The U.S. Centers for Medicare & Medicaid Services (CMS) late last week finalized the 2022 home health payment rule, which contained provisions that redesign multiple aspects of the agency’s survey process. This is likely just the tip of the iceberg of what’s to come in the hospice industry, according to Theresa Forster, vice president for hospice policy and programs at National Association for Home Care & Hospice (NAHC).
The 2022 final home health rule contained nine new survey and enforcement provisions for hospice programs pursuant to the Consolidated Appropriations Act. Congress included these provisions 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).
“This is just the beginning of the activity around survey changes for hospice. There is going to be a lot of activity, so you definitely want to hold on to your hats for this,” said Forster during a recent NAHC webinar. “CMS has been working on a number of survey issues. The Consolidated Appropriations Act requires CMS to implement programs to measure and reduce inconsistency in hospice survey results. There’s quite a bit of work that goes into establishing these programs, so this is something that we’re going to see rollout over time.”
Consistency of survey results is an area of great concern among providers, according to Forster. Revisions to surveyor training and interpretive guidelines contained in the 2022 rule are designed to move the needle on this goal.
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.
CMS will require state agencies or accreditors to evaluate surveyors on the accuracy of their findings. These agencies will calculate the frequency of which surveyors failed to previously acknowledge, recognize or cite a condition level deficiency during a period of time and develop a corrective action plan when excessive disparities are identified.
CMS will also conduct a representative sample of validation surveys to find the percentage of condition-level deficiencies that were not identified during state agency surveys. This could also result in corrective action plans. The agency plans to develop objective measures of survey accuracy, but has not yet indicated what those would look like, according to Forster.
While CMS delayed finalizing provisions in the 2022 home health payment rule that would have created a Special Focus Program (SFP) for hospice, the agency anticipates revisiting the SFP in a future rulemaking. However, the agency did make significant changes to its enforcement remedies, including the suspension of Medicare payments for organizations that have a history of serious deficiencies.
Any payment suspension would apply only to claims for new patient admissions. It would remain in effect until CMS is satisfied that the hospice is in compliance. Enforcement remedies are applied based on factors such as the extent to which the deficiency poses immediate jeopardy to patient health and safety, the degree and duration of deficiency or noncompliance, and the presence of repeat deficiencies.
“When the payment is suspended for new admissions, it means any admission into your program from the date that suspension is imposed until it is resolved is not paid,” said Katie Wari, director of home health and hospice regulatory affairs at NAHC. “This is a true suspension, not just an interruption to the cash flow. You’ll get paid retroactively, and these patients would then have to go through a new election statement when you get to the point of having your payments resumed again.”
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