On October 4, 2021, California Governor Gavin Newsom signed California bill SB-664 “Hospice licensure: moratorium on new licenses” (the “Bill”) into law.  The Bill, which passed the California Assembly on September 8, 2021 and the California Senate on September 9, 2021, imposes a moratorium on the California Department of Public Health (the “Department”) issuing new hospice licenses on or after January 1, 2022.  Under the California Hospice Licensure Act of 1990, a person, political subdivision of the state, or other governmental agency must obtain a license from the Department to pr ..read more

On December 3, 2020, MEDPAC reviewed hospice data from 2019, noting these key metrics: Medicare payments grew just under 10% to $20.9 billion; Hospices served 1.6 million patients, including 51% of 2019 decedents (both modest increases); Average length of stay grew by 2 days to 92.6 days; and 4,800 providers gave service, numerical growth of 4.3%. MEDPAC notes that although hospice was supposed to save money, evidence on this point is just “mixed.” At the same time, MEDPAC concedes that hospice is loved by patients, providing choice, quality of life, less invasive treatment, and dignified de ..read more

Hospice providers within regions administered by NGS are reporting that NGS is presently finalizing and serving out final 2019 hospice cap repayment demands.  This action, which tacks on sequestration (funds never received) to revenue, is entirely inappropriate and must be rescinded. In years past, after hospices would submit self-reports (end of February), CMS and its contractors would wait at least six months (August) before finalizing cap demands.  This was reasonable in light of shifting per-patient allowances under the pro-rated allocation method (2/3 of expected allowance change will oc ..read more

In the CARES Act, passed last night, section 3706 allows hospices to conduct recertifications including face to face visits using telehealth “during the emergency period.” Trump declared a national emergency on March 13, 2020, but governing law allows the Secretary of HHS to extend the “emergency period” retroactively to the beginning of the emergency, potentially as early as January 31, 2020, the date President Trump halted flights from China. It is worth noting that section 1135 of the Social Security Act gives the Secretary broad waiver power during national or local emergencies to waive a ..read more

Our healthcare system is in just the initial stages of the Coronavirus19 crisis.  Hospices have a role to play.  Let’s keep it short.  Here is what we need to do: Telehealth. Many hospices report that nursing homes and assisted living facilities are on infection lockdown (perhaps rightly so) and will not admit hospice staff to see patients.  And hospice staff, like all other healthcare professionals, should not be spreading the virus by unnecessary in person visits.  Medicare has temporarily expanded telehealth in other contexts (office visits, mental health counseling, and preventive health ..read more

Direct Data Entry (DDE) access is a company’s revenue lifeline: without it, hospices cannot comply with NOE filing requirements or submit claims for payment.  Every hospice has DDE login rights, but many fail to recognize (and take due care to avoid) the serious hidden pitfalls that are found in this system.  Failure to avoid these pitfalls can cause loss of access; and, in turn, hospices face at least significant administrative work to recover access and perhaps forfeiture of certain billings (if NOEs cannot be timely filed).  Many hospices (and other Medicare providers) have found themselves ..read more

Last week, the 11th Circuit Federal Court of Appeals reversed summary judgment given to AseraCare in its hospice false claims case, setting up more litigation on the question whether AseraCare’s certifications were made in good faith. But, the appeals court also affirmed a critical trial court ruling on the standard to be applied to review of hospice claims for “falsity,” holding that a mere difference of opinion among physicians is insufficient to establish that a claim is false; and, holding that, a “physician’s clinical judgment dictates eligibility as long as it represents a reasonable int ..read more

On August 6, 2019, CMS finalized its 2020 hospice rule, including adopting, without substantial modification, two controversial and material changes to the hospice benefit: Rebasing payment rates to shift about $500 million from routine care to enhanced levels of care including general inpatient, continuous, and respite care. Adopting a requirement that, upon request (either at admission or later), hospices disclose in an extensive written addendum to patients (and other health care providers) any care that would be deemed unrelated to hospice care. We reviewed these proposals in detail in pri ..read more

On August 6, 2019, CMS finalized its 2020 hospice rule, including adopting, without substantial modification, two controversial and material changes to the hospice benefit: Rebasing payment rates to shift about $500 million from routine care to enhanced levels of care including general inpatient, continuous, and respite care. Adopting a requirement that, upon request (either at admission or later), hospices disclose in an extensive written addendum to patients (and other health care providers) any care that would be deemed unrelated to hospice care. We reviewed these proposals in detail in pri ..read more

With the FY 2020 proposed hospice rule, CMS proposes two material changes for hospice providers: CMS proposes to shift approximately $500 million of hospice funding (2.7% of payments) from routine care to enhanced care payments (inpatient, continuous, and respite care); and CMS also proposes, as a condition of payment, to require hospices to provide patients with a complete list (on request) of any services, drugs, or treatments that will be deemed unrelated to terminal illness (and therefore covered separately by Medicare). In a prior post, we reviewed the proposed change for unrelated treatm ..read more