2024 Hospice Reminders

As we get closer to the New Year, there are a few changes in hospice that will go into effect as of January 1, 2024. While not all inclusive, LeadingAge provided a nice summary to help hospices prepare for the upcoming changes.

• Special Focus Programs (SFP) begin in 2024 as a way for The Centers for Medicare and Medicaid Services (CMS) to regulate poor preforming hospices. Hospices will be identified through defined quality measures – survey reports with Condition-Level Deficiencies (CLDs) and complaints with substantiated allegations and CMS Medicare data sources from the Hospice quality Reporting Program (HQRP) (CAHPS). Hospices flagged by the SFP will be surveyed every 6 months, may face monetary fines, suspended reimbursement, appointment of temporary management to bring the hospice into compliance or revocation of a provider’s Medicare certification. (Hospice News 11/1/2023)
• CMS will implement the 36-month rule for hospices: If a change in majority ownership occurs within 36 months of an initial enrollment or previous change in majority ownership the Medicare provider agreement will not be assigned to the purchaser.
• All certifying physicians and attending physicians for hospice must be registered in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). They must be enrolled in Medicare or officially opt out. While the official implementation date is not until May of 2024, it is recommended to start verification immediately. You can check  here to see if a provider has been enrolled in Medicare or has officially opted out.
  • Only applies to Fee-for-Service Medicare
  • Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B
  • Applies to all written or oral certifications under §418.22(c)
• Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC) were added to the list of providers eligible to serve on a hospice Interdisciplinary Group (IDG) in place of a social worker (SW). Clarification on the final Physician Fee Schedule from CMS states that these professionals are not required to be on every IDG but could be members when the hospice chooses to use them. In addition:
  • MFT or MHC will be added to the personnel requirements in the hospice Conditions of Participation (CoPs) (Refer to CFR at 410.53 and 410.54) that will outline the qualification of these new provider types.
  • The hiring of these new staff is up to the hospice, but it is not required to employ them. If a hospice does hire a MFT or MHC, they must be direct employees with and issued W2- either full time, part time, or per diem.
  • MFT and MHC can be volunteers as long as the individual meets the provider qualifications (CFR410.53 and 410.54) they can serve in those roles.
  • MFT, MHC, and SW all have scope and licensure which allows them to conduct counseling.  However, medical SW can conduct additional services including case management and referral to services and resources, MFT and MHC cannot.
  • MFTs and MHCs do not need to go through PECOS enrollment if they are employed directly by the hospice.  If the MFT or MHC plans to treat Medicare beneficiaries outside hospice, they will need to go through the PECOS process.
  • CMS is putting together a Q&A document and information for surveyors.