NAHC/HAA Submit Comments on FY2015 Proposed Hospice Payment Rule
July 9, 2014 12:52 PM
The National Association for Home Care & Hospice’s (NAHC) Hospice Association of America (HAA) has submitted detailed comments to the Centers for Medicare & Medicaid Services (CMS) in response to the May 2 release of a proposed rule to govern the 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 NAHC/HAA comments, focusing on several areas of particular interest and concern, are summarized below.
The full text of the NAHC/HAA letter to CMS’ Administrator Marilyn Tavenner is available HERE.
CMS’ request for comments on definitions of “terminal illness” and “related conditions” that could be considered in future rulemaking. NAHC/HAA expressed concern over CMS’ interest in establishing a new definition for “terminal illness” and for codifying a definition for “related conditions”. While CMS’ proposed definition of “terminal illness” is a thoughtful one, NAHC/HAA were unclear as to whether a new definition is warranted at this time. NAHC/HAA cautioned that in hospice care, each patient must be viewed individually, with full consideration given to the individual patient’s medical and social history. NAHC/HAA also raised concerns that movement toward any definition (whether for “terminal illness” or “related conditions”) that does not maintain a hospice patient’s right to care outside of the hospice benefit for conditions unrelated to the terminal condition would be a dereliction of duty on the part of CMS. NAHC/HAA took explicit issue with inclusion of “[conditions that] interact or potentially interact with terminal illness’ and/or which are contributory to the symptom burden of the terminally ill individual” as it is believed that inclusion of these phrases would imply that “related conditions” would, by definition, result in ALL of a patient’s conditions as being part of a hospice’s responsibility.
CMS’ proposed requirement that hospices calculate their own caps within five months of the close of the cap year and remit any overpayment directly to the Medicare Administrative Contractor (MAC) serving the hospice’s jurisdiction. NAHC/HAA suggested that five months is insufficient time to ensure that the cap calculations made by hospice providers will be accurate. Further, NAHC/HAA expressed concern over many hospices’ level of comfort with accessing the proper information from the Provider Statistical & Reimbursement (PS&R) system, and the great potential for inaccuracies. NAHC/HAA recommended that CMS extend the time frame to somewhere between eight to 12 months after the close of the cap year and consider having the MACs calculate the caps (since they have ready access to the data). CMS must ensure that providers have full information from the MACs related to establishing extended repayment schedules, and,(if hospices will be responsible for calculating the caps), they should be provided explicit instructions for accessing the proper reports in the PS&R system to ensure proper and accurate calculation of their caps.
CMS’ proposed limit of three days following the effective day of election (and three days following termination or revocation) for filing of the Notice of Election (NOE) or Notice of Termination/Revocation (NOTR). While NAHC/HAA is supportive of CMS’ intent in imposing these time limits, there are overriding concerns that CMS has not included any penalty for failure to file the NOTR, which could lead to difficulties in meeting the NOE filing time frame for any subsequent hospice provider that takes a patient onto care. NAHC/HAA also believe three days following the election/termination/revocation may be insufficient given other administrative requirements (such as establishment of the principal diagnosis to include on the NOE). NAHC/HAA have suggested 10 days as the deadline for filing of the NOE, and five days for filing of the NOTR. NAHC/HAA have also cautioned that if CMS moves forward with this requirement it must ensure that other technical issues related to sequential billing and delays in filing of a final claim (due to new drug reporting requirements) do not create technical difficulties with processing of the NOE/NOTR and future patient benefits.
CMS’ proposed addition of the attending physician to the election form. NAHC/HAA are very supportive of this change but caution that CMS must provide clear guidance to hospices to ensure that they are meeting CMS’ intent relative to any formal changes made to the attending physician designation. NAHC/HAA also encourage CMS to provide physician education to ensure that physicians are not improperly billing Medicare as a hospice patient’s attending physician when not so designated with and by the hospice.
CMS’ solicitation of comments on coordination of benefits and appeals for hospice patients on Part D. NAHC/HAA continue to have serious concerns about imposition of a prior authorization process on terminally ill patients and commented on continuing problems that are arising as the result of CMS’ March 10 guidance to Part D plans. NAHC/HAA conveyed that any process that does not formally include all relevant parties and that does not guarantee timely access to medications for hospice patients will continue to be fraught with problems. NAHC/HAA understands, however, that if CMS should continue the PA process, codification of elements of the process is essential to ensure that the requirements on plans can be adequately enforced, and made several recommendations relative to specific elements of the coordination process that were included in the March 10 guidance.
Diagnosis Codes on hospice claims. As part of the proposed rule CMS reminds hospice providers that beginning Oct. 1, 2014, hospice claims will be returned to provider (RTPd) if they do not include an appropriately selected principal diagnosis. NAHC/HAA recommended that CMS provide a comprehensive list of codes that will result in a claim being RTPd, and that the list be made available as soon as possible.
As mentioned previously, this is a brief summary of the NAHC/HAA comments; we encourage those interested in greater detail to refer to the link provided at the start of this article.