CMS is implementing new oversight measures for hospice programs, which include an updated scoring system, state-specific oversight and changes to election statement addenda.
The new scoring system is part of an effort to “strengthen oversight, improve transparency for patient families and ensure Medicare hospice benefits are not abused,” according to an April 2 agency news release.
Here’s what to know:
1. The new scoring system will be based on indicators of potential inappropriate utilization, quality of care and compliance concerns. CMS will gather data on metrics including non-hospice spending, percent of beneficiaries discharged with a length of stay of 180 days or more, average minutes per routine home care day and percent of live discharges where beneficiaries return to the same hospice in seven days. These metrics are not a direct indicator of fraud, waste or abuse, but a high score would indicate a potentially higher level of concern and could mean further oversight is needed, the agency said.
2. The agency is expanding its state-specific “targeted oversight approach” to identify and address fraudulent activities in hospices, which will include unannounced hospice site visits and the revocation or deactivation of hundreds of hospice providers engaged in fraudulent activities.
3. Georgia and Ohio were added to CMS’ list of states with elevated fraud risk, joining Arizona, California, Nevada and Texas. The latter four have been issued more than 200 hospice Medicare enrollment revocations for failure to comply with CMS requirements.
4. The agency proposed a new icon for the Care Compare site to identify hospices that do not meet requirements under the Hospice Quality Reporting Program.
5. Hospices will be required to provide an election statement addendum to all Medicare beneficiaries upon election of hospice care. The addendum will plainly explain which items, services, drugs and conditions are not related to a patient’s terminal illness or conditions, and will not be covered under the Medicare hospice benefit. Currently, this addendum is only required to be presented upon request by the patient or a representative.
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