Hospice Update

Quarterly Release: October 2019

CAHSAH advocates and provides regular updates to its members on regulations that impact our industry. Some of the recent regulatory actions included:

Hospice Final Payment Rule Released: The Centers for Medicare & Medicaid Services (CMS) has issued the final rule governing hospice payment for FY2020. The changes made by the rule become effective, October 1, 2019, with the exception of the new election statement addendum which has been delayed for another year. Hospices have new rates resulting from the rebasing. While some rates went up, hospices will see a 2.72% reduction in the routine home care rate.

Hospice CASPER Review Correct Reports Update: Medicare has released new information about getting started with Hospice CASPER Review and Correct Reports. They have created a guide that will assist providers in understanding what the Review and Correct Reports are and how to use them. Download the Getting Started with Review and Correct Report, which is in the “Downloads” section of the HQRP Requirements and Best Practices webpage.

New Hospice Measures Fact Sheet: An updated version of the CASPER Quality Measure (QM) Reports Fact Sheet is now available in the Downloads section of the HQRP Requirements and Best Practices page. This updated document reflects the addition of the Hospice When Death Is Imminent Measure Pair to both the HospiceLevel and Patient Stay-Level CASPER QM Reports.

Supplemental Medical Review Contractor Posts New Hospice Project: Noridian, the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare & Medicaid Services (CMS), has posted another project targeting hospices. This project, Hospice Portfolio (01-013), targets hospices providing the general inpatient (GIP) level of care to beneficiaries in skilled nursing facilities (SNF) and hospice services provided in assisted living facilities (ALF). This project will be broken into two phases with the first phase focusing on GIP in the SNF (Q5004) and the second phase focusing on hospice services provided in the ALF (Q5002). The GIP level of care cannot be provided in the ALF. The second phase of this project will focus on hospices services (not on a particular level of care) provided in the ALF.

OIG Issues Report on 2019: Vulnerabilities in Hospice Care: The Department of Health and Human Services Office of Inspector General has released two reports which found that from 2012 through 2016, most U.S. hospices that participated in Medicare had one or more deficiencies in the quality of care they provided to their patients. Some Medicare beneficiaries reported being seriously harmed when hospices provided poor care or failed to act in cases of abuse. The OIG has made several recommendations in both reports to strengthen the safeguards to protect Medicare hospice beneficiaries from harm and to ensure hospices are held accountable for deficiencies in their programs.

CDPH Issues Power Outage Notification Requirements: The Department of Public Health (CDPH) has issued AFL-19-30 which specifies that all facilities must follow the guidelines on reporting power outages to their local licensing division.

LVN Scope of Practice Update: The Board of Vocational Nursing and Psychiatric Technicians (BVNPT), along with the Respiratory Care Board, continue to work to clarify the role and scope of practice for Licensed Vocational Nurses (LVNs) in caring for patients on ventilators. The BVNPT released draft proposed statutory changes for the scope of practice for LVNs. CAHSAH wants to ensure that providers review the proposed language and report any concerns and suggestions to CAHSAH so that we can provide a united response to the Board.

Review Your Hospice Provider Preview Reports: Hospice provider preview reports and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey ® provider preview reports have been updated and are now available. These two separate reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder. Hospice providers are encouraged to review their Hospice Item Set (HIS) quality measure results from Quarter 1, 2018 to Quarter 4, 2018 and their facility-level CAHPS® survey results from Quarter 1, 2017 to Quarter 4, 2018.

Palliative Care Funding Opportunity: The National Institutes of Health has announced two funding opportunities, both called “Palliative Care in Home and Community Settings,” intended to stimulate research to determine needs and best practices for the integration of palliative care into home and community settings. The first opportunity consists of an R01 Research Project Grant, whose combined budget for direct costs for the two-year project period may not exceed $275,000. The second is an R21 Exploratory/Developmental Research Grant, for which application budgets are not limited, but need to reflect the actual needs of the proposed project, with a maximum five-year period.


CAHSAH has identified over 200 bills that will be tracked during the 2019 Legislative year. The following bills are CAHSAH’s “priority” legislation in relation to Medicare services:

AB 5 (Gonzalez) CAHSAH took an “Oppose Unless Amended” position on this bill which would codify the Dynamex decision relative to classifying independent contractors. The bill was passed by the Legislature without a carve out for home health and hospice providers and goes into effect January of 2020.

AB 714 (Wood) CAHSAH supported this bill which provides an exemption for hospice agencies from the requirements to offer an opioid reversal drug and educate patients about opioid overdose. The bill was signed into law and goes into effect immediately.

AB 1544 (Gipson) CAHSAH opposed this bill which would have expanded the scope of paramedicine into hospice services by individuals who are neither trained, licensed, nor regulated to provide such services. The bill failed passage by the Legislature.

 California Association for Health Services at Home
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