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How to Prepare for the New Hospice Final Rule

Hospice survey and enforcement requirements will change soon. These additions to the Social Security Act by the Centers for Medicare and Medicaid Services (CMS) are split into seven separate provisions.

Several of these provisions directly affect hospice organizations and are valuable to know.

Hospice provisions effective January 1, 2022, include:

  • Requirements for use of multidisciplinary survey teams
    • All survey entities must include diverse professional backgrounds among their surveyors to reflect the disciplines responsible for providing care, including physicians, nurses, medical social workers, pastors or other counselors. The changes included at least one registered nurse (RN) within multidisciplinary survey teams when the survey team comprises of more than one surveyor.
  • The prohibition of conflicts of interest of surveyors
    • Both State Agencies (SA) and Accrediting Organization (AO) surveyors would be prohibited from surveying a hospice program if the surveyor currently serves, or within the previous two years has served, on the staff of or as a consultant to that program. CMS modified the regulation to add that surveyors must disclose actual or perceived conflicts of interest prior to participating in a survey and recuse themselves.
  • Expanding CMS-based surveyor training to Accrediting Organizations (AOs)
    • CMS will provide training for state and federal surveyors, and any surveyor employed by an AO, no later than 60 days after the start of 2022. No surveyor can conduct hospice program surveys until they complete training and testing. The revised training will emphasize individualized written plans of care and regular updates with the full involvement of the interdisciplinary team, patients and their families.
  • The requirement for AOs to begin use of the Form CMS-2567 to document survey findings
    • AOs are now required to include the Form CMS-2567 in their reports to CMS. However, the AO surveyor is allowed to use their own form and translate survey findings to the CoPs on the form. A hospice can document their Plans of Correction (POCs) in their preferred format, including the format currently used by an AO. However, CMS states that all elements of an acceptable POC are still required.
  • The establishment of a hospice complaint hotline
    • The final rule added hospice programs to the previous hotline requirement for home health organizations with an effective date of December 27. The hotline will collect and update information on certified hospices, receive complaints and answer questions. Hospice providers should track whether the toll-free phone number for consumers has changed.
  • The public disclosure of survey information
    • CMS finalized a new provision which would require the posting of the Form CMS-2567 in a manner that is prominent, easily accessible, readily understandable and searchable for the general public and allows for timely updates. The addition clarified that the POC must be submitted for approval by the SA or CMS but only CMS can impose an enforcement remedy, termination or both.
  • The requirement to develop and implement a range of enforcement remedies effective no later than October 1, 2022
    • Requirements will be established for enforcement remedies to be imposed when hospices are out of compliance with federal requirements. These remedies can be imposed instead of, or in addition to, termination of the hospice program’s participation in the Medicare program for a period not to exceed six months. CMS will provide training on when remedies should be applied and develop processes to ensure these remedies are consistently implemented. The guidance and training will be made publicly available.

For more details on the 2022 Final Rule and its effect on hospice organizations, watch this Axxess webinar.

Axxess Hospice, a hospice and palliative care software, is HIPAA compliant and cloud based, with all CMS regulations automatically updated within the solution for compliant claims.


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