Congress Poised to Set Minimum Hospice Survey Frequency
September 18, 2014 09:42 AM
For many years, the National Association for Home Care & Hospice (NAHC) and its Hospice Association of America (HAA) have supported greater frequency in hospice surveys. Currently, there is no set time frame for frequency of hospice surveys, and the average length of time between surveys for hospice providers is six to eight years. Some hospices have not been surveyed in over a decade. More frequent surveys are a step toward helping ensure hospice provider compliance with regulations and proper administration of the hospice benefit.
On September 16, the House of Representatives passed, by a voice vote, legislation that requires the Centers for Medicare & Medicaid Services (CMS) to survey hospices at least as frequently as every three years for the next 10 years. The legislation also corrects a legislative drafting error that has prevented implementation of an Affordable Care Act provision requiring medical review of hospices with a high proportion of long-stay patients. These provisions were first included in legislation introduced earlier this year by Reps. Tom Reed (R-NY) and Mike Thompson (D-CA); House Ways and Means Chairman Dave Camp (R-MI) and Senate Finance Chairman Ron Wyden (D-OR) worked in recent weeks to include these provisions as part of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.
NAHC President Val J. Halamandaris noted that, “NAHC applauds the efforts of Chairmen Wyden and Camp, as well as those of Congressmen Reed and Thompson, for their foresight and leadership in working to realize these important changes.”
In order to pay for the increase in surveys the legislation would alter the method for calculating the annual adjustment to the hospice aggregate cap calculation. The aggregate cap is the annual dollar limit that hospices can receive from Medicare on a per-patient basis. If a hospice’s payments exceed its aggregate cap limit, a hospice must pay back to Medicare any payments it received beyond the cap amount. The cap is updated on an annual basis, as are the hospice payment rates, but the annual updates are calculated using different economic indices (the cap is updated by the CPI-M, while payment rates are updated by the hospice market basket).
This legislation would make a change in the hospice cap update calculation, tying it to the net hospice market basket value, as well. This would more closely align the methodology for the cap update amount and the hospice payment rate updates. While we predict that the change in the calculation of the hospice cap update will not impact most hospices it is expected to slow the rate of growth in the hospice cap, which may mean that, over time, more providers exceed the cap or that those exceeding the cap do so by a higher amount than would otherwise be the case. NAHC’s review of recent cap updates as compared with net market basket updates indicates that the impact of this change would vary from year to year, but in most recent years would have reduced the cap update by amounts ranging from 0.13 to 1.48 percentage points. This will provide a strong incentive for those hospices with cap-related overpayments to review their admission/discharge criteria.
The IMPACT Act would require development of a uniform assessment instrument and enhance the discharge planning process related to post-acute care. Hospices are not included in the list of post-acute care providers that are part of the IMPACT Act. Senate passage of this legislation is anticipated in the near future.
To read a letter sent by NAHC to Rep. Wyden on the IMPACT Act, please click here.