Centers for Medicare and Medicaid Services (CMS)
What’s New for Fiscal Year 2023?
CMS issued the Fiscal Year (FY) 2023 Hospice Payment Rate Update final rule to update Medicare hospice payments, wage index, quality reporting programs, and policies. Areas of interest are:
- Routine annual rate setting changes resulting in a 3.8% increase in payments for FY 2023. The cap amount for FY 2023 is $32,486.92 (FY 2022 cap amount of $31,297.61 increased by 3.8%).
- Permanent 5% cap on negative wage index changes; and
- Hospice Quality Reporting Program (HQRP) updates, including the new Hospice Outcomes and Patient Evaluation Tool, the Consumer Assessment of Healthcare Providers and Systems hospice survey, quality measures for FY 2023, and a summary of public comments from the request for information to inform future efforts related to HQRP health equity
Detailed information on the wage index can be found here: https://www.cms.gov/medicaremedicare-fee-service-paymenthospicehospice-regulations-and-notices/cms-1773-f.
In depth summation on the above areas can be found here: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2023-hospice-payment-rate-update-final-rule-cms-1773-f.
988 Suicide & Crisis Lifeline Available Nationwide
Anyone experiencing a mental health crisis, including substance use crisis or thoughts of suicide, can get confidential support 24/7 by calling 988 or visiting https://988lifeline.org/. Visit the Substance Abuse and Mental Health Administration 988 Partner Toolkit for information and resources: https://www.samhsa.gov/find-help/988/partner-toolkit.
Hospices & Home Health Agencies: Submit Technical Expert Panel Nominations by August 12
CMS wants input on a proposed health equity structural composite measure for hospice and home health care settings. Visit the Current Technical Expert Panel Opportunities webpage to submit a nomination or learn more. Go to: https://mmshub.cms.gov/get-involved/technical-expert-panel/current.
HOPE BETA Test Recruitment
CMS and their contractor, Abt Associates, are recruiting additional Medicare-certified hospice providers to participate in a beta test of the draft hospice patient assessment instrument called Hospice Outcomes & Patient Evaluation (HOPE). Recruitment is ongoing. Training will occur mid-July 2022, with data collection slated to begin in August 2022 and continue through fall 2022. The detailed recruitment announcement is available on CMS’s Hospice QRP Provider and Stakeholder Engagement webpage. Those interested in participating should email [email protected]. The HOPE development work is conducted under CMS contract number 75FCMC18D0014 and task order number 75FCMC19F0001.
Health and Human Services (HHS)
Public Health Emergency Renewed
As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective April 16, 2022, the January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021, July 19, 2021, October 15, 2021, and January 14, 2022, that a public health emergency exists and has existed since January 27, 2020, nationwide. You can access the announcement at: https://aspr.hhs.gov/legal/PHE/Pages/COVID19-12Apr2022.aspx.
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 the information here:
You can use telehealth as allowed in the waivers but be sure to keep up with them as they change and are updated frequently! Texas providers: Even though the HCSSA PHE rules have expired the blanket waivers can be used!
TNMHO shared coalition questions with you last week; however, these were related to home health. This document is hospice related.
Hospice Coalition Questions and Answers: June 9, 2022
The June 9, 2022, Hospice Coalition Questions and Answers are not available. Please review this information and share it with your staff. https://www.palmettogba.com/palmetto/jmhhh.nsf/DID/PVKRE0Y8K5#ls
MACtoberfest – Palmetto GBA Hospice Billing & Reimbursement Conference
Hospice providers please mark your calendars because from Nov. 9-10, 2022, in Houston, TX key Palmetto staff will be in Texas! It is important that your billers and any new providers and their billers attend this training! Palmetto staff have expressed grave concerns about the lack of knowledge hospice providers have on Palmetto’s expectations of them. Why take the chance of having fiscal issues when you have a great opportunity to learn and connect with Palmetto staff?
National Hospice and Palliative Care Organization (NHPCO)
NHPCO shared the following information with the states: HR 4040: Advancing Telehealth Beyond COVID-19
The House is scheduled to vote on the Advancing Telehealth Beyond COVID-19 Act (H.R. 4040). The bill, introduced by Congresswomen Cheney and Dingell, extends hospice telehealth flexibilities to conduct face-to-face visits prior to recertification and allow home as an originating site for telehealth visits, through the end of 2024. These flexibilities are currently scheduled to expire 151 days after the end of the Public Health Emergency.
You can review the bill at: https://www.congress.gov/bill/117th-congress/house-bill/4040.
To support this bill, and hospice telehealth flexibilities please complete this Action Alert and share it with your members! Go to: https://www.hospiceactionnetwork.org/take-action/#/67. You may also consider sending a note, like the Action Alert text, directly to any House-side health staffers you have been in touch within the past.
Updates to the Members Only Website!
The Texas New Mexico Hospice Organization has posted the following items to its Members Only website:
We also created specific categories for federal, New Mexico and Texas! Check it out at: https://www.txnmhospice.org/
Texas News and Information
Public Health Emergency (PHE) Update
Governor Gregg Abbott extended the public health emergency on July 21, 2022.
Please note that the Home and Community Support Services Agencies PHE rules have expired, and we now operate under and comply with 26 TAC Chapter 558 and Chapter 570 Long Term Care Rules During a Public Health Emergency or Disaster. You must ensure your emergency preparedness plans are up to date and infection control policies are up to date. Rules can be accessed at: https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=3&ti=26&pt=1.
Texas Medicaid and Healthcare Partnership (TMHP)
Suspension of Payment for Not Submitting the Required SB 809 Rider 143 Reports
Beginning August 12, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will begin to suspend payment to the impacted provider types that have not submitted the required Senate Bill (SB) 809 Rider 143 Reports for COVID-19. The list of impacted providers can be found on the Provider Finance Department web page under Provider Finance Communications by selecting SB 809/Rider 143 COVID-19 Reporting Healthcare Institution List from the drop-down list. https://pfd.hhs.texas.gov/provider-finance-communications.
The 87th Texas Legislature directed the Texas Health and Human Services Commission (HHSC) to report federal COVID-19 funding from specific health care institutions and certain costs those providers have spent related to the COVID-19 public health emergency. Impacted provider types that have not submitted their required reports will receive the following explanation of benefits (EOB) message that will show the amount and reason for payment suspension: PAYMENT IN THE AMOUNT OF $______ SUSPENDED DUE TO NONRECEIPT OF SB809/R143 COVID REPORTING This message will also appear on future Remittance and Status (R&S) reports. Impacted required provider types that are unable to meet the reporting deadline should contact the Provider Finance Department at [email protected] for assistance.
Important: Payments for claims billed with any Texas Provider Identifiers (TPIs) associated or linked to an impacted provider’s National Provider Identifier will also be suspended.
Avoid Payment Suspension
Impacted provider types can avoid suspension by submitting the required documentation online through the Provider Finance web page (https://pfd.hhs.texas.gov/provider-finance-communications) for the monthly report that is required by Rider 143 [2022-23 General Appropriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular Session, 2021 (Article II, HHSC, Rider 143) and S.B. 809 (87th Legislature, Regular Session, 2021], Texas Administrative Code (TAC) §355.7201 Novel Coronavirus (COVID-19) Fund Reporting (https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=1&pt=15&ch=355&rl=7201).
Impacted provider types can also refer to a Frequently Asked Questions (FAQ) document that is located on the website listed above. Providers can view the HHSC-created list of frequently asked questions for answers to common questions to assist providers in completing the report.
Health and Human Services Commission (HHSC)
PL 2022-15 Offsite Review Responsibility Requirements was released on July 19, 2022.
This letter reminds facilities and agencies that they have the same obligation to respond to an investigation that HHSC conducts virtually and offsite as they do during an investigation that HHSC conducts in-person and onsite. To review the provider letter, go to: https://www.hhs.texas.gov/sites/default/files/documents/pl-2022-15.pdf.
August 2022 LTCR Provider Training Opportunities
Hospice providers, HHSC is offering many training opportunities specific to hospice, C.N.A.s, frequently cited deficiencies, abuse/neglect/exploitation etc. Here are the links to register for training:
- Joint Training website: https://apps.hhs.texas.gov/providers/training/jointtraining.cfm
- HCSSA Training website: https://apps.hhs.texas.gov/providers/training/HCSSAJT/index.cfm
Take advantage of these training opportunities!
Screening of Staff and Visitors Entering Nursing Facilities to Continue
The nursing facility COVID-19 Response Emergency Rule expired on July 26, 2022. However, in accordance with CMS and CDC, nursing facilities must continue to screen staff and visitors for:
- A positive COVID-19 test result.
- Symptoms of COVID-19.
- Whether the visitor meets criteria for quarantine.
- Whether the staff member is subject to a work exclusion.
- For residents, the CDC recommends evaluating all residents upon admission and at least daily. Ask residents to report if they feel feverish or have symptoms of COVID-19.
- Resident screenings must be documented in the resident’s chart.
- NFs are required to have an Infection Prevention and Control Program based on national standards (26 TAC §554.1601).
- Documentation of visitor and staff screening is no longer required.
Email questions to [email protected].
HHSC Adopts New Medicaid Hospice Rules
HHSC has adopted new Hospice Program rules in the Texas Administrative Code, Title 26, Chapter 266 effective July 26, 2022. Previous Medicaid Hospice rules from 40 TAC Chapter 30 have been repealed.
The adoption of new 26 TAC Chapter 266 will make HHSC’s Medicaid Hospice Program rules consistent with the federal Medicare hospice regulations; add definitions used in the chapter; include details of utilization review policy requirements, such as describing what the individualized plan of care must include, types of required documentation that a hospice must maintain and specifics regarding the certification of terminal illness; and update standards to protect the health and safety of people receiving hospice care.
The update will streamline processes and procedures that guide hospice services delivery to Texans. New Subchapter B is entitled Utilization Review and covers election, certification, respite, continuous home care, UR reviews etc. Subchapter C Contracting Requirements addresses eligibility, changing hospices and contracts with the state, nursing facilities and ICFIID providers. Please review these rules very carefully to ensure that you continue to comply and are aware of any new changes to the rules. Go to:
Email questions to [email protected].
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.