Hospice

CMS has posted the 2022 Technical Expert Panel and Stakeholder Listening Sessions: Hospice Special Focus Program Summary Report.  The special focus program was one of the hospice survey reforms that was included in the Consolidated Appropriations Act of 2021 and the CY 2022 home health final rule, however, CMS has not yet implemented the SFP.  The SFP will monitor hospices identified as poor performers based on selected quality indicators. Hospices selected for the SFP will be under additional oversight to enable continuous improvement and would include enforcement remedies for noncompliant hospice programs, as well as procedures for appealing determinations regarding these remedies. These enforcement actions can be imposed instead of, or in addition to, termination of the hospice program's participation from the Medicare program. CMS has indicated that a proposal for the SFP structure will be part of the CY 2024 home health proposed rule which is currently under review at the Office of Management & Budget (OMB) and is usually posted mid-summer.

NAHC staff are currently reviewing the Report and there will be a forthcoming NAHC Report article.  Until then, the key findings of the TEP are listed below.

• SFP Algorithm: The TEP supported the use of an algorithm that incorporates the HCI, CAHPS® Hospice Survey data, surveyor-cited Quality of Care CLDs, and substantiated complaints. The TEP agreed that no stratification, size quartile stratification, or CMS Location stratification were preferred to a state-based stratification approach. Overall, the TEP felt that all hospices should be held to the same standards regardless of their size or geographic location.

• SFP Survey Frequency: The TEP agreed that hospices in the SFP should be surveyed once every six months while in the program with most TEP participants suggesting these more frequent surveys be conducted by SAs only, as opposed to AOs. The group also suggested including a transition period, whereby after a hospice graduates from the SFP, the hospice is surveyed annually before returning to the standard hospice survey frequency of once every three years.
• SFP Technical Assistance: The TEP urged that TA be provided to all hospices in the SFP, with CMS setting the guidelines and metrics for TA agencies to follow. The TEP indicated that these TA agencies should not be the surveying entities, but third parties to ensure objectivity and timeliness/availability of TA. Ideas for financing the TA included using funds from civil monetary penalties or monthly claims reconciliation methods.
• SFP Graduation Criteria: The TEP suggested that to graduate from the SFP, hospices should have no CLDs for two consecutive six-month surveys, no substantiated complaints, and less than a certain number of SLDs. Once graduated, SFP hospices could then enter a transition period where they would be subject to annual surveys before returning to the three-year survey period.
• SFP Termination Criteria: The TEP generally agreed that the SFP should use progressive enforcement, starting with actions such as civil monetary penalties and/or denial of a percentage of Medicare payments. If, after 18 to 24 months, a hospice did not improve enough to graduate from the SFP, the hospice would be placed on the termination track.
• Public Reporting: The TEP would like the SFP clearly defined on Care Compare's hospice page, and SFP hospices marked with a noticeable icon. There was also agreement that a hospice's individual page should include additional information about the SFP and the hospice's full survey information. The information should be easy-to-understand and not require consumers to have to search the website for pertinent information.