Hospice Regulatory Updates


The Texas and New Mexico Hospice Organization will be hosting MACTOBER FEST in November 2022!  It is important for new providers to make every effort to attend this training!  Palmetto has expressed concern that new hospice providers, especially billers, are very unaware of its expectations of the new provider.

We strongly encourage all to consider sending their billers to this training.  More information to come in the upcoming weeks!  Stay tuned!!


Federal News and Information

Centers for Medicare and Medicaid Services (CMS)

Pilot Medicare Part D and Hospice

As you may know, CMS is concerned about hospice related prescription drugs being paid by the Part D benefit instead of the Hospice benefit.  The pilot’s goal is to alert the Part D plan of a hospice election.  The intent is to address the hospice enrollment and ensure their responsibility for the hospice medications in a timely manner.

In the 2022 Fiscal Year Hospice Wage Index and Quality Reporting proposed rule, published in April 2021, CMS reported that in 2019, the amount of Part D spending, while patients were on hospice care, reached almost $500 million ($498,913,448). A concern identified by CMS Part D is that the hospice election is not reaching the Medicare Part D plan timely. Due to this delay, the Medicare Part D plan does not know that an enrollee has elected their hospice benefit and is continuing to pay for medications that should be paid by the hospice

CMS Part D has contracted with RelayHealth to design a hospice election notification system to provide the notice of hospice election to the Medicare Part D plans timelier, allowing the Medicare Part D plan to reject medications when a drug may be related to the hospice patient’s condition.

Relayhealth, Transaction Facilitator:  https://medifacd.mckesson.com/Hospice/


COVID 19 Emergency Declaration Blanket Waivers for Health Care Providers

CMS released an updated version on the blanket waivers on June 16, 2022.  Topics for hospice are:  volunteers, comprehensive assessments update timelines, waive non-core services, waive on-site visits for hospice aide supervision, hospice aide competency testing using pseudo patients, 12 hour annual in service training for hospice aides, annual training,  You can access it here:


Texas reminder about the blanket waivers:  You can use telehealth as allowed in the waivers but be sure to keep up with them as they change and are updated frequently!

Free Antigen Tests

Free Antigen tests are available.  Please remember that testing kits have expirations dates on them and must be disposed of accordingly.  See your pharmacist if you have questions about how to dispose of any testing kits.



Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related to Terminal Diagnosis) Job Aid

The Billing Hospice Physician, Nurse Practitioner (NP) and Physician Assistant (PA) Services job aid assists hospices, physicians, NPs and PAs in how to properly bill these services. It was developed in collaboration between HHH MACs CGS, NGS and Palmetto GBA. To access the flow chart, go to:  https://www.palmettogba.com/palmetto/jmhhh.nsf/DID/B7LLWH3025#ls.


Home Health and Hospice Coalition Questions and Answers: June 6, 2022

The hospice coalition met in June 2022.  To access the questions and answers go to: https://www.palmettogba.com/palmetto/jmhhh.nsf/DID/CBDAO0QH8O#ls.


Important Reminder: Medicare FFS Claims Payment Adjustment (Sequestration) Resumes

Providers are reminded the Payment Adjustment (Sequestration) will be reinstated beginning April 1, 2022. The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims in the following way:

  • No payment adjustment May 1, 2020, through March 31, 2022
  • 1 percent payment adjustment April 1 – June 30, 2022
  • 2 percent payment adjustment beginning July 1, 2022

Claims with dates-of-service or dates-of-discharge on or after April 1, 2022, will incur a 1 percent reduction in Medicare payment through June 30, 2022. The payment adjustment percentage increases to 2 percent reduction beginning July 1, 2022. The claims payment adjustment will be applied to all claims after determining coinsurance, deductible, Merit-based Incentive Payment (MIPS) adjustments and any applicable Medicare Secondary Payment adjustments. Patients may not be billed for these reductions.

Part B Claim; Remittance Advice
This reduction appears on your remittance advice (RA) with CO-253 and an associated dollar amount. When the total allowed amount for an individual service is applied to the patient’s deductible the Sequestration reduction is not applied to that detail line.

Unassigned Claims
Although beneficiary payments for deductibles and coinsurance are not subject to the payment reduction, Medicare’s payment to beneficiaries for unassigned Part B claims is subject to the applicable percent reduction. CMS encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to have discussions with beneficiaries on the impact of sequestration on Medicare’s reimbursement.


Texas and New Mexico

New Training Posted

TNMHO has posted a workplace violence and harassment training on the Learning Model System.  It is about 20 minutes long.  We hope you will take advantage of this training.  Let us know if there are other trainings you would like to see posted.  Go to:   https://txnmhospice.talentlms.com/.


Texas News and Information

Health and Human Services Commission (HHSC)

Inpatient Hospice please note the following:

Hospital Off-Site Facilities and Designation of Licensed Hospital Space in Response to COVID-19 Emergency Rule Expired July 12, 2022

Emergency rule §500.1, Hospital Off-Site Facilities in Response to COVID-19, adopted under Texas Administrative Code Title 26, Part 1, Chapter 500 expired on July 12, 2022. This emergency rule permitted a currently licensed hospital to apply to temporarily operate an off-site inpatient facility, including hospital space designated by another currently licensed hospital for use as an off-site facility, without obtaining a new license to more effectively treat and house patients in response to the COVID-19 pandemic.  Effective July 13, 2022, all licensed hospitals utilizing this emergency rule must resume operations and obtain licensure for off-site locations as required by Texas Administrative Code Title 25, Chapter 133.  For questions or more information, please contact us by emailing [email protected].


COVID Rules are Expired

Emergency rules for Inpatient Hospice COVID-19 Response – Expansion of Reopening Visitation in 26 Texas Administrative Code Section 558.950 expired on June 16.  Emergency rules for Home and Community Support Services Agencies Response to COVID-19 in 26 TAC Section 558.960 will expire on July 21.

Email questions to LTCR Policy.

The HCSSA COVID rules have expired!  It is back to business as usual in Texas.  You will refer to 26 Texas Administrative Code Chapter 570 Long Term Care Provider Rules During a Public Health Emergency or Disaster at:  https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=26&pt=1&ch=570.


  • Infection control policy and procedures must be up to date.
  • Infection control policy and procedures must address the prevention of infectious and communicable diseases.
  • Emergency plans must be up to date to address any approaching disaster.
  • Staff must be aware of what to do in the event of any sort or emergency.

Reminder:  HHSC does NOT advise on OSHA ETS.  Please go to:  https://www.osha.gov/coronavirus/ets.


TULIP:  Common Mistakes on Licensure Applications

Stephanie Allred and Trent Banks spoke on the common mistake they are finding on the licensure applications.  The PDF document was shared.  Please review. https://www.hhs.texas.gov/business/licensing-credentialing-regulation/tulip-online-licensure-application-system


Texas Behavioral Health Executive Council/Social Work Board

Texas Social Workers, please be aware of the following! 

Texas Behavioral Health Executive Council

The Council of State Governments’ (CSG) National Center for Interstate Compacts is excited to announce that the initial draft of the Social Work Compact has been finalized and posted online for review and public comment at https://compacts.csg.org/compact-updates/social-work/. On this webpage you will also find a list of FAQs and a two-page educational fact-sheet.  This is NOT a “done deal”.  It has to be legislatively approved.  The goal for the CSG is to have seven states sign on to the compact.

CSG will host weekly review sessions to explain the provisions of the compact. These meetings are open to the general public.   The draft, please fill out the online survey which is linked here: https://www.surveymonkey.com/r/socialworkcompact.



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.