Category Archives: Hospice Law

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CMS Proposes To Shift Hospice Funding From Routine To Enhanced Care Days

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 … Continue Reading

CMS Proposes To Force Hospices to Specify Unrelated Treatments

In its FY 2020 proposed hospice update, CMS proposes two changes of significant interest to providers: Shifting $500 million of reimbursement from routine to enhanced care levels; and Requiring providers to notify patients in writing of treatments that will be deemed “unrelated” to the terminal illness (and therefore still covered by Medicare separately). Given that … Continue Reading

PRRB Sides With CMS On Hospice Cap Sequestration – Federal Court Next

On Thursday, February 28, 2019, two years after hearing arguments in lead group cases, the Provider Reimbursement Review Board affirmed CMS’ approach to counting sequestered funds as part of provider revenue for hospice cap calculations. In 2012, to address budget deficits, Congress passed the Budget Control Act, providing for, among other things, a 2% reduction in … Continue Reading

Hospice Short Film End Game Up For Academy Award

Though beloved as a service, hospice can be a difficult subject for patients, families, and even caregivers. The recent short film, End Game (2018 NetFlix), follows a set of patients, families, and their caregivers through the difficult discussions and choices faced at end of life. It may help facilitate difficult discussions. End Game provides a … Continue Reading

Humana, TPG Capital, and Welsh, Carson, Anderson & Stowe Create the Country’s Largest Hospice Provider, “Kindred at Home”

This article was originally posted on the Healthcare Law Blog on July 12, 2018. Kindred Healthcare. On July 2, 2018, Humana Inc. and private equity firms TPG Capital (TPG), and Welsh, Carson, Anderson & Stowe (Welsh) (collectively referred to as the Consortium) issued a press release announcing the closure of their $4.1 billion joint acquisition … Continue Reading

Can AI Help Solve The Hospice Eligibility Question?

Medicare beneficiaries are eligible for hospices if they have a life expectancy of six months or less if the illness runs its normal course. And, while providers can take an objective set of characteristics (FAST score, PPS, hospitalizations, MAC, etc.) and predict life expectancy for a population around an average, no one has come close … Continue Reading

CMS Rolls Out Provider Appeals Settlement Efforts

This year CMS is rolling out two new programs aimed, finally, at helping to settle certain types of pending provider reimbursement appeals. The programs are the Low Volume Appeals Initiative and Settlement Conference Facilitation. As pointed out in this space before, CMS’ longstanding policy of refusing to negotiate overpayment findings has been a significant factor … Continue Reading

Tax-Exempt Healthcare Organizations Brace for Impact as Senate Tax Reform Bill Passes

Update. We described in a previous blog post major changes that tax-exempt hospitals and other tax-exempt organizations in the healthcare industry face in the tax reform proposals working their way through Congress. In the early hours of Saturday, December 2, 2017, the Senate narrowly passed its tax reform bill. Although the Senate’s bill has much in common … Continue Reading

Tax-Exempt Hospitals & Other Tax-Exempt Healthcare Organizations Not Immune from Federal Tax Reform

As federal tax reform efforts proceed rapidly in both chambers of Congress, tax-exempt hospitals and other tax-exempt healthcare organizations are facing major potential changes. New tax burdens on tax-exempt organizations are among the ways in which the bills would raise revenue to pay for proposed tax cuts for businesses and individuals. Importantly, it is still … Continue Reading

Hospice Live Discharges: Some Perspective

News outlets have noted that hospices discharge, on average, 1 in 5 patients alive. The presumptive and easy explanation, one that fits political assumptions, is profit motive: for profit hospices admit unwitting patients, earn fees, then discharge them alive. The truth is that assessing when someone will pass away is among the most complex medical determinations. … Continue Reading

CMS Plans To Reopen Cap Demands Forever

In recent weeks, hospice providers have been receiving revised cap demands for fiscal years 2012 and earlier.  Although the initial demands in these cases were issued more than three years earlier, CMS now claims that it can reopen and revise cap demands for up to three years from the most recent demand.  Based upon this … Continue Reading

Hospice Cap Calculation Changes

Traditionally, the cap accounting year has ended October 31, putting the cap accounting year one month off of the Federal government fiscal year.   In May 2015, CMS proposed to adjust the cap accounting year to end September 30 to align with the Federal government fiscal year.  This transition will occur in 2017. To change the accounting … Continue Reading

CMS Issues Suggested Notice Of Election Statement

Following an OIG report on election statements in September, CMS has posted a suggested, but not mandatory, notice of election statement. From inception of the benefit, hospices have been required to formulate their own notice of election.  Regulations require only that the election statement: (a) identify the hospice; (b) identify the attending physician chosen by the … Continue Reading

ZPICs Terrorize, Close Hospices; CMS Blesses Approach

In recent months, ZPICs, tiring of the post-payment audit due process constraints imposed by Congress, have begun utilizing devastating and unlawful tools to put hospices, and presumably other providers, out of business – full payment suspension and full prepayment audit.  CMS has now reviewed and blessed this conduct. In the case of a longstanding Puerto … Continue Reading

OIG Issues Report On Hospice Election Statements

On September 16, 2016, the Office of Investigator General for CMS issued a report on hospice election statements, concluding that many of the statements in use by hospices are deficient in some respect.  In its review of 565 election statements, OIG concluded that 35 percent were deficient in some manner. Hospice patients are required to … Continue Reading

CMS Proposes ALJ Hearing Changes

As most hospice providers know all too well, CMS faces an ever growing backlog of ALJ cases.  This backlog stems in large part from aggressive audit procedures employed by ZPICs, RACs, and MACs that issue sweeping numbers of pre- and post-payment denials, often on less than substantive or meritorious grounds, leading to more appeals.… Continue Reading

Hospice Payment Changes Take Effect

With the advent of the 2016 (Happy New Year!), hospices now face the revised hospice payment system. Specifically, Medicare will pay a higher routine home care rate for the first 60 days of care ($187 average) and a lower routine home care rate for days beyond 60 ($147 average).  These adjustments are supposed to be … Continue Reading

Hospice False Claims Case Helps Clarify Law

Following a trial in which a national hospice chain (AseraCare) was initially found to have submitted false claims, the Court ordered a new trial.  In making this rare order, the Court acknowledged that it had failed to provide the jury with proper instructions as to required findings for a false claim, including that the government … Continue Reading

Hospice Cap Sequestration Update

In March 2015, CMS instructed its contractors to add sequestered funds, amounts never paid to providers, to revenue for purposes of calculating the hospice cap. This results in cap repayment demands that are overstated, in that they require repayment of funds never received.… Continue Reading

ALJ Now Dismissing Hospice Appeals For Allegedly Insufficient Service On Beneficiary

In the last few years, we have seen a growing and alarming trend of administrative law judges (“ALJ”) dismissing appeals solely based on purported lack of service to the hospice patient (the Medicare beneficiary).  A search of recent decisions shows over 150 such cases at the Medicare Appeals Council starting in 2012 and continuing to … Continue Reading
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