May 20, 2020

Temporary Changes for Hospice Programs

By Laura Hutchinson, APRN, ACNS-BC, AGPCNP-BC, ACHPN, King University

In the midst of the 2019 novel coronavirus (COVID-19) global pandemic, there have been numerous rapid changes throughout our health-care system. In late March, the Centers for Medicare and Medicaid Services (CMS) made temporary changes to certain hospice regulations in order to allow hospice programs across the country to continue providing care and support to terminally ill patients and their families. The CMS changes affect multiple areas, including patient visits, use of volunteers, nurse documentation, and payments.

Workforce

The impact to workforce utilization has been profound in many areas throughout health care, particularly in hospice care. CMS regulations mandate that hospice programs utilize volunteers for administrative and/or direct patient care tasks and that it should equal at least 5% of the total paid patient care hours (employees and contract staff) (Department of Health and Human Services Centers for Medicare and Medicaid Services, 2010 ). With many facilities restricting visitors and almost all states instituting stay-at-home orders, the use of volunteers at this time is risky. New temporary regulation changes have waived the mandatory use of volunteers.

In-Home Hospice Care

The unique and beneficial services of in-home hospice care have also been a focus of concern during this time of quarantine. With frequent in-home visits from hospice staff, the fear of exposing an already fragile hospice patient or their caregiver is significant. Hospice programs, like many other inpatient and ambulatory settings, can now utilize telehealth services for certain visit types, including a routine home care visit as well as the hospice face-to-face visit for recertification.

Upon hospice admission, the hospice program is required to complete a comprehensive assessment, which is a reportable quality measure. With the use of telehealth and the likelihood for fewer in-person visits, CMS has extended the timeframe for this assessment to 21 days from 15 days. Other regulatory assessments that have been impacted include the required in-person/home hospice aide supervisory visits by a licensed nurse every 2 weeks. These visits can now be temporarily suspended if the program cannot complete them.

Along with the standard nursing, aide, social work, chaplain, and bereavement services, hospice programs are required to incorporate other disciplines such as physical therapy, occupational therapy, and speech therapy into the patient’s individualized plan of care when appropriate. During COVID-19, CMS is waiving this requirement for what they consider “non-core” services.

Finance

Workforce and staffing areas are not the only aspects of the hospice program that are seeing provisional changes. The financial impact on hospice programs cannot be overlooked. In light of COVID-19, hospice programs may be eligible for accelerated or advanced payments from CMS when there is a disruption in their claims submissions or processing. CMS is also allowing for certain leniencies to the appeals process for Medicare Administrative Contractors (MACs) and Qualified Independent Contractor (QICs) who participate in the fee-for-service program as well as Part C and Part D Independent Review Entities (IREs).

These temporary changes to certain business and clinical rules from CMS have provided hospice agencies with the opportunity to continue and possibly expand services in a safe manner and provide some leniency to both quality and financial reporting during the current state of emergency. In the future, hospice programs will need to stay abreast of continued changes to the CMS Conditions of Participation.

References

Department of Health and Human Services Centers for Medicare and Medicaid Services. (2010). Regulations and Guidance. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R65SOMA.pdf

Read more from the APSHO Advance: Special COVID-19 Series