Bipartisan Push in Congress to Make Medicare Enrollment Easier

Legislation has recently been introduced that would work to improve the Medicare enrollment process for individuals nearing Medicare eligibility, aged 60-64. Longtime home care champions Senators Bob Casey (D-PA) and Todd Young (R-IN) are leading the charge for the Beneficiary Enrollment Notification and Eligibility Simplification 2.0 (BENES 2.0) Act, (S. 2675). BENES 2.0 continues the theme of the original BENES Act, many provisions of which became law in the Consolidated Appropriations Act of 2021, in supporting individuals in their Medicare enrollment process.

BENES 2.0 would require the federal government to provide clear explanation on Medicare benefit eligibility, information on late enrollment penalties, coordination of benefits, and resources available for further assistance. This information is to be included on Social Security Account statements for those attaining the ages of 60 – 65.

At introduction Senator Casey stated, “Medicare is one of America’s greatest success stories, but we need to make sure people can make the most of the Medicare benefits they have earned. That’s why I introduced the bipartisan BENES 2.0 Act to ensure that fewer people miss the deadline to enroll, which can lead to costly lifelong penalties.”

Senator Young added, “Currently, seniors who miss the sign-up deadline for Medicare Part B face onerous penalties that persist for the rest of their lives. The BENES 2.0 Act will ensure individuals have access to the information necessary to make more informed decisions as they approach Medicare eligibility.”

Joining Senator Casey and Young with introduction were Senators Debbie Stabenow (D-MI), Susan Collins (R-ME), Kyrsten Sinema (D-AZ), Tim Scott (R-SC), Sherrod Brown (D-OH) and Tina Smith (D-MN).

Bipartisan Push in Congress to Make Medicare Enrollment Easier

Legislation has recently been introduced that would work to improve the Medicare enrollment process for individuals nearing Medicare eligibility, aged 60-64. Longtime home care champions Senators Bob Casey (D-PA) and Todd Young (R-IN) are leading the charge for the Beneficiary Enrollment Notification and Eligibility Simplification 2.0 (BENES 2.0) Act, (S. 2675). BENES 2.0 continues the…

Bipartisan Push in Congress to Make Medicare Enrollment Easier

Legislation has recently been introduced that would work to improve the Medicare enrollment process for individuals nearing Medicare eligibility, aged 60-64. Longtime home care champions Senators Bob Casey (D-PA) and Todd Young (R-IN) are leading the charge for the Beneficiary Enrollment Notification and Eligibility Simplification 2.0 (BENES 2.0) Act, (S. 2675). BENES 2.0 continues the theme of the original BENES Act, many provisions of which became law in the Consolidated Appropriations Act of 2021, in supporting individuals in their Medicare enrollment process.

BENES 2.0 would require the federal government to provide clear explanation on Medicare benefit eligibility, information on late enrollment penalties, coordination of benefits, and resources available for further assistance. This information is to be included on Social Security Account statements for those attaining the ages of 60 – 65.

At introduction Senator Casey stated, “Medicare is one of America’s greatest success stories, but we need to make sure people can make the most of the Medicare benefits they have earned. That’s why I introduced the bipartisan BENES 2.0 Act to ensure that fewer people miss the deadline to enroll, which can lead to costly lifelong penalties.”

Senator Young added, “Currently, seniors who miss the sign-up deadline for Medicare Part B face onerous penalties that persist for the rest of their lives. The BENES 2.0 Act will ensure individuals have access to the information necessary to make more informed decisions as they approach Medicare eligibility.”

Joining Senator Casey and Young with introduction were Senators Debbie Stabenow (D-MI), Susan Collins (R-ME), Kyrsten Sinema (D-AZ), Tim Scott (R-SC), Sherrod Brown (D-OH) and Tina Smith (D-MN).

HHS Financial Report for 2021 Identifies Increases in Hospice Payment Error Rates

  • Increases not “statistically significant”, according to HHS

On an annual basis, the Department of Health & Human Services (HHS) issues a financial report that provides fiscal and high-level performance results that allow for the assessment of HHS’ performance over the previous fiscal year.  Last week HHS issued its FY2021 HHS Agency Financial Report (Report) containing an overview of programs, accomplishments, challenges and management’s accountability for the resources entrusted to it.

Financial projections for the report (which were largely taken from the 2021 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Insurance Trust Funds) are based on actual experience through 2019.

The Report notes that Medicare was dramatically affected by the COVID-19 pandemic.  The Trust Funds saw increased spending in areas related to testing and treatment of the disease as well as connected to legislative and regulatory waivers of existing policy (such as the waiver of the three-day hospital stay requirement to receive skilled nursing services and the 20 percent increase in payments for inpatient hospital admissions).  However, these costs were more than offset by decreases in spending for non-COVID-19 care, particularly for elective services.  The report notes that spending for certain services – including hospice – do not appear to have been materially impacted by the pandemic.  While the public health emergency has impacted trust fund financing over the short term, it is not expected to have a large effect on the financial status of the trust funds after 2024.

While the Report explores HHS’ management and financial operations in depth, information that may be of greatest interest to home health and hospice providers is housed in Section 3 of the report, which contains a listing of current individual civil monetary penalties, the Payment Integrity Report, FY2021 Top Management and Performance Challenges facing HHS as identified by the Office of the Inspector General (OIG) and HHS’ response to the OIG report.

While hospice civil monetary penalties were authorized under the Consolidated Appropriations Act of 2021, those penalties will not become effective until October 1, 2022, so they are not listed in the Report.  HHS has, however, published other provider-specific civil monetary penalties (including home health) along with the statutory authority for each penalty.  This information was also recently published in the Federal Register and is available in the following location:  https://www.govinfo.gov/content/pkg/FR-2021-11-15/pdf/2021-24672.pdf.

Also included in Section 3 is the Payment Integrity Report, which outlines the department’s efforts to improve payment accuracy in all of HHS’ programs.  Specifically, this section includes detailed information regarding improper payments, an area of significant focus by HHS and others.  HHS uses the Comprehensive Error Rate Testing (CERT) program to estimate Medicare fee-for-service (FFS) improper payments.  The CERT program reviews a stratified random sample of Medicare FFS claims to determine if HHS properly paid claims based on Medicare’s policies on coverage, coding and billing.  In response to COVID-19, the CERT program suspended documentation requests and phone calls for a portion of the FY2021 report period (claims submitted July 1, 2019, through June 30, 2020).  As a result, the FY2021 improper payment rate reflects a four-month pause.

The improper payment rate estimate for FY2021 is 6.62 percent of total outlays, or just over $25 billion, nearly 70 percent of which is attributable to insufficient or no documentation. Improper payments for hospital outpatient, SNF, home health, and hospice claims were major contributing factors to the improper payment rate, comprising just over 38 percent of the overall estimate.  Following are comments from the report relative to the primary causes of improper payments relative to hospice:

Hospice: Insufficient documentation is the major error reason for hospice claims. The improper payment estimate for hospice claims increased from 6.69 percent in FY 2020 to 7.77 percent in FY 2021; the change is not statistically significant. The primary reason for these errors is missing or insufficient documentation to support certification or recertification. Medicare coverage of hospice services requires physician certification that the individual is terminally ill (42 CFR §418.22) and must meet all coverage criteria (42 CFR §418.200).

Action by HHS over recent years has led to reductions in the Medicare FFS improper payment rates since 2014.  HHS has taken corrective action across services areas as well as corrective actions by service area to address improper payments.  Actions across service areas include medical review/targeted probe and educate (TPE), Supplemental Medical Review Contractor (SMR) Reviews, and Recovery Audit Contractor (RAC) reviews.  All of these corrective actions underwent a temporary pause, were limited, or altered during FY2021 due to COVID-19.  HHS also implemented sector-specific corrective actions, including the following:

Home Health Hospice
Review Choice Demonstration for Home Health Services* Medical Review/TPE for Hospice*
Medical Review/TPE for Home Health Agencies* SMRC Hospice Reviews* – including general inpatient levels of care, services provided in a SNF, and services provided in an Assisted Living Facility.  These reviews included hospice services associated with certain diagnoses and hospices that do not provide all levels of hospice care.
Elimination of Home Health Request for Anticipated Payment RAC Hospice Reviews* – including reviews for physician services during hospice and continuous  home care (CHC) medical necessity and documentation requirements

*indicates actions that were temporarily paused, limited, or otherwise altered during FY2021 due to COVID-19

HHS Financial Report for 2021 Identifies Increases in Home Health, Hospice Payment Error Rates

Increases not “statistically significant”, according to HHS On an annual basis, the Department of Health & Human Services (HHS) issues a financial report that provides fiscal and high-level performance results that allow for the assessment of HHS’ performance over the previous fiscal year.  Last week HHS issued its FY2021 HHS Agency Financial Report (Report) containing…

CMS Updates Benefit Policy Manual to Provide Hospice Clarifications

The Centers for Medicare & Medicaid Services (CMS) has updated Chapter 9 of the Medicare Benefit Policy Manual to provide clarification for two hospice items:

  1. Election statement addendum
  2. Aggregate cap calculation methodology

The clarifications are welcome especially for the election statement addendum.  Since its implementation last year hospices have been asking for more information about certain aspects of the addendum.  In the FY 2022 hospice final rule CMS provided the following related to the addendum:

  • If the beneficiary dies, revokes, or is discharged within the required timeframe after requesting the addendum (i.e., within five (5) days or three (3) days of the request, depending on when the request was made), and before the hospice has furnished the addendum, the addendum is not required to be furnished and the condition for payment is considered satisfied. 2
  • If the beneficiary requests the addendum and the hospice furnishes the addendum within 3 or 5 days (depending upon when the request for the addendum was made), but the beneficiary dies, revokes, or is discharged prior to signing the addendum, a signature from the individual (or representative) is no longer required in order for the condition for payment to be considered met.
  • Hospices must include the “date furnished” on the addendum.
  • The “date furnished” must be within the required timeframe (that is, 3 or 5 days of the beneficiary or representative request, depending on when such request was made), rather than the signature date.
  • If a beneficiary requests the addendum within the first 5 days of the effective date of the election, the hospice has 5 days from the request date to furnish the addendum. If a beneficiary requests the addendum after the first 5 days of an election, the hospice has 3 days from the date of the beneficiary request to furnish the addendum.
  • If a patient or representative refuses to sign a requested addendum, the hospice must document clearly on the addendum the reason the addendum itself is not signed in order to mitigate a claims denial for this condition for payment.
  • The hospice has “3 days” rather than “72 hours” to furnish the requested addendum when the request is made after the first 5 days of the hospice election date.
  • If a non-hospice provider requests the election statement addendum, the non-hospice provider is not required to sign the addendum.

Change Request (CR) 12491/Transmittal 11056 updates the Manual to reflect these changes and also updates the Manual to reflect an extension of the hospice aggregate cap calculation methodology required by the IMPACT Act of 2014.  Specifically, the IMPACT Act of 2014 requires that, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap be updated by the hospice payment update percentage rather than using the medical care expenditure category of the Consumer Price Index for Urban consumers (CPI–U).

The 2021 Consolidated Appropriations Act (CAA 2021) has extended the accounting years impacted by the adjustment made to the hospice cap calculation until 2030. Therefore, the hospice cap amount is updated by the hospice payment update percentage rather than using the CPI–U for accounting years that end after September 30, 2016 and before October 1, 2030, at which time the annual update to the cap amount will revert back to the original methodology.

CMS Updates Benefit Policy Manual to Provide Hospice Clarifications

The Centers for Medicare & Medicaid Services (CMS) has updated Chapter 9 of the Medicare Benefit Policy Manual to provide clarification for two hospice items: Election statement addendum Aggregate cap calculation methodology The clarifications are welcome especially for the election statement addendum.  Since its implementation last year hospices have been asking for more information about…

CMS Compliance Monitoring of Some Hospice Reforms Limited Until After Proposed Rule

The sweeping changes to the hospice survey program enacted by the Consolidated Appropriations Act of 2021 (CAA 2021) in late 2020 have various implementation dates, ranging from immediate, to October 1st of this year, to future dates, but the ability of the Centers for Medicare & Medicaid Servicse (CMS) to conduct compliance monitoring activities for these provisions will…

Proposed Physician Payment Rule Addresses Attending Physician Services Provided by RHCs, FQHCs

–CMS Proposes Part D EPCS Exceptions that Exclude Hospice Waiver The Centers for Medicare & Medicaid Services (CMS) recently issued its proposed CY2022 physician payment rule  and, as is frequently the case, the rule addresses some issues relevant to hospice care (as well as other matters).  This article will discuss two hospice issues: Proposed implementing…

Survey Reforms & Other Significant Changes for Hospice

The Consolidated Appropriations Act 2021 was passed at the end of December 2020, contains numerous provisions applicable to all provider types and some that are hospice-specific. (See this NAHC Report for earlier news & analysis on the subject.) Below is a detailed summary of the hospice-specific provisions in date order, as appropriate, and any additional information…