Recent CMS Changes and Revisions for Hospices
October 13, 2014 01:08 PM
CMS recently issued Transmittal 123 – Revisions to State Operations Manual For Home Care and Hospice. The revisions affect Chapters 1, 2 and 3 of the Manual. CMS additionally also recently released Change Request 8501 – Instructions to MACs for Defending Medical Review Decisions.
What the new revisions and change request mean for hospices is detailed below.
Revisions to State Operations Manual Impacting Home Health and Hospice
CMS recently released Transmittal 123, Revisions to State Operations Manual (SOM) Chapters 1, 2, and 3. The revisions do impact both home health and hospice but are only updates in the SOM to reflect current policies and procedures concerning home health and hospice agencies deemed to satisfy participation requirements on the basis of their accreditation by a CMS-approved Medicare accreditation program; reflect current regulations governing determination of the effective date of the Medicare agreement/supplier approval; and clarify the type of subsequent survey required when an initial applicant for participation in Medicare has been denied initial certification based on an initial survey findings. There is no new information in the revisions.
CMS Change Request 8501 – Instructions to MACs for Defending Medical Review Decisions
CMS recently released change request (CR) 8501 – Defending Medical Review Decisions at Administrative Law Judge (ALJ) Hearings. This CR instructs the Medicare Administrative Contractors (MACs) in supporting their medical review decisions through the ALJ level. These instructions are contained in and update the Medicare Program Integrity Manual, Chapter 3. MACs are to have a physician present or taking party in ALJ hearings and are to oversee the hearing support process. This CR outlines these processes and MAC coordination with the Qualified Independent Contractor (QIC).