NAHC Seeks Input on Provisions Contained in CMS’ Proposed Hospice Payment Rule
June 12, 2014 12:12 PM
On May 2, the Centers for Medicare & Medicaid Services (CMS) released a proposed regulation, Medicare Program; FY 2015 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements and Process and Appeals for Part D Payment for Drugs for Beneficiaries Enrolled in Hospice. The proposed regulation included the following:
Estimates of applicable FY2015 hospice payment rates;
Several hospice policy changes; and
Requests for comment on other policy changes that CMS could consider as part of future rulemaking.
CMS will accept comments until COB on July 1.
The National Association for Home Care & Hospice (NAHC) is soliciting input on four specific issues that CMS has put forth as part of the proposed rule. Those issues are:
A definition for "terminal condition" that CMS may consider for use in future rulemaking
A definition for "related conditions" that CMS may consider for use in future rulemaking
A proposed deadline for filing a hospice Notice of Election (NOE) and Notice of Termination or Revocation (NOTR) with the MAC
A requirement that a hospice patient (or representative) affirm their choice of attending physician on their election statement and affirm any change in attending physician, as well.
PLEASE SUBMIT YOUR COMMENTS ABOUT THESE CMS PROPOSALS as part of the Survey Monkey survey form NAHC has developed for this purpose. The survey is available here. Comments that are submitted will be considered for inclusion in NAHC's comment letter to CMS. Your input must be received by COB Tuesday, June 24. If you prefer to submit your input by email, please send your comments to Theresa Forster (firstname.lastname@example.org).
In related news, NAHC has developed a comprehensive template in Word format that stakeholders may use to develop comments they wish to submit directly to CMS on the regulation; the template is available here.
The template contains information on each of the proposals in summary format. The template also contains information on how comments on the regulatory proposals can be submitted electronically.
Following are the specific issues and questions for consideration that are included as part of NAHC’s survey that is linked above:
1. DEFINITION OF “TERMINAL ILLNESS.” CMS believes that longstanding, preexisting conditions should be considered part of the bundle of covered hospice services, that all body systems are interrelated; all conditions, active or not, have the potential to affect the total individual. The presence of comorbidities is recognized as potentially contributing to the overall status of an individual and should be considered when determining the terminal prognosis. The 1983 rule governing creation of hospice under Medicare does not delineate between pre-existing, chronic, nor controlled conditions.
CMS is asking for comment on a definition for "terminal illness" that it has developed, as follows:
TERMINAL ILLNESS -- “Abnormal and advancing physical, emotional, social and/or intellectual processes which diminish and/or impair the individual’s condition such that there is an unfavorable prognosis and no reasonable expectation of a cure; not limited to any one diagnosis or multiple diagnoses, but rather it can be the collective state of diseases and/or injuries affecting multiple facets of the whole person, are causing progressive impairment of body systems, and there is a prognosis of a life expectancy of six months or less”.
Questions to consider as you provide your input: As a hospice medical or clinical staff member, do you believe this definition is appropriate or is it too broad? If you were to apply this definition to patients under care at your hospice, would it result in the same determination as you are currently making relative to what care/services are the responsibility of your hospice and what responsibilities fall outside of hospice care?
2. DEFINITION OF "RELATED CONDITIONS"-- CMS includes a definition of "related conditions" and requests input on this definition:
RELATED CONDITIONS -- “Those conditions that result directly from terminal illness; and/or result from the treatment or medication management of terminal illness; and/or which interact or potentially interact with terminal illness; and/or which are contributory to the symptom burden of the terminally ill individual; and/or are conditions which are contributory to the prognosis that the individual has a life expectancy of 6 months or less”.
Questions for hospices to consider as you comment on this definition: As with definition of “terminal illness” (above), do hospice medical/clinical staff believe this definition is appropriate or is it too broad? If you were to apply this definition to patients under care at your hospice, would it result in the same determination as you are currently making relative to what care/services are the responsibility of your hospice and what responsibilities fall outside of hospice care?
3. Timeframes Proposed for Filing NOE and NOTR.CMS proposes that:
(1) a hospice must file the NOE with its MAC within 3 calendar days following the hospice effective date of election, regardless of how the NOE is filed (by direct data entry, or sent by mail or messenger). Hospices not filing the NOE within the required 3 calendar days would receive no payment from the effective date of election to the date the NOE is received by the MAC, and could not bill the beneficiary for the services provided.
(2) similarly, a hospice must file a notice of termination/revocation (NOTR) within 3 calendar days following the patient’s revocation/discharge date if a final claim has not been filed within that time frame.
CMS proposes these time frames to safeguard the integrity of the Medicare Trust Fund and enable smooth and efficient operation of other Medicare benefits (i.e. Part D); additionally, timely filing of the NOE is necessary so that the Medicare claims processing system can properly enforce the Medicare hospice benefit waiver.
Questions to consider as you provide comment on this proposed requirement: From the hospice perspective, a 3-day requirement may be burdensome, particularly for small hospice providers and those who file by mail/messenger. What is the shortest amount of time (following the effective date of election) within which your hospice would be able to file ALL of its NOEs with the MAC? Within what time frame would your hospice be able to file ALL of its NOTRs?
4. Designation of Attending Physician. CMS is concerned that hospices may be assigning patients' attending physicians rather than ensuring that the choice of attending is made by the patient or patient's representative. CMS is proposing that the election statement identify the patient's (or representative's) choice of attending physician and include an acknowledgement by the patient (or representative) that the designated attending physician was their choice. CMS is proposing that, when a patient changes his/his attending, the hospice follows a process similar to that in use when the patient changes hospice providers; that is, the patient (representative) signs and dates a statement that identifies the new attending physician and affirms that the change was the patient's (or representative's) choice.
To consider when you comment on this proposed change: how might these procedural changes for designation of attending physician impact your hospice's operations? What circumstances would make it difficult to comply with these changes?