Civil Rights, Incapacity Legal guidelines of Rising Significance in Hospice Compliance

Hospice providers need to be familiar with laws and regulations and actively engage in compliance training to avoid bringing regulators on their doorstep. This increasingly includes careful compliance with laws and regulations related to civil rights and the protection of the disabled.

Compliance is a key priority for hospice providers as regulators sharpen the focus on the industry. The U.S. Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health (HHS) Inspector General (OIG) continue to engage extensively with hospice providers to address concerns ranging from billing to claims to patient eligibility rich the hospice benefit.

According to Bill Dombi, president of the National Association for Home Care and Hospice (NAHC), patient eligibility issues for the hospice affect many aspects of a provider’s business. Dombi recently stated in a NAHC webinar that patient eligibility decisions can raise legal concerns, compliance issues with Medicare and Medicaid rules, and state licensing laws.

“The hospice was examined in more detail in several areas. This includes federal fraud and abuse investigations and charges related to Medicare claims by the OIG and [the U.S. Department of Justice]as well as complaints and audits about the quality of care and concerns about profit margins and payment model issues by the [Medicare Payment Advisory Commission (MEDPAC)]”Dombi told Hospice News.” In terms of quality of care, Congress has taken the unusual step of including laws approving hospice interim sanctions, including civil fines, at the end of the year under the COVID act. ”

Federal legislators incorporated the language from the Act to Support Our Older Population in Comfort Environments (HOSPICE) into the Consolidated Funds Act of 2021, which was passed at the end of December last year. The bill created a Special Focus Facility program to examine hospices with serious deficiencies in the past. These organizations must be interviewed at least every six months. It also doubles the fines for companies that do not report quality data to HHS. The law also contained provisions to improve the CMS survey and train surveyors.

CMS proposed a new rule last month that would increase the hospice payment rate by 2.3% for fiscal 2022. The agency also increased the hospice payment cap from $ 30,683 in 2021 to $ 31,389. The rule also includes updates to quality reporting requirements and CoPs.

The combination of these measures is a strong indicator that the hospice is on the radar of regulators, according to Dombi.

CMS suspended audits and medical reviews by Medicare Administrative Contractors (MACs) in July 2020, but resumed enforcement activities through August, despite the ongoing status of the federally declared national public health emergency. Hospice providers have seen an increase in audits since then.

Hospices need to be diligent to keep abreast of the details of the laws and regulations. Areas of focus include Medicare’s Anti-Discrimination Laws, State Civil Laws, Malpractice Laws, and Americans with Disabilities Law.

Although largely underserved by hospices, patients with disabilities represent a growing need and an untapped market for providers. According to a 2014 report by the US Census Bureau, nearly 40% of those 65 and over had at least one disability from 2008 to 2012. More than a quarter (25.4%) of disabled seniors were 85 years or older, though that age group made up just over 13% of the country’s aging population, the report said.

Hospice companies, dedicated to addressing the specific needs of these patients, focus on the key components of the Medicare Hospice Benefit, which require that they give patients “the right, and should be, access to quality end-of-life care” tailored to the specific needs of the patient and the family, ”said Sarah Simmons, Interim Executive Director of Calvert Hospice in Maryland.

“The hospices need to be more careful to ensure that their staff are trained to provide culturally competent care in all settings, and that there are quality interpreting services, visual aids and other means of caring for people with disabilities,” Simmons told Hospice News. “The population of people in need of hospice care is diverse and diverse, and our ability to provide excellent care must evolve to meet the needs of all of our patients.”

Hospices must understand the relevant provisions of the Disabled Americans Act, 1974 Rehabilitation Act, state civil rights laws, and Medicare discrimination rules to ensure they comply. According to Dombi, providers can expect more potential oversight in these areas.

“[With] Your [patient] Admission Decisions: When You Start Rationing Care, Are You Discriminating Certain Types of Patients Who May Demand More Service Than Others? Does that lead to discrimination based on the Disabled Americans Act? “Said Dombi. “You don’t want to face a demolition suit where the allegation and main charge made is that you discharged a patient for not being profitable enough. That won’t put you in a good position in court. “

According to Dombi, a shortage of staff can also trigger discharges. Focusing on staff training will be key to a hospice’s compliance strategy. Having an adequate and well-educated workforce trained in Medicare coverage standards, claims handling requirements, and eligibility requirements is an ongoing challenge for hospice providers. Hospices should consider internal auditing to ensure employees are fully informed about these rules and regulations, Dombi said.

Simmons says training staff on rules for disabled patients can help hospice providers identify and proactively address compliance issues.

“Our most effective strategy to ensure we stay vigilant was to drag our entire team into the world of hospice compliance,” said Simmons. “Every member of our team is informed about hospice regulations and receives a monthly report on our performance in compliance audits. When we identify an issue that needs improvement, we make sure to involve key stakeholders in this process so that the conversation takes place on the ground floor, where the real work is done. “

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