CMS Open Door Forum Explores Home Health and Hospice Issues
August 25, 2014 08:34 AM
On Wednesday, August 20, 2014, the Centers for Medicare & Medicaid Services (CMS) hosted a Home Health, Hospice, and DME Open Door Forum. A significant portion of the ODF was dedicated to the recently finalized hospice payment rule for FY2015. A summary of Home Health and Hospice issues covered is provided below.
HOME HEALTH ISSUES
OASIS C1/ICD-9 Webinar: CMS will conduct a webinar on the OASIS C1/ICD-9 on Wednesday, September 3, from 2:00-3:30pm EST, as announced in the July 25 Survey and Cert letter. There is no registration for the webinar; it will be conducted on a first come first serve basis. CMS has reserved 1000 lines however the webinar is intended for both State survey personnel and home health providers. Participants are encouraged to sign in at least 20 -30 minutes prior to the start of the webinar. On the day of the webinar go directly to https://webinar.cms.hhs.gov/oasisc1/.
Webinar materials will be forthcoming prior to the webinar on the OASIS training page. A recording of the webinar will be available several weeks after the webinar and also be posted OASIS training page.
CMS is awaiting the Office of Management and Budge (OMB) approval for the OASIS C1/ICD-9 item set. Until approval is received from OMB, the OASIS C1/ICD-9 form is a draft format. However, CMS does not expect that there will be any changes to the draft OASIS C1/ICD-9.
FINAL HOSPICE PAYMENT RULE
CMS staff outlined key issues addressed in the final FY2015 Hospice Payment and Wage Index Rule issued on Aug. 4. Hospice payment rates are estimated to increase, effective Oct. 1, 2014, by an average of 1.4 percent.
Please note: Subsequent to August 4, CMS released a change request (CR 8876) and an accompanying MedLearn Matters Article (MM 8876) that provide summaries of the Hospice Payment Rates, Hospice Cap, Hospice Wage Index, Quality Reporting Program and the Hospice Pricer for FY 2015.
FINAL PAYMENT RULE POLICY CHANGES
Timely filing of the NOE and NOTR. In electing hospice care, a beneficiary waives the right to care for the terminal illness and related conditions except as provided by the hospice and the patient’s attending physician. There has been growing concern that, absent a required time frame for hospice submission of a Notice of Election (NOE) or Notice of Termination/Revocation (NOTR), the patient’s status relative to hospice election is not accurately reflected in CMS systems. The rule finalizes a requirement that the NOE be filed within 5 calendar days after the effective date of election. CMS has included an exceptions process for failure to meet the time frame for the NOE due to circumstances beyond the control of the hospice. Similarly, a NOTR must be filed within 5 calendar days after discharge or revocation of hospice unless a final claim is filed within that time frame.
Attending physician designation on hospice election statement. Medicare hospice policy indicates that that a patient’s attending physician is identified by the beneficiary at the time he/she elects to receive hospice care as having the most significant role in the determination and delivery of the individual’s medical care. CMS has heard reports that some hospices are assigning a physician or nurse practitioner (NP) as the patient’s attending; data also indicates that during 2012 more than 1/3 of hospice patients had multiple providers submit claims as the hospice attending physician. CMS is implementing a requirement that the hospice election form include the attending physician with an attestation from the patient or other responsible individual that this is the patient’s choice or that of the responsible individual. Similarly, in cases where a change in attending occurs, CMS will require that hospices secure from the patient a signed document identifying the new attending physician and affirming that the change is the choice of the patient or responsible individual.
Estimated Hospice Cap Overpayment Recovery. Currently hospice cap determinations, along with any overpayment determination, are calculated by the Medicare Administrative Contractor (MAC) and provided to the hospice between 16 to 24 months following the end of the applicable cap year. CMS is requiring that hospices calculate their aggregate cap liability no sooner than 3 months following the close of the cap year and no later than 5 months following the close of the cap year. Hospices must remit their calculation, along with any payment due, to the MAC within those time frames. Hospices that fail to submit their aggregate cap calculation will have payment suspended until the information is received by the MAC.
Request for comment on definitions for “terminal illness,” “related conditions” and Part D/hospice coordination processes. CMS took no action on these issues but will consider comments for possible future rulemaking.
Hospice Cost Report revisions. CMS representatives provided an update on upcoming release of revised hospice cost report (1984-14) for freestanding hospices. CMS made only minimal changes since release of the most recent draft in November 2013; these changes include shading of a few lines on Worksheet B and correction of grammatical errors in the instructions. If CMS had made significant changes it would have had to go through another public comment period. Since early this year CMS has been working on the electronic specifications for cost report filing. CMS anticipates posting of the finalized cost report, instructions, and electronic specifications some time next week and these will be required for freestanding hospices with cost reporting years beginning on or after October 1, 2014.
During the Q & A period, CMS confirmed that it does plan to revise the hospice cost report requirements for facility-based hospices (home health, hospital, etc.) to reflect the same expansion of data collection but provided no specific time frame for that activity. As with the freestanding forms, the facility-based form and instruction changes will go through two public comment periods. (Note: based on earlier communication with CMS, NAHC has learned that the changes to the freestanding hospice cost report will include MAC edits that will require internal data consistency or the forms may not be filed and accepted by the MAC.)
Hospice CAHPS. The final rule reminds hospices that national implementation of the hospice CAHPS survey begins Jan. 1, 2015; hospices must participate for at least 1 month during first quarter of 2015 and begin continuous monthly participation April 1. Any questions about hospice CAHPS should be submitted to the survey team at hospicecahpssurvey@HCQIS.org or to CMS hospice CAHPS staff at email@example.com. Participation during CY2015 will impact hospice payment rates during FY2017.
If a hospice is eligible to participate, the hospice will be required to select and contract with a vendor - from the vendor list will be provided on the Hospice CAHPS websitein early September - and the hospice will be required to authorize the vendor to collect and submit data on the hospice’s behalf. These actions must be taken prior to beginning of participation in the “dry run” period, which runs for the first quarter of CY2015.
Once monthly participation begins (April 1, 2015), hospices will submit contact information for relatives of patients that died that month to the vendor of their choosing. After a short time lag (a few months) vendors will distribute the Hospice CAHPS survey to the family members of the patients. CMS advises that hospices develop a policy that will help ensure compliance with the requirement for monthly data submission to the vendor.
CMS plans to post the approved vendor list in early Septemberand recommends that hospices contact several vendors to discuss contracting as each vendor may offer different packages of services. Registration for vendor training will be open between the second week in September and the end of September; all vendors MUST participate in training but hospices are welcome to sign up, as well, and may find participation valuable.
The Hospice CAHPS Quality Assurance Guidelines (QAG) Manual will be available in the next few weeks online (anticipated posting is the end of August) and covers numerous issues, including program requirements, survey procedures, and data handling. The QAG Manual will inform hospices what information must be reported monthly to the vendor.
Hospice CAHPS will include a size exemption-- if a hospice has less than 50 survey-eligible deaths in CY2014 it will be eligible for an exception. CMS cautions that hospices SHOULD NOT ESTIMATE their eligible deaths to determine eligibility for the size exemption in order to guard against possible error. The deadline for requesting a size exemption is August or exception. Do not estimate number of deaths -- count them individually to guard against error. The deadline for requesting a size exemption is August 12, 2015.
Q & A Session
Following are some of the questions and responses during the Q & A session for the ODF related to hospice.
Question:If a hospice submits the NOE after the 5-day time frame, does the hospice list those dates on the claim or only list dates for which it will be paid?
Answer:Additional instructions will be available by Labor Day at the latest (in the form of CR 8877) and should have additional claims processing detail.
Question:What form will be used for the NOTR and where is it sent? What about sequential billing concerns related to the NOE/NOTR requirements?
Answer:The CR (referenced above) should have technical detail. The NOTR will be a bill type 81B. CMS will work with claims processing experts to ensure sequential billing issues are addressed (to extent possible).
Question:Relative to the attending physician requirement -- will a form be made available for hospices to use when the patient changes attending physicians?
Answer:Hospices must create their own form; it is to be kept on file at the hospice.
Question: Are their multiple hospice CAHPS surveys?
Answer:Originally there were three surveys; there is now a single questionnaire that will be used for hospice CAHPS. The survey contains some site-of-care specific questions, but all questions will be on a single survey. Data provided to vendor will relate only to deaths during a single month. CMS, as part of CAHPS process, will also request a count of all patient discharges for the month (but this is separate and apart from the family contact information for patient deaths that will go to the vendor).
Question:Caller had question about use of 81B for NOTR since they have historically been instructed not to use the 81B since it is impossible to make changes once the 81B is submitted.
Answer:The CR will clarify what bill type will be used for the NOTR and CMS will discuss historical issues related to use of the 81B with the MACs.
Question:For a new hospice, what requirements will apply for hospice CAHPS?
Answer:CMS will have a “newness” exemption but the date of certification has not yet been set, and an application will not be required. However, if hospices have their provider number during 2014, the “newness” exemption will not likely apply.
Question:Only the English “mail” version of the CAHPS survey is available online when will the other versions be made available?
Answer: OMB has not yet approved ANY of the CAHPS survey versions; once the survey is approved by OMB all versions that CMS plans to post will be made available. CMS plans to issue English and Spanish surveys but other language versions must be requested specifically from CMS.
Question:Will there be additional information available related to exceptions to the penalty for late filing of the NOE?
Answer:CMS will not likely go beyond a general description for exceptions in the CR. The MACs will provide more detail on the information that must be submitted to be considered for an exception. The MACs will process the exceptions.
Question: Is the NOE required for transfer?
Question:Must a hospice pay for the services of the CAHPS vendor?
Question:Will levels of participation affect payment rates?