Providers are grasping for a foothold around recently proposed changes to the U.S. Centers for Medicare & Medicaid Services (CMS) hospice survey process. Hospices are working through the intricacies of the evolving requirements to ensure they can remain in compliance.
The new requirements are likely to come with potentially heavy penalties for providers in consistent noncompliance. CMS last month announced the overhaul via the proposed payment rule for home heath agencies in Fiscal Year 2022. Though the agency has not finalized the rule, they have very little wiggle room when it comes to revisions. Congress mandated many of these provisions in the Consolidated Appropriations Act of 2021. Legislators added the hospice language in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS).
Hospices should expect that these reforms will be included in the final rule, sources from the National Association for Home Care & Hospice (NAHC) told Hospice News. The revised guidance to hospice surveyors is intended to better emphasize issues related to quality of care, according to Theresa Forster, NAHC’s vice president for hospice policy and programs, and Katie Wehri, its director of home health and hospice regulatory affairs.
“Given the deadlines of the reforms that are required by the Consolidated Appropriations Act, hospices should expect the reforms to be finalized as proposed, or at least very close to how they are proposed,” said Forster and Wehri. “However, this does not mean that CMS does not have the option to incorporate some of the comments made by stakeholders immediately or in the future. Hospices can best prepare by being certain they understand the conditions of participation fully and are implementing them as required with a focus on those conditions of participation CMS considers to be most closely related to patient care.”
CMS has indicated that hospices can anticipate revisions to the CMS State of Operations Manual that will increase emphasis on four “core” hospice Conditions of Participation (CoPs).
The following CoPs are part of the revised surveyor guidance:
- Section 418.52 Condition of Participation: Patient’s rights
- Section 418.54 Condition of Participation: Initial and comprehensive assessment of the patient
- Section 418.56 Condition of Participation: Interdisciplinary group, care planning and coordination of care
- Section 418.58 Condition of Participation: Quality assessment and performance improvement
“We understand that there may be some structural changes, but they will not change the content or specific CoP requirements. Rather, the goal is to increase emphasis and focus on COPs related to quality of care,” Forster and Wehri said.
Nine specific changes that CMS is implementing will affect hospice providers. These reforms have various effective dates. For example, the provision requiring a new hospice program hotline is effective Dec. 27., one year since the date Congress approved the legislation in late 2020. Several other revisions take effect on Oct. 1, including the requirement to use multidisciplinary survey teams and the prohibition of conflicts of interest.
According to the proposed rule, CMS would establish a Special Focus Program (SFP) with the authority to penalize hospices that have a history of serious deficiencies during CMS or accreditation surveys. SFPs would be authorized to impose fines, suspend reimbursement, appoint temporary management to bring the hospice into compliance or revoke a provider’s Medicare certification.
The OIG reports received a great deal of media attention and sparked some outrage among the hospice community and the public. The first report indicated that about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a condition-level deficiency that posed a serious safety risk.
A second report discussed 12 examples of those deficiencies in-depth. OIG examined state agency and accreditor survey findings as well as complaint data from 2012 through 2016. Regulators and accreditors surveyed nearly all hospice providers in the nation during those years.
Industry stakeholders and advocacy groups have voiced a number of concerns about the law, recommending that remedies should be focused specifically on organizations with a history of serious deficiencies rather than the hospice community as a whole. Some see the SFP program as an effort to do just that, though the revamped survey requirements would affect every provider.
As part of the proposed requirements, CMS must implement a range of enforcement remedies and publicly disclose accreditation survey information effective no later than Oct. 1, 2022. Historically, accreditation survey results have been kept confidential. When the requirements are finalized, accreditors will have to develop a way to present arcane survey reports into a format that is accessible and understandable to the general public.
The enforcement remedies likely will have the broadest impact among the rule’s provisions, according to Forster and Wehri. Some of these, such as the suspension of Medicare payments, could “severely impact the ability of hospices to remain open,” they said.
Hospices strategizing to navigate these changes can arrange to undergo mock surveys completed by objective parties in order to prepare, Forster and Wehri stated.
“Hospices should revisit their most recent surveys to ensure they have sustained compliance with any previous deficiencies, especially condition-level deficiencies as prior survey performance will impact enforcement remedies and SFP eligibility,” Forster and Wehri told Hospice News. “Hospices should also be prepared for more surveys as a greater number of validation surveys are expected to be conducted.”
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