Posted July 5, 2023
McKnight’s Home Care
By: Liza Berger
The Centers for Medicare & Medicaid Services outlined plans for the Special Focus Program (SFP) for poor-performing hospices in the home health proposed rule released Friday.
The SFP would be for hospice programs that have failed to meet applicable requirements. CMS would identify a subset of 10% of hospice programs based on the highest aggregate scores determined by an algorithm. Indicators used to identify “poor performance” would be survey reports and Hospice Quality Reporting Program (HQRP) data. CMS proposes selecting SFP hospices in 2024. A Special Focus Facility program already is in effect for nursing homes.
SFP hospices would be subject to one or more enforcement remedies. These include: civil money penalties (CMP), suspension of payment for all new patient admissions, temporary management of the hospice program, directed plan of correction and directed in-service training. SFP hospices can graduate from SFP status in an 18-month time frame based on satisfying certain compliance criteria. But CMS can extend the 18-month time frame. Hospices that do not successfully complete the SFP process can be terminated from the Medicare program.
CMS convened a Technical Expert Panel (TEP) in the fall of 2022 regarding the development of an SFP. The TEP provided feedback and considerations on preliminary SFP concepts, including developing a methodology to identify hospice poor-performers, and criteria for completing the SFP.
IDR process
Beyond the SFP, CMS proposed in the home health rule an informal dispute resolution (IDR) process to provide hospice programs an informal opportunity to resolve disputes related to condition-level survey findings. Hospice programs that are seeking recertification or reaccreditation would be able to use the IDR process. Informal dispute resolution would also be available to hospice programs following a complaint or validation survey and those in the SFP.
36-month rule
Also, CMS is proposing a new ownership rule due to hospice program integrity concerns. It would like to extend to hospice providers the 36-month rule in effect for home health agencies (HHAs). The rule applies when there has been a change of ownership within 36 months after the effective date of the HHA’s initial enrollment. In such cases the prospective owner must enroll in Medicare as a new (initial) HHA. They also must obtain a state survey or an accreditation from an approved accreditation organization.
CMS is proposing this rule due to a “flipping” trend in the hospice community. It also pointed out that there has been a flood of ownership changes since 2018, which has raised compliance concerns.
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