CMS Delays Hospice Special Focus Program, Approves Survey Redesign

The U.S. Centers for Medicare & Medicaid Services (CMS) did not finalize provisions in the 2022 home health payment rule that would have created a Special Focus Program (SFP) for hospice. However, the agency does expect to revisit the SFP in a future rulemaking.

In response to comments on the proposed rule, CMS opted to create a Technical Expert Panel (TEP) to examine the SFP to ensure that the program is designed effectively for hospices.

“We are particularly encouraged to see that CMS plans to delay creation of a Special Focus Program for hospice in order to more fully consider stakeholder feedback as part of its development,” Theresa Forster, vice president for Hospice Policy at the National Association for Home Care & Hospice, said. “The SFP is a crucial element of the survey reforms, and it is vital that this program be crafted to ensure that it effectively promotes improvement in hospice compliance with the hospice Conditions of Participation.” 

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The Special Focus Program (SFP) would have the power to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys. Hospices flagged by the proposed Special Focus Program would be surveyed every six months rather than the current three-year cycle.

The SFP would have the authority to impose fines, suspend reimbursement, appoint temporary management to bring the hospice into compliance, or revoke a provider’s Medicare certification altogether.

The agency did move forward with finalizing requirements that redesign elements of the hospice regulatory survey process.

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The updated regulations require hospice surveys to be conducted by multidisciplinary teams, prohibit surveyor conflicts of interest and update the surveyor training process. Surveyors from accreditation organizations with deeming authority will now have to undergo the same training as those employed by government agencies and use similar assessment forms during surveys.

Three accreditors currently have this authority: the Accreditation Commission for Health Care (ACHC), Community Health Accreditation Partner (CHAP), and The Joint Commission.

The agency will also implement a hospice program complaint hotline through which the public can report issues to CMS.

Through the rule, CMS is implementing requirements established by the Consolidated Appropriations Act of 2021. Congress included 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). CMS expects that implementation of these proposals would cost an estimated $5.5 million annually.

“Implementing these reforms will help to ensure the competency and consistency of surveyors which is critically important to establish if enforcement remedies are to be levied against hospices based on their findings,” the National Hospice & Palliative Care Organization commented on the proposed rule. “However, we note that there is no mention of updating the surveyor training modules when new regulations are promulgated and urge CMS to provide updates to the surveyor modules and add requirements for continuing education for surveyors.”

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