2018 Hospice Regulatory Blueprint for Action

2018 Hospice Regulatory Blueprint for Action

National Association for Home Care & Hospice/Hospice Association of America 228 Seventh Street, SE

Washington DC 20003-4306

TABLE OF CONTENTS

INTRODUCTION.............................................................................................................................. 5

PART I: HOSPICE-SPECIFIC ISSUES ........................................................................................6

? WORK WITH STAKEHOLDERS TO CLARIFY "RELATEDNESS" AND ADDRESS CODING ISSUES UNDER HOSPICE CARE .........................................................................7

? PROTECT HOSPICE PATIENT ACCESS TO PART D DRUGS FOR CONDITIONS UNRELATED TO THE HOSPICE DIAGNOSES ..................................................................9

? ESTABLISH TIME FRAMES FOR APPROVAL OF HOSPICE LOCATION CHANGES .................................................................................................................................11

? ENFORCE REQUIREMENT THAT MEDICAID HOSPICE BENEFITS MIRROR THOSE IN MEDICARE...........................................................................................................12

? WORK WITH HOSPICE INDUSTRY TO EVALUATE IMPACT OF HOSPICE PAYMENT REFORM; REJECT REBASING AND SITE-OF-SERVICE ADJUSTMENT FOR NF RESIDENTS...............................................................................................................13

? PROVIDE FULL DISCLOSURE OF HOSPICE AVAILABILITY AND CHOICE OF PROVIDER TO TERMINALLY ILL BENEFICIARIES RESIDING IN SNFs/NFs .......15

? REVISE FACE-TO-FACE REQUIREMENTS FOR HOSPICES ......................................17

? ADDRESS PAYMENT DELAYS AND INCREASED REGULATORY BURDENS CAUSED BY SEQUENTIAL BILLING POLICY FOR HOSPICE....................................19

? ENCOURAGE ACCOUNTABILITY FOR HOSPICE UTILIZATION ............................20

? PROMOTE NATIONWIDE CONSISTENCY OF LCDs THAT REFLECTS CURRENT HOSPICE CODING AND DIAGNOSIS REQUIREMENTS...............................................21

? BASE SURVEY FREQUENCY FOR MEDICARE HOSPICE PROVIDERS ON PERFORMANCE .....................................................................................................................23

? COMPENSATE PHYSICIANS FOR HOSPICE CERTIFICATIONS...............................24

? PROCEED WITH A THOUGHTFUL AND DELIBERATE EXPANSION OF THE HOSPICE QUALITY REPORTING PROGRAM ................................................................26

? REINSTATE PRESUMPTIVE STATUS FOR HOSPICE WAIVER OF LIABILITY ....28

? STUDY HOSPICE REIMBURSEMENT FOR DUALLY ELIGIBLE PATIENTS RESIDING IN NURSING FACILITIES ................................................................................29

? EXPAND THE USE OF AND REIMBURSEMENT FOR TECHNOLOGIES IN HOSPICE ...................................................................................................................................31

? OPPOSE EFFORTS TO REQUIRE PHYSICIAN CERTIFICATION FORMS TO INCLUDE A FALSE CLAIMS WARNING...........................................................................32

? CREATE WAIVER FOR EXCEPTION TO SOCIAL WORK SUPERVISION REQUIREMENT ......................................................................................................................33

? CLARIFY HOSPICE RESPONSIBILITIES RELATED TO DISPOSAL OF CONTROLLED MEDICATIONS ..........................................................................................34

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? ENSURE APPROPRIATE DEVELOPMENT OF PERFORMANCE-BASED PAYMENT FOR MEDICARE HOSPICE SERVICES .............................................................................36

PART II: COMBINED HOME HEALTH AND HOSPICE ISSUES........................................38

? IMPROVE APPLICATION OF WAGE INDEX FOR MEDICARE HOME HEALTH AND HOSPICE .........................................................................................................................39

? REIMBURSE HOME HEALTH AGENCIES AND HOSPICES FOR TELEHEALTH AND PROVIDE FOR REGULATORY FLEXIBILITY.......................................................41

? ENSURE USE OF STATISTICALLY VALID SAMPLING METHODOLOGY FOR MEDICAL REVIEW ................................................................................................................43

? ENSURE FAIRNESS IN GOVERNMENT FRAUD AND ABUSE ACTIVITIES ............45

? ENSURE FAIR IMPLEMENTAION OF THE TARGETED PROBE AND EDUCATE .47

? ENSURE TRAINING IS CONDUCTED AND CONSISTENT FOR HOME HEALTH AND HOSPICE SURVEYORS................................................................................................48

? REQUIRE REGION OFFICE REVIEW OF CHALLENGES TO STANDARD-LEVEL DEFICIENCIES ........................................................................................................................50

? REQUIRE FEDERALLY FUNDED CRIMINAL BACKGROUND CHECKS AND ESTABLISH A NATIONAL REGISTRY SYSTEM.............................................................52

? ALLOW HHAs AND HOSPICES TO PROVIDE UNLIMITED SERVICES UNDER ARRANGEMENTS................................................................................................................... 55

? ENSURE THE EMERGENCY PREPAREDNESS PLAN REQUIREMENTS ADEQUATELY ADDRESSES THE NEEDS OF PROVIDERS OF SERVICES IN THE HOME ........................................................................................................................................56

? ENSURE EFFECTIVE EMERGENCY PREPAREDNESS COMMUNICATION AND REGULATORY RELIEF FOR HOME CARE AND HOSPICE ........................................57

? ESTABLISH REFERRAL STANDARDS AND DISCHARGE PLANNING REGULATIONS THAT ENSURE PATIENT CHOICE AND EQUAL ADVANTAGE TO ALL PROVIDERS ....................................................................................................................59

? CONTROL PAPERWORK BY REQUIRING CMS TO FOLLOW THE PAPERWORK REDUCTION ACT ...................................................................................................................61

? SUPPORT PHYSICIANS IN ADOPTION OF E-PRESCRIBING AND E-HEALTH RECORDS RELATED TO HOME HEALTH AND HOSPICE SERVICES .....................62

? REQUIRE MEDICARE TO FULLY ASSESS AND REPORT ON THE IMPACT OF ITS NEW RULES .............................................................................................................................63

? ENSURE REASONABLE SCREENING, MORATORIA AND COMPLIANCE PLAN PROVISIONS FOR HOME HEALTH AGENCIES AND HOSPICES ..............................65

? ADVANCE THE ADOPTION AND USE OF HEALTH IT IN HOME HEALTH AND HOSPICE ...................................................................................................................................68

? ADOPT DUE PROCESS PROVISIONS BEFORE SUSPENDING PAYMENT...............70

? ENSURE THAT HOME HEALTH AND HOSPICE ARE INCLUDED AS REQUIRED HEALTH BENEFITS BY HEALTH PLANS ........................................................................71

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? ENSURE CLAIMS REVIEW DECISIONS AT ALL LEVELS OF APPEAL THAT ARE CONSISTENT AND IN COMPLIANCE WITH MEDICARE COVERAGE REQUIREMENTS ....................................................................................................................72

? REFINE CLAIMS REVIEW AND ADDRESS TECHNICAL ERRORS ...........................74 ? ELIMINATE DELAYS IN MEDICARE APPEALS TO ADMINISTRATIVE LAW

JUDGES .....................................................................................................................................77 ? PROVIDE HEALTH IT VENDORS SUFFICIENT TIME TO IMPLEMENT NEW

REGULATIONS .......................................................................................................................78 ? PROMOTE PROVIDER RIGHTS AND OPPORTUNITIES TO COMPETE THROUGH

EFFECTIVE ENFORCEMENT OF ANTITRUST LAWS ..................................................79 ? ENSURE REASONABLE POLICIES FOR PROVIDERS SERVING PERSONS WITH

LIMITED ENGLISH SKILLS.................................................................................................81 ? APPLY REGULATORY RELIEF FAIRLY TO INCLUDED HOME HEALTH AND

HOSPICE PROVDERS ............................................................................................................82

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INTRODUCTION

The Hospice Association of America (HAA) 2018 Regulatory Blueprint for Action identifies key regulatory issues of interest to hospice providers and includes a summary of each issue comprised of background information, recommendations, and the rationale behind the recommendations. This document provides a guide to the hospice industry's position on the issues addressed. The HAA Regulatory Blueprint for Action has been developed with input from the HAA Advisory Board, hospice agencies, and associations that represent hospice organizations at the state level, and was subsequently approved by the Board of Directors. The 2018 Regulatory Blueprint for Action is divided into two parts ? Part I contains hospice-specific issues and Part II contains issues that are applicable to both hospice and home health. The Blueprint serves as HAA's regulatory plan of action for the forthcoming year. Issues that are identified as most important by members become the priorities in the plan of action. However, HAA recognizes that priorities may shift during the course of any year as a result of federal regulatory action or policy changes. HAA is an affiliate organization of the National Association for Home Care & Hospice (NAHC).

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