Good afternoon!
As many of you are aware, as part of the CY2024 Proposed Physician Payment Rule, the Centers for Medicare & Medicaid Services (CMS) addressed several issues of interest to hospice providers, including proposed regulations designed to implement a provision of the Consolidated Appropriations Act of 2023 (Section 4121) providing hospices the option of utilizing either Marriage and Family Therapists (MFT) or Mental Health Counselors (MHC) in lieu of Social Workers (SW) as part of the inter-disciplinary group (IDG). However, based on comments made by representatives of CMS at various points during the comment period, there was some confusion as to whether hospices would be required to employ and/or contract with MFTs and MHCs and include both disciplines (in addition to SW) as part of the IDG to be in compliance with the provision. Other provisions in the physician rule include changes to provider enrollment requirements and updates to the electronic prescribing for controlled substances (EPCS) rules.
Relative to the provision related to MFTs and MHCs, as part of the final CY2024 Final Payment Rule (posted today HERE), CMS has clarified that hospices would be required to include only one of the disciplines (SW, MFT, MHC) as part of the IDG, and has also removed a reference to use of SW, MFT, or MHC "based on the needs and preferences of the patient" that raised concerns. Following are some excerpts from the final rule that respond to hospice stakeholders' comments in response to the proposed rule:
"The hospice IDG has will only be required to include one SW, one MFT, or one MHC. The hospice is not required to include all three of these professions as members of the IDG. We note that the hospice may choose (although is not required) to select more than one of these professions to serve as member(s) of the IDG. The MFT or MHC must be hired as a direct employee which would include the options of hiring full time, part time or per diem."
Relative to concerns about staffing shortages and potential difficulties in hiring MFTs and MHCs, particularly in certain areas of the country, CMS states, "We believe the MFT and MHC primarily provide counseling services and that counseling services are considered core services of the hospice. The "extraordinary circumstance" provision is generally a short-term temporary event that was unanticipated. This may allow hospices the flexibility to contract for the MFT or MHC during temporary staffing shortages. If a hospice chooses to contract with another Medicare-certified hospice or a non-hospice entity, the contracting hospice or non-hospice entity must maintain professional management responsibility for the services provided, in accordance with § 418.100(e)."
In response to concerns that CMS may have exceeded its legislative authority by including as part of the implementing regulation that the hospice must select among the disciplines of Social Work, MFT, and MHC based on the "needs and preferences of the patient", CMS indicates the following: "We believe it is important for the hospice IDG to consider the patients' assessed needs to ensure IDG member, whether it be a SW, MFT or MHC, have the appropriate knowledge and scope of practice to share and recommend care options related to the services that patient is receiving or may need. We agree the hospice has the choice to select either a SW, MFT or MHC. We also understand that hospice may have IDG team members pre-selected to serve on specific teams, and it may be administratively impractical to change a member based on the needs of one patient. Therefore, we are not finalizing the requirement '"
"Additional information regarding the implementation and execution of these proposals will be provided in the hospice interpretive guidance, which will be published following the publication of this final rule. It is important for the hospice to assess and determine, along with the input from the patient and family, which care and services are most appropriate/ ensure the health and safety of the patient. Therefore, we expect that during the care planning process, the hospice IDG would consider the patient's needs and preferences will provide services to meet the needs of the patient. As stated earlier, the information from the patient's assessment would be included in the individualized patient plan of care, as well as which professional(s) (SW, MFT or MHC) will be caring for the hospice patient."
NAHC will be reviewing and analyzing relevant provision of the final rule in greater depth (including the provider enrollment, EPCS, and MFT/MHC provision) in the coming days and providing more details in NAHC Report.
Take care,
Theresa
Theresa M. Forster
VP for Hospice Policy & Programs
National Association for Home Care & Hospice
Office: 202-547-7424
Direct: (202) 355-1661
tmf@nahc.org
