payment reductions are based on individual fiscal year reporting.
To assist and support new and existing hospices, the CMS Hospice Quality Reporting Program (HQRP) webpage provides detailed information and training a hospice may use to ensure HQRP compliance. Below are just a few of the resources you will find on the CMS HQRP webpage.
- HQRP Training and Education Library — The purpose of this page is to provide 24/7 access to materials from past HQRP trainings and educational events. Materials on this page are organized by event and listed below in order of the date of release.
- HQRP Requirements and Best Practices — The Requirements and Best Practices webpage for the HQRP provides updates about reporting requirements and best practice methods to help hospices succeed with the HQRP. Specific resources available on this page include a Provider Toolkit section with “Getting Started” documents and tip sheets for all current and new providers. This webpage also provides resources for the HQRP overall, which currently includes:
- The Hospice Item Set (HIS)
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice survey
- Administrative data (Medicare claims)
- Hospice QRP Announcements & Spotlight — The Announcements & Spotlights webpage provides recent news and updates pertinent to the HQRP. On this page, you will find announcements about newly posted resource guides and factsheets, available Quarterly Update documents and APU updates, among other notifications.
- Hospice Public Reporting: Background and Announcements — This page provides an overview of public reporting, Care Compare and some general resources for the HQRP.
All items listed above can be accessed at the HQRP website: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospice-quality-reporting.
Palmetto has provided important facts about the VBID program:
Value-Based Insurance Design Model Hospice Benefit Component Overview
On January 1, 2021, CMS began testing the inclusion of the Part A Hospice Benefit within the Medicare Advantage (MA) benefits package through the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This test allows CMS to assess the impact on care delivery and quality of care, especially for palliative and hospice care, when participating MA plans are financially responsible for all Parts A and B benefits.
Currently, when an enrollee in an MA plan elects hospice, fee-for-service (FFS) Medicare becomes financially responsible for most services, while the MAO (MA Organization) retains responsibility for certain services (e.g., supplemental benefits). Under the Hospice Benefit Component of the VBID Model, participating MAOs retain responsibility for all Original Medicare services, including hospice care.
Key Policies and Requirements for CY 2022 (Continued from CY 2021)
- Participating MAOs must continue to cover hospice care for enrollees who choose to elect hospice through an in-network or out-of-network hospice provider
- Participating MAOs continue to be prohibited from applying any prior authorization to hospice care related to the enrollee’s terminal condition
- Participating MAOs must continue to pay for out-of-network hospice care at 100% of Original Medicare rates, including physician services and the service intensity add-on (SIA) payments
- Participating MAOs must continue to pay for any unrelated services and/or post-hospice live discharge costs, as long as they are deemed to be appropriate and medically necessary
Billing and Claims Under the Hospice Benefit:
- For questions about enrollment, billing, claims, and contracting related to enrollees of participating plans, hospice providers should contact the participating MAO
- If you contract to provide hospice services with the plan, be sure to confirm billing and processing steps before the calendar year begins, as they may be different
- Hospice providers must continue (as they have in CY 2021) to send all notices and claims to both the participating MAO and the relevant MAC on a timely basis
- The MAO will process payment, and the Medicare Administrative Contractor (MAC) will process the Notice of Elections (NOEs) and claims for informational and operational purposes and for CMS to monitor the Model
- How the MAC will process informational NOEs and claims:
- NOE processes and approves like normal (PB9997 location)
- A hospice would not know a patient is in a VBID MAO with the processing of the NOE
- The NOE will open the election in Medicare’s eligibility systems, same as a patient in Original Medicare
- Claims will reject with Reason Code (RC) U523A
- RC Narrative: The dates of service are during both a hospice election period and a MA plan’s period that is in a VBID Model
- The rejected claims will open benefit periods in Medicare’s eligibility systems
- Therefore, if a patient leaves the MAO plan, returns to Original Medicare and continues the hospice election, they will continue from the current period on Medicare’s eligibility systems. The hospice would continue to bill the MAC and the MAC would issue payment, assuming the patient’s MAO plan has a termination date on Medicare’s eligibility systems for the dates of service billed. The MAC would not pay if Medicare’s eligibility systems were not updated to show the termination. The patient or hospice would have to contact the MAO to submit the termination.
- NOE processes and approves like normal (PB9997 location)
All VBID information can be accessed at: https://innovation.cms.gov/innovation-models/vbid-hospice-benefit-overview.
Hospice providers should keep in mind that a patient may travel for their hospice care so they may see a patient enrolled in one of the participating plans offering coverage not in their service area.
- Example: A patient with coverage from a participating plan whose service area is in Ohio may travel to receive hospice care from a hospice provider in Florida. The provider should submit all notices and claims to the plan in Ohio.
- The hospice continues to bill claims for informational and operational purposes to their current MAC
Reimbursement for “Unrelated Care”
- Any unrelated care associated with an enrollee’s hospice stay which is covered by a plan participating in the Hospice Benefit Component is now the financial responsibility of the participating plan
- FFS Medicare should not process any claims for unrelated care for an enrollee which is covered by a plan participating in the Hospice Benefit Component
Calculation of the Aggregate Cap and the Inpatient Cap
- All billing related to care provided to an enrollee who have coverage through a plan participating in the Hospice Benefit Component shall not be included in calculating a hospice’s progress towards the aggregate and inpatient cap
Contacting the VBID Model Team
- All stakeholders can reach out to the VBID Model Team with any questions, comments, or concerns about the Hospice Benefit Component at [email protected]
United States senators sent a letter to The Honorable Chiquita Brooks-LaSure, Administrator, Centers for Medicare and Medicaid Services (CMS) urging the implementation of a Community Based Palliative Care demonstration project. This project would support concurrent palliative and curative care for those with a serious illness or injury, which would include essential interdisciplinary care in their homes. You can read the letter at: https://www.rosen.senate.gov/sites/default/files/2022-06/Letter%20to%20CMS%20on%20Palliative%20Care%20Demonstration%20Project%20FINAL%20w.%20Signatures.pdf.
The group would like this future model to be like the Expanding Access to Palliative Care Act (S.2565), which proposes creating a demonstration project to support improved access to palliative care services through a community-based model. You can review S.2565 at: https://www.congress.gov/bill/117th-congress/senate-bill/2565.
National Hospice and Palliative Care Organization
Edo Banach Stepping Down
The following article was published on June 17, 2022.
- After five years as the President & CEO of the National Hospice and Palliative Care Organization (NHPCO), Edo Banach has decided to step down from that role at the end of August.
- Norman McRae, Chair of the NHPCO Board of Directors, said, “Edo came to NHPCO with the skills and expertise needed at a time of transition in the hospice and palliative care community and in the direction of NHPCO and our advocacy affiliate, the Hospice Action Network. For five years he poured his heart and soul into this organization. His leadership has helped us professionalize key elements of the benefits we provide to the community, most notably our best-in-class advocacy operations. During his tenure, NHPCO’s financial position has improved greatly, despite the tremendous challenges of the last two years. We are grateful to Edo for his leadership. His work has positioned NHPCO to continue to succeed into the future on behalf of our members and the entire hospice and palliative care community.”
- Banach said, “My time with NHPCO has been one of the most fulfilling chapters of my career. Over the last five years, NHPCO has delivered on the promise to provide our members with the best possible resources, networking, education, and advocacy to advance their organizations, their careers, and the interests of the hospice and palliative community. I am proud of that work, I look forward to my next challenge, and I’ll remain a cheerleader for NHPCO.”
- McRae continued, “The NHPCO Board of Directors will use this summer to work with Edo and the NHPCO Leadership Team to plan for a smooth transition as we work with a national search firm to hire the organization’s next President & CEO. During the search, Ben Marcantonio, NHPCO’s COO will serve as interim President & CEO. Ben has more than 20 years of hospice and palliative care experience, including nine years of executive leadership with providers on both the east and west coasts.” (https://www.rosen.senate.gov/rosen-barrasso-fischer-lead-bipartisan-letter-centers-medicare-and-medicaid-services-requesting)
Texas News and Information
Health and Human Services Commission (HHSC)
COVID-19 Visitation Emergency Rules Expiring June 16, 2022
The following rules will end on June 16th: Visitation requirements for essential caregivers and clergy in a disaster can be found at Texas Administrative Code Chapter 570: https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=3&ti=26&pt=1.
- Assisted Living: 26 Texas Administrative Code (TAC) Chapter 2001
- Inpatient Hospice: 26 TAC §558.950
HHSC Issues Provider Letter 2022-13 Essential Caregiver, Chaplain and End of Life Visits in Long Term Care
HHSC issued PL 2022-13 with information on new rules implementing Senate Bill (S.B.) 25 and Senate Bill (S.B.) 572, 87th Legislature, Regular Session, 2021 and relating to the right of residents in certain long-term care facilities to designate an essential caregiver for in-person visitation and ,receipt of chaplain and end of life visits during a pandemic was effective on September 1, 2021. Providers can access resources at the following:
The following COVID rules expired on June 16,2022:
- 26 TAC §551.47 – ICF COVID-19 Response – Expansion of Reopening Visitation
All HHSC Long Term Care rules on the visitation requirements for essential caregivers and clergy in a disaster can be found in Texas Administrative Code Chapter 570 at the link above.
COVID-19 Cases Rise – Guidance for LTC Providers
COVID-19 cases are increasing across Texas. HHSC reminds providers to follow the guidelines listed below and ensure their emergency plan is up to date. Staff must be aware of what to do in the event of any emergency, including an outbreak of flu or COVID-19.
Review the following guidelines and rules:
- COVID-19 mitigation rules.
- Any applicable COVID-19 response plans for your provider type.
- Your provider’s own infection prevention and control policies.
Find COVID-19 resources on:
- Your provider portal under the COVID-19 Resources section.
- The HHSC COVID-19 Provider Information webpage.
Long-term care providers are always required to provide services to residents or clients before, during and after an emergency. The emergency plan or policy must include:
- Planning for staff shortages.
- A backup plan to ensure operations and care of residents or clients continue.
Read program specific rules related to staffing, emergency preparedness and infection control below:
- Assisted Living Facilities
- Intermediate Care Facilities
- Home and Community Support Services Agencies
- Nursing Facilities
- Prescribed Pediatric Extended Care Centers
You can access the respective rules at: https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=3&ti=26&pt=1.
A checklist is available to assist you with creating a plan for dealing with an outbreak of flu or COVID-19. Go to: https://www.phe.gov/Preparedness/COVID19/Documents/COVID-19%20Healthcare%20Planning%20Checklist.pdf.
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.