Now in iQIES: Preview Reports & Star Rating for April 2022 Refresh

For this refresh, Home Health (HH) Outcome and Assessment Information Set (OASIS) measure scores are based on the standard number of quarters. The April 2022 refresh will add new OASIS-based measures for public reporting in alignment with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: Percent of Residents Experiencing One or More Falls…

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 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…

NAHC Supports The Resetting the IMPACT Act

The National Association for Home Care & Hospice (NAHC) has joined the other major post-acute care organizations (American Health Care Association, American Medical Rehabilitation Providers Association, National Association of Long Term Hospitals, Leading Age+VNAA) to commend members of Congress for the introduction of The Resetting the IMPACT Act (TRIA) of 2021 and urge legislators to…

NEW TRAINING EVENT – Section N: Medications – Drug Regimen Review Web-Based Training

The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of the Drug Regimen Review standardized patient assessment data elements (SPADEs) found in the Medications Section of the guidance manuals. This 45-minute course is intended for providers in Home Health Agencies (HHAs),…

MedPAC Pushes for Aligning Payments, Regs, Benefits

The Medicare Payment Advisory Commission (MedPAC) recently convened for a session furthering their work on the development of a unified post-acute care prospective payment system (PAC PPS). In this most recent session, a focus was placed on the applicability of co-pays and potential requirements to access post-acute care (PAC) care via a required hospitalization. MedPAC staff…

CMS Proposes Changes to Home Health Quality Reporting Program

In the 2020 home health prospective payment system (HHPPS) rate update proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposes a number changes to the Home Health Quality Reporting Program (HHQRP) for calendar year (CY) 2022. CMS proposes to eliminate one measure and add two new measures. In addition, in accord with the…

CMS to Add Publicly Reported Quality Measure for Home Health

The Centers for Medicare & Medicaid Services (CMS) has announced that the Potentially Preventable 30-Day Post-Discharge Readmissions measure is scheduled to be publicly displayed in Home Health Compare with the October 2019 refresh. This measure was originally scheduled to be added to Compare with the January 2019 refresh, but CMS decided to conduct further testing.…

MedPAC Opposes Episode-Based Payment for Post-Acute, For Now

On March 8, 2019 the Medicare Payment Advisory Commission (MedPAC) panel concluded that a unified payment system for post-acute care facilities should be based on each patient stay and not the entire episode of care. The discussion among commission members focused on how to create a unified prospective payment system to make Medicare fee-for-service payments…